Methods used to design audit and feedback interventions to change clinical practice: a scoping review.

Background: To optimize interventions that modify clinical practice, developers should use a systematic design process based on established frameworks. Reviewing current design practices in published literature and understanding established methodological guidelines is essential to identify gaps in knowledge, areas for improvement and promote best practices among interested groups. Objectives: This scoping review aims to synthesise the evidence on systematic design processes and methodologies for designing healthcare interventions published in articles and grey literature in the last fifteen years. Methods: Following PRISMA guidelines, we searched MEDLINE, Embase, and PsycINFO databases for peer-reviewed studies (April 2015-October 2025) describing in detail the selected framework and design process used. We also searched selected websites for published grey literature (from 2011 to October 2025) detailing specific intervention frameworks and design processes. Documents were excluded if healthcare professionals were not among the target recipients, intervention stages were poorly described, or the focus was exclusively on lifestyle habit changes. A narrative synthesis of findings was conducted. Results: We analysed 59 source documents (49 scientific studies; 10 grey literature documents). Across the studies, we identified up to 22 distinct theoretical frameworks (used alone or in combination) and between 2 and 10 process stages. In grey literature documents we identified five different theoretical frameworks and outlined between 4 and 11 stages. The inclusion of sustainability and implementation planning represents a new stage compared to models from 15 years ago, with piloting also emerging as a new, albeit less frequently reported, stage. Conclusion: Variability was identified in the theoretical models used to guide intervention design, which may be applied individually or in combination. Up to eleven stages were identified in the intervention design process. Greater methodological rigour and transparency in study reporting would be needed to improve replicability. Future research areas identified include assessing the impact of systematic design on effectiveness and cost-effectiveness, prioritising the development of de-implementation guidelines, and incorporating diverse, multidisciplinary perspectives into intervention design guidance documents, among others. Systematic Review Registration: https://doi.org/10.17605/OSF.IO/T5ZSX.