Open Access Open Badges Research article

Contextualized analysis of a needs assessment using the Theoretical Domains Framework: a case example in endocrinology

Patrice Lazure1*, Robert C Bartel2, Beverly MK Biller3, Mark E Molitch4, Stephen M Rosenthal5, Judith L Ross6, Brock D Bernsten7 and Sean M Hayes1

Author Affiliations

1 AXDEV Group Inc., 210–8, Place du Commerce, Brossard, QC J4W 3H2, Canada

2 The Endocrine Society, 8401 Connecticut Avenue, Suite 900, Chevy Chase, MD, USA

3 Neuroendocrine Unit, Harvard Medical School/Massachusetts General Hospital, 55 Fruit St, Bulfinch 457B, Boston, MA 02114-2096, USA

4 Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University, Feinberg School of Medicine, 645 N. Michigan Ave., Suite 530, Chicago, IL 60611-3008, USA

5 Department of Pediatrics, University of California, 513 Parnassus Ave Room S-672, Box 0434, San Francisco, CA 94143-0434, USA

6 Pediatric Endocrinology, Jefferson Medical College, 1025 Walnut St Ste 726, Philadelphia, PA 19107-6799, USA

7 Town and Country Pediatric Medical Associates, 3838 California St., #111, San Francisco, CA 94118, USA

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BMC Health Services Research 2014, 14:319  doi:10.1186/1472-6963-14-319

Published: 24 July 2014



The Theoretical Domains Framework (TDF) is a set of 14 domains of behavior change that provide a framework for the critical issues and factors influencing optimal knowledge translation. Considering that a previous study has identified optimal knowledge translation techniques for each TDF domain, it was hypothesized that the TDF could be used to contextualize and interpret findings from a behavioral and educational needs assessment. To illustrate this hypothesis, findings and recommendations drawn from a 2012 national behavioral and educational needs assessment conducted with healthcare providers who treat and manage Growth and Growth Hormone Disorders, will be discussed using the TDF.


This needs assessment utilized a mixed-methods research approach that included a combination of: [a] data sources (Endocrinologists (n:120), Pediatric Endocrinologists (n:53), Pediatricians (n:52)), [b] data collection methods (focus groups, interviews, online survey), [c] analysis methodologies (qualitative - analyzed through thematic analysis, quantitative - analyzed using frequencies, cross-tabulations, and gap analysis). Triangulation was used to generate trustworthy findings on the clinical practice gaps of endocrinologists, pediatric endocrinologists, and general pediatricians in their provision of care to adult patients with adult growth hormone deficiency or acromegaly, or children/teenagers with pediatric growth disorders. The identified gaps were then broken into key underlying determinants, categorized according to the TDF domains, and linked to optimal behