***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background In the field of implementation research , there is an increased interest in use of theory when design ing implementation research studies involving behavior change . In 2003 , we initiated a series of five studies to establish a scientific rationale for interventions to translate research findings into clinical practice by exploring the performance of a number of different , commonly used , overlapping behavioral theories and models . We reflect on the strengths and weaknesses of the methods , the performance of the theories , and consider where these methods sit alongside the range of methods for study ing healthcare professional behavior change . Methods These were five studies of the theory-based cognitions and clinical behaviors ( taking dental radiographs , performing dental restorations , placing fissure sealants , managing upper respiratory tract infections without prescribing antibiotics , managing low back pain without ordering lumbar spine x-rays ) of r and om sample s of primary care dentists and physicians . Measures were derived for the explanatory theoretical constructs in the Theory of Planned Behavior ( TPB ) , Social Cognitive Theory ( SCT ) , and Illness Representations specified by the Common Sense Self Regulation Model ( CSSRM ) . We constructed self-report measures of two constructs from Learning Theory ( LT ) , a measure of Implementation Intentions ( II ) , and the Pre caution Adoption Process . We collected data on  theory-based cognitions  ( explanatory measures ) and two interim outcome measures ( stated behavioral intention and simulated behavior ) by postal question naire survey during the 12-month period to which objective measures of behavior ( collected from routine administrative sources ) were related . Planned analyses explored the predictive value of theories in explaining variance in intention , behavioral simulation and behavior . Results Response rates across the five surveys ranged from 21 % to 48 % ; we achieved the target sample size for three of the five surveys . For the predictor variables , the mean construct scores were above the mid-point on the scale with median values across the five behaviors generally being above four out of seven and the range being from 1.53 to 6.01 . Across all of the theories , the highest proportion of the variance explained was always for intention and the lowest was for behavior . The Knowledge-Attitudes-Behavior Model performed poorly across all behaviors and dependent variables ; CSSRM also performed poorly . For TPB , SCT , II , and LT across the five behaviors , we predicted median R2 of 25 % to 42.6 % for intention , 6.2 % to 16 % for behavioral simulation , and 2.4 % to 6.3 % for behavior . Conclusions We operationalized multiple theories measuring across five behaviors . Continuing challenges that emerge from our work are : better specification of behaviors , better operationalization of theories ; how best to appropriately extend the range of theories ; further assessment of the value of theories in different setting s and groups ; exploring the implication s of these methods for the management of chronic diseases ; and moving to experimental design s to allow an underst and ing of behavior change UNLABELLED What is already known about this subject . Computerized prompts and reminders have been shown to be effective in changing the behaviour of health professionals in a variety of setting s. There is little literature describing or evaluating electronic decision-support for pharmacists . What this study adds . An electronic prompt in dispensing software for a targeted clinical intervention has a significant effect on  pharmacists  ' behaviour . A markedly increased rate of recording and performing the targeted clinical intervention was found . The effect of the prompt reduces markedly once the prompt is deactivated . AIM To evaluate the effect of an electronic prompt in dispensing software on the frequency of clinical interventions recorded by community pharmacists . METHOD An electronic decision-support prompt identifying patients for a targeted proactive clinical intervention was developed and implemented . Each time an oral antidiabetic agent was dispensed , a prompt was displayed reminding pharmacists to discuss the suitability of aspirin therapy in eligible patients with diabetes . The prompt was r and omly assigned to 31 of 52 metropolitan pharmacies in Melbourne ( Australia ) for 6 weeks , with the remaining pharmacies as controls . RESULTS One hundred and fifty pharmacists in 52 pharmacies recorded a total of 2396 clinical interventions at an intervention rate of 0.92 interventions per 100 patients [ 95 % confidence interval ( CI ) 0.58 , 1.23 ] . Pharmacists recorded a total of 201 target interventions related to aspirin therapy in diabetes at an intervention rate of 2.55 interventions per 100 diabetic patients ( 95 % CI 0.85 , 4.24 ) . All of the targeted clinical interventions were recorded in the prompt arm ; no targeted interventions were recorded in the control group . The effect of the prompt decreased over the study period and was not maintained after prompt deactivation . CONCLUSION An electronic prompt significantly increased pharmacists ' recording of the targeted clinical intervention in diabetic patients . An electronic decision-support prompt has significant potential to promote community pharmacists ' contribution to the quality use of medicines Developing an evidence base for making public health decisions will require using data from evaluation studies with r and omized and nonr and omized design s. Assessing individual studies and using studies in quantitative research syntheses require transparent reporting of the study , with sufficient detail and clarity to readily see differences and similarities among studies in the same area . The Consoli date d St and ards of Reporting Trials ( CONSORT ) statement provides guidelines for transparent reporting of r and omized clinical trials . We present the initial version of the Transparent Reporting of Evaluations with Nonr and omized Design s ( TREND ) statement . These guidelines emphasize the reporting of theories used and descriptions of intervention and comparison conditions , research design , and methods of adjusting for possible biases in evaluation studies that use nonr and omized design Background Despite the availability of evidence -based guidelines for the management of mild traumatic brain injury in the emergency department ( ED ) , variations in practice exist . Interventions design ed to implement recommended behaviours can reduce this variation . Using theory to inform intervention development is advocated ; however , there is no consensus on how to select or apply theory . Integrative theoretical frameworks , based on syntheses of theories and theoretical constructs relevant to implementation , have the potential to assist in the intervention development process . This paper describes the process of applying two theoretical frameworks to investigate the factors influencing recommended behaviours and the choice of behaviour change techniques and modes of delivery for an implementation intervention . Methods A stepped approach was followed : ( i ) identification of locally applicable and actionable evidence -based recommendations as targets for change , ( ii ) selection and use of two theoretical frameworks for identifying barriers to and enablers of change ( Theoretical Domains Framework and Model of Diffusion of Innovations in Service Organisations ) and ( iii ) identification and operationalisation of intervention components ( behaviour change techniques and modes of delivery ) to address the barriers and enhance the enablers , informed by theory , evidence and feasibility/acceptability considerations . We illustrate this process in relation to one recommendation , prospect i ve assessment of post-traumatic amnesia ( PTA ) by ED staff using a vali date d tool . Results Four recommendations for managing mild traumatic brain injury were targeted with the intervention . The intervention targeting the PTA recommendation consisted of 14 behaviour change techniques and addressed 6 theoretical domains and 5 organisational domains . The mode of delivery was informed by six Cochrane review s. It was delivered via five intervention components : ( i ) local stakeholder meetings , ( ii ) identification of local opinion leader teams , ( iii ) a train-the-trainer workshop for appointed local opinion leaders , ( iv ) local training workshops for delivery by trained local opinion leaders and ( v ) provision of tools and material s to prompt recommended behaviours . Conclusions Two theoretical frameworks were used in a complementary manner to inform intervention development in managing mild traumatic brain injury in the ED . The effectiveness and cost-effectiveness of the developed intervention is being evaluated in a cluster r and omised trial , part of the Neurotrauma Evidence Translation ( NET ) program In Australia , there are two categories of non-prescription medicines : pharmacy medicines and pharmacist only medicines . St and ards were developed to define and describe the professional activities required for the provision of these medicines at a consistent and measurable level of practice . Objective Our objective was to implement nationally a quality improvement package in relation to the St and ards of Practice for the Provision of Non-Prescription Medicines . Methods Approximately 50 % of Australian pharmacies ( n = 2,706 ) were r and omly selected by local registering authorities . Trained pharmacy educators audited each community pharmacy in the study three times , 7 weeks apart on St and ards of Practice for the Provision of Non-Prescription Medicines , Visit 1 involved the educator explaining the project and conducting an assessment of the pharmacy ’s level of compliance  . Behaviour of community pharmacists and their staff in relation to these st and ards was measured by conducting pseudo-patron visits . Pseudopatron visits were conducted at Visit 2 , with the educator providing immediate feedback and coaching and a compliance assessment . Visit 3 involved a compliance assessment , and a second pseudo-patron visit for those pharmacies that had performed poorly at the first visit . Results At Visit 1 , the lowest levels of compliance were to the st and ards relating to the documentation process ( 44 % ) and customer care and advice ( 46 % ) . By Visit 2 , more than 80 % of pharmacies had met most criteria . At Visit 3 , compliance had significantly improved compared to Visits 1 and 2 ( P < 0.001 ) . The lowest levels of compliance were to criteria which required written operating procedures for specific tasks , but these also improved significantly over time ( P < 0.001 ) . Conclusions Professional practice in relation to the h and ling of pharmacist only and pharmacy medicines improved considerably as measured by the auditing process , and the results indicate that Australian pharmacies are well-equipped to provide high quality service to consumers of these medicines . The acceptability of national implementation of these st and ards of practice in Australia indicates that such an approach could be taken internationally Background : Despite national disease management plans , optimal asthma management remains a challenge in Australia . Community pharmacists are ideally placed to implement new strategies that aim to ensure asthma care meets current st and ards of best practice . The impact of the Pharmacy Asthma Care Program ( PACP ) on asthma control was assessed using a multi-site r and omised intervention versus control repeated measures study design . Methods : Fifty Australian pharmacies were r and omised into two groups : intervention pharmacies  implemented the PACP ( an ongoing cycle of assessment , goal setting , monitoring and review )  to 191 patients over 6 months , while control pharmacies gave their usual care to 205 control patients . Both groups administered question naires and conducted spirometric testing at baseline and 6 months later . The main outcome measure was asthma severity/control status . Results : 186 of 205 control patients ( 91 % ) and 165 of 191 intervention patients ( 86 % ) completed the study . The intervention result ed in improved asthma control : patients receiving the intervention were 2.7 times more likely to improve from “ severe ” to “ not severe ” than control patients ( OR 2.68 , 95 % CI 1.64 to 4.37 ; p<0.001 ) . The intervention also result ed in improved adherence to preventer medication ( OR 1.89 , 95 % CI 1.08 to 3.30 ; p = 0.03 ) , decreased mean daily dose of reliever medication ( difference −149.11 μg , 95 % CI −283.87 to −14.36 ; p = 0.03 ) , a shift in medication profile from reliever only to a combination of preventer , reliever with or without long-acting β agonist ( OR 3.80 , 95 % CI 1.40 to 10.32 ; p = 0.01 ) and improved scores on risk of non-adherence ( difference −0.44 , 95 % CI −0.69 to −0.18 ; p = 0.04 ) , quality of life ( difference −0.23 , 95 % CI −0.46 to 0.00 ; p = 0.05 ) , asthma knowledge ( difference 1.18 , 95 % CI 0.73 to 1.63 ; p<0.01 ) and perceived control of asthma question naires ( difference −1.39 , 95 % CI −2.44 to −0.35 ; p<0.01 ) . No significant change in spirometric measures occurred in either group . Conclusions : A pharmacist-delivered asthma care programme based on national guidelines improves asthma control . The sustainability and implementation of the programme within the healthcare system remains to be investigated Clinical and health services research is continually producing new findings that may contribute to effective and efficient patient care . However , the transfer of research findings into practice is unpredictable and can be a slow and haphazard process . Ideally , the choice of implementation strategies would be based upon evidence from r and omised controlled trials or systematic review s of a given implementation strategy . Unfortunately , review s of implementation strategies consistently report effectiveness some , but not all of the time ; possible causes of this variation are seldom reported or measured by the investigators in the original studies . Thus , any attempts to extrapolate from study setting s to the real world are hampered by a lack of underst and ing of the effects of key elements of individuals , interventions , and the setting s in which they were trialled . The explicit use of theory offers a way of addressing these issues and has a number of advantages , such as providing : a generalisable framework within which to represent the dimensions that implementation studies address , a process by which to inform the development and delivery of interventions , a guide when evaluating , and a way to allow for an exploration of potential causal mechanisms . However , the use of theory in design ing implementation interventions is method ologically challenging for a number of reasons , including choosing between theories and faithfully translating theoretical constructs into interventions . The explicit use of theory offers potential advantages in terms of facilitating a better underst and ing of 
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Conclusions Studies in this review did not generally have a well thought-out rationale for the choice of implementation strategy .
Most utilised educational strategies , but the greatest effect on outcomes was demonstrated using computerised clinical decision support systems .
Poor methodology , in the majority of the research , provided insufficient evidence to be conclusive about the best implementation strategies or the benefit of clinical guidelines in this setting .
However , the generally positive outcomes across studies and strategies indicate that implementing clinical guidelines to community pharmacy might be beneficial .