What is the difference between explanatory theory and change theory

As noted elsewhere [ 6 ], the FITT framework has been used to guide the successful implementation of an innovative electronic order system for post-operative surgical care [ 41 ]. Researchers in that study explicitly used the FITT framework to help them interweave their new electronic system with the healthcare environment in which they implemented it. Adequate understanding of human environments requires that explanatory theories take the enormous complexity of those environments appropriately into account.

Creating explanatory theories of human environments that help implement successful improvement interventions apparently requires open-ended, multi-level data on working relationships in organizations [ 1 , 9 , 10 , 11 , 29 , 31 , 36 , 37 , 38 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. Research groups are now laboring to clarify the essential nature of such data Table 3 , while also obtaining insights into effective techniques for collecting and analyzing those data Table 4.

It is important to note in this connection that improvement interventions reach their full potential more successfully when their implementation builds on the complexity of the systems they intend to change than when they underestimate or ignore that complexity [ 9 ].

Codebook for Quality Improvement Practice, for example [ 37 ], p. In like fashion, answering a question regarding organizational complexity e. Traditional scientific methods will undoubtedly continue over time to help understand human environments, including environments that are as complex and dynamic as healthcare systems.

At the same time, the difficulty of understanding those environments in the concepts and language of sciences suggests that explanatory theories of those environments will be more meaningful when they include contributions from the arts and humanities.

Examples of this startling apophatic i. In articulating her explanatory theory of the world of falconry , the scholar and writer Helen Macdonald also turns, as follows, to this paradoxical, inverse way of understanding the deeper meaning of a complex human environment [ 51 ]:. They are all things in themselves, but we make them sensible to us by giving them meanings that shore up our own views of the world.

This commentary considers evidence that reinforces the crucial reality that the healthcare systems in which improvement programs take place—or, more specifically, the values and character of those systems—are at least as important in improving care as the specifics of the improvement interventions themselves.

This obvious but often underappreciated reality environmental feature argues strongly for the development of sophisticated, nuanced understanding of those environments early in the implementation of improvement programs, and consistent application of that understanding during the improvement process.

Realistically, understanding a human environment—especially one as complex and dynamic as a healthcare system—is an arduous, demanding undertaking, which further underscores the value of building a basic set of context-related initiatives into the implementation of any sizeable healthcare improvement program.

These initiatives might include the following:. If possible, involve social scientists, as well as professionals from humanities e.

Use that explanatory theory in coordinating and linking the intervention with the host environment;. Explore the use of established mature explanatory theories, individually or collectively, in making sense of the local host environment;. From time to time, review the most current version of the explanatory theory and revise it if necessary as more is learned about the host environment and about the interaction between environment and intervention.

To avoid creating jitter and instability in the program, resist unnecessary tinkering with the makeup and application of the explanatory theory;. Adapt the focus, comprehensiveness, organization, and level of detail of the explanatory theory of the host environment, to make it as useful as possible for its most important users. Organizing and the process of sense-making. Organization Sci. Article Google Scholar. Bate P. Context is everything. In: Perspectives on context. London: The Health Foundation; Google Scholar.

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Political science and the logic of representations. New York: Oxford University Press; Curing healthcare: new strategies for quality improvement. San Francisco: Jossey-Bass; Braithwaite, J. Complexity science in healthcare —aspirations, approaches, applications and accomplishments: a white paper. Accessed 1— Greenhalgh T. In: How to implement evidence-based medicine. Nardi BA. Studying context: A comparison of activity theory, situated action models, and distributed cognition.

Cambridge: MIT Press; Greenhalgh T, Stones R. Theorising big IT programs in healthcare: Strong structuration theory meets actor-network theory. Soc Sci Med; ;— Pitt JC. Theories of explanation. Glouberman S, Zimmerman B.

Complicated and complex systems: what would successful reform of Medicare look like? Accessed 8— Hempel CG, Oppenheim P. Studies in the logic of explanation. In: Pitt JC, editor. Salmon WC. Statistical explanation and causality. Radford A.

These processes result in strategies that help people make and maintain change. There are several limitations of TTM, which should be considered when using this theory in public health. The Transtheoretical Model provides suggested strategies for public health interventions to address people at various stages of the decision-making process. This can result in interventions that are tailored i. The TTM encourages an assessment of an individual's current stage of change and accounts for relapse in people's decision-making process.

The Social Norms Theory was first used by Perkins and Berkowitz in to address student alcohol use patterns. As a result, the theory, and subsequently the social norms approach, is best known for its effectiveness in reducing alcohol consumption and alcohol-related injury in college students. The approach has also been used to address a wide range of public health topics including tobacco use, driving under the influence prevention, seat belt use, and more recently sexual assault prevention.

The target population for social norms approaches tends to be college students, but has recently been used with younger student populations i.

This theory aims to understand the environment and interpersonal influences such as peers in order to change behavior, which can be more effective than a focus on the individual to change behavior.

Peer influence, and the role it plays in individual decision-making around behaviors, is the primary focus of Social Norms Theory. Peer influences and normative beliefs are especially important when addressing behaviors in youth. Peer influences are affected more by perceived norms what we view as typical or standard in a group rather than on the actual norm the real beliefs and actions of the group. The gap between perceived and actual is a misperception , and this forms the foundation for the social norms approach.

The Social Norms Theory posits that our behavior is influenced by misperceptions of how our peers think and act. Overestimations of problem behavior in our peers will cause us to increase our own problem behaviors; underestimations of problem behavior in our peers will discourage us from engaging in the problematic behavior. Accordingly, the theory states that correcting misperceptions of perceived norms will most likely result in a decrease in the problem behavior or an increase in the desired behavior.

Social norms interventions aim to present correct information about peer group norms in an effort to correct misperceptions of norms. In particular, many social norms interventions are social norms media campaigns where misperceptions are addressed through community-wide electronic and print media that promote accurate and healthy norms about the health behavior. The phases of a social norms media campaign include:.

Social norms media campaigns are currently being funded by many federal agencies, state agencies, foundation grants, and non-profit organizations. Sometimes social norms media campaigns are funded by industry. There has been a good deal of evaluations conducted on social norms campaigns. There are several limitations of Social Norms Theory that need to be considered prior to using the theory.

Limitations of the theory include the following:. We define change research broadly, as any scholarship that focuses on how to make change happen. Some change research has a strong theoretical or empirical basis, while other scholarship may be more conjectural.

An important subset of change research is change theory , which we define as a framework of ideas, supported by evidence, that explains some aspect of change beyond a single project. Change theories represent generalized knowledge about how change works.

Some theories are mature, with a strong empirical basis, whereas other theories may have emerged from a single context and thus are supported by more limited evidence. In the realm of educational change, there are relevant theories that deal with many different components and processes related to change. A theory of change for a change effort in undergraduate STEM education can better serve a project and the larger community when it is developed in consultation with theory and research from the scholarly literature.

The degree to which theories of change draw on change theory and research varies considerably. Change initiatives that are not informed by change research including theory have two major limitations: 1 the initiative is less likely to succeed, because it does not leverage the wealth of knowledge already developed by change researchers, and 2 without building on what is already known in the field, the initiative itself is less likely to contribute to generalizable knowledge, because it will be more difficult to cast the findings of the study in terms of existing scholarship.

Although there are many ways that research and theory can contribute to a change effort, we focus on five that we argue are a useful guiding framework for grounding a theory of change in existing scholarly work.

For each category, we give two examples of change research and theory to illustrate how they can inform the development of a theory of change Table 2. The change theories and research we have used to illustrate each category do not represent endorsements of the utility or value of these particular theories, nor a negative evaluation of theories not mentioned. A single change theory can contribute to multiple aspects of a theory of change, or it can only contribute to one.

Similarly, a project may draw from multiple change theories to inform each part of a theory of change. Each project is unique, which means that existing research and theory must be adapted to the specific initiative.

Once a theory of change is created using an amalgam of prior work, it will represent a synthesis of change theory and research that is relevant and unique to a given project. An important advancement for education reform efforts in undergraduate STEM has been increased focus on the system and culture in which teaching and learning occur e.

Change theory and research can inform our understanding of the context of a change effort, including relevant communities, actors, and stakeholders; existing policies, practices, and beliefs; capacity and receptiveness of the targets of the change effort; and historical, political, and sociocultural factors. Viewing change as occurring within a complex system is important because context will influence the impact of a change intervention.

Theories relevant to context help change agents and researchers identify and characterize aspects of the system and culture and describe how these might moderate how a change intervention proceeds. Projects benefit from drawing on diverse research and theory to adequately describe context. To illustrate how theory can inform the recognition of context in a theory of change, we provide examples from two theoretical frameworks: the teacher-centered systemic reform model TCSR and the four frames model.

The model inventories and describes parts of this system and why they can be expected to influence education reform. Though developed with K contexts in mind, this framework can be translated to a higher education system.

The four frames model of organizational change can draw attention to different aspects of the system, because it focuses specifically on culture within organizations. These theories, and others like them, help change efforts recognize the various parts of their system that are likely to be important to a change effort. Since change agents work from one particular vantage point of the system e. In summary, change theory and research can inform a theory of change by mapping out and defining the components of a system and the various ways those components interact with each other that may influence i.

A key part of the process of developing a theory of change is identifying the short- and intermediate-term outcomes, called preconditions, that may need to be met to arrive at the ultimate long-term outcome of the change effort.

The preconditions included in a theory of change should be necessary and sufficient to achieve the long-term outcome. Thus, there must be a rationale for linking a precondition to another precondition and for linking preconditions to the ultimate outcome Anderson, Rationales explain how the expected interventions in a change effort are likely to result in meeting preconditions and achieving the long-term outcome. How does intervention A cause precondition B to be met?

And how does meeting precondition B help to achieve the long-term outcome? Change theory and research can help a team recognize important preconditions and why it will be necessary to achieve them on the path to the long-term outcome.

Drawing on diverse work is crucial for developing a theory of change with preconditions and rationales that are based on more than our own intuitions about how to achieve change. We introduce two theoretical frameworks that can inform preconditions and rationale in a theory of change, including one framework relevant to achieving behavioral change among individuals—the theory of planned behavior—and one framework relevant to achieving organizational change—the 4I framework of organizational learning.

The theory of planned behavior was developed to explain what shapes behaviors over which individuals have the ability to exert self-control. Subjective norms include perceived social pressures or expectations to perform or not perform the behavior. Applied to a change effort to increase the adoption of evidence-based teaching practices, the theory of planned behavior proposes that preconditions to adopting a new teaching strategy include a positive attitude about the strategy, perceptions of social pressure to adopt the strategy, and confidence that one can successfully adopt the strategy.

The theory stipulates the preconditions and provides rationales for why we can expect these preconditions to lead to the long-term outcome of the adoption of evidence-based teaching strategies. The framework contends that organizational learning is a multi-level process that involves individual, group, and organizational learning.

Individual, group, and organization learning are connected by four bi-directional processes: intuiting, interpreting, integrating, and institutionalizing Crossan et al. These insights might recognize patterns and new possibilities based on personal experience and may become metaphors that individuals use to talk about experiences with others.

Interpreting is a bridge between individuals and groups, and involves explaining an insight to oneself and others. This level is more conscious than intuiting and involves conversation and dialogue that names ideas, makes them explicit, and links them to other ideas. This can lead to enhanced mental models among individuals and improved organizational knowledge.

Integrating is the third process and it connects the group and organizational levels. It involves developing shared understanding among individuals and taking coordinated actions. This process is focused on coherent, collective action. The last process, institutionalization, occurs at the organization level when new ideas and actions become embedded into routines, rules, procedures, and infrastructures.

This is the hallmark of organizational learning because changes in structures makes the change available to all members, independent of the original individual or group that generated the idea.

They observed intuiting among local institutional CIRTL leaders, interpreting in the work between local leaders and local constituents, and integration of learning gains associated with CIRTL across campus by the local leaders Hill et al. The 4I model helped these researchers recognize the role of the local CIRTL leader in all four of the organizational learning processes in the 4I model. Thus, a precondition for the impact of the CIRTL network on member institutions may be a local CIRTL leadership team that can translate and tailor the network efforts to the specific needs of their institution Hill et al.

This model could also be used to inform the design of a change project. For example, applied to an effort to change how teaching is evaluated for promotion and tenure, the 4I framework of organizational learning suggests that a precondition to institutionalizing new structures includes individuals in a group e.

In this example change effort, that might be shared understanding about what constitutes effective teaching and how effectiveness can be documented. Shared understandings can then inform collective actions, such as piloting a new evaluation approach.

Developing shared understandings occurs through interpreting and integrating, and relies heavily on developing common language, ongoing dialogue, and even storytelling to reflect complexity without abstraction Crossan et al.

These shared understandings then provide the basis for a change that can affect the organization as a whole. In summary, change theory and research can inform a theory of change by helping a team determine what preconditions are likely to be important to achieve a desired long-term outcome and why those particular preconditions are important.

Indicators are how a project team determines if each precondition and the long-term outcome have been met. Ideally, a theory of change specifies one or more indicators for each precondition and the long-term outcome. This allows a project to assess the degree to which implementation of project activities is having the intended impact.

Indicators must be fully operationalized to usefully inform a project. Operationalizing an indicator includes determining what variable will be measured, the target population for change, what threshold of change will be sufficient to conclude that a precondition or outcome has been met, and how long it is expected to take to achieve this threshold in the target population Anderson, ; Aspen Institute Roundtable on Community Change, Setting indicators aids in setting outcomes for a project, so they should be set early in the planning stages of a project.

In addition, assessing indicators helps measure progress made toward those outcomes as a project is being implemented. For members of a project team, assessing indicators can help provide motivation as it makes progress towards outcomes visible.

It also provides formative feedback to support revision of activities and the theory of change as a whole. Furthermore, assessment of indicators helps communicate the outcomes and progress toward outcomes for people outside of the project team Kotter, Many researchers have developed approaches and tools to measure important variables in the context of undergraduate STEM education. Change research draws attention to variables that can be measured and how to measure them, including a wide variety of qualitative and quantitative research techniques and methodologies.

Projects may use surveys and inventories, interviews, systematic classroom observations, participant observation, and other approaches to collect data about an indicator. Some desired outcomes in a change project in undergraduate STEM education may deal with teaching practices.

Many possible indicators for teaching practices are described in a single report that reviews approaches to measuring and documenting STEM teaching practices American Association for the Advancement of Science, Some projects may aim to measure the quality of education on a larger scale.

The National Academies of Science, Engineering, and Medicine published a report that outlines a set of national-level indicators of the status and quality of undergraduate STEM education National Academies of Sciences, Engineering, and Medicine, Change projects in undergraduate STEM education will also include important preconditions and long-term outcomes besides changes in teaching practice.

This requires different indicators. For instance, research on social networks can be useful because it helps identify opinion leaders and tracks relationships across a social system, such as a department e. Examples of social network indicators may be increasing the number of opinion leaders, increasing the density of a network, or increasing the strength of relationships related to undergraduate teaching in a department.

In summary, change theory and research can inform a theory of change by helping a team determine which indicators can assess progress toward a long-term outcome and the preconditions on the way to the outcome. Interventions are often described as a list of steps, even though the steps may be nonlinear and not all steps are always followed in order. Many different terms are used to describe interventions, such as strategy, process, approach, and model.

The intervention provides an organizing framework for the types of project activities that a change effort engages in. Often, a project team has made tentative decisions about their intervention before they begin developing a theory of change. Building a theory of change ensures that careful consideration has been given to how the activities will lead to preconditions and how preconditions contribute to achieving the long-term outcome.

Change interventions are generally part of the change research literature, rather than being change theories themselves. Some interventions that have been implemented and studied are solidly grounded in existing change theory and others have less robust theoretical underpinnings. Which change interventions have been designed and revised with change theory in mind may become obvious as a team builds their own theory of change around an intervention and is faced with questions about how the suggested activities will result in the desired outcomes.

This model is informed by change theories about organizational learning, organizational culture, readiness for change, and more. The River Model includes eight stages: 1 establishing vision, 2 examining the landscape and conducting capacity analysis, 3 identifying and analyzing challenges and opportunities, 4 choosing strategies, 5 determining readiness for action, 6 beginning implementation, 7 measuring results, and 8 disseminating results and planning next steps.

For example, stages 1 establishing vision and 2 examining the landscape and conducting capacity analysis are envisioned as two looping and iterative processes that ultimately align a change effort with institutional priorities.

Kezar and Elrod is a report designed to guide step-by-step planning, provide tools, and prompt ongoing reflection. A change effort that opts to use the River Model as its guiding intervention may also need to incorporate interventions at other levels of the system, such as departments and individual faculty. Departmental Action Teams DATs are externally facilitated groups of faculty, students, and staff working collaboratively in a department toward a collective educational outcome.

DATs focus on a single department as a unit of change, recognizing that a departments tend to have relatively consistent cultures, and b making sustainable changes to education requires cultural change Reinholz et al. A DAT meets regularly for up to four semesters, typically for an hour every other week. To guide its work, a DAT completes a series of shared visioning activities to develop consensus on a focal issue and set of outcomes. Next, the DAT collects, analyzes, and interprets relevant data.

Washington, D. Control Scoring Direct Measur. Not only are they related, but they are each essential to health education and health behavior. Theory and research should not be solely the province of academics, just as practice is not solely the concern of practitioners.

The best theory is informed by practice; the best practice should be grounded in theory.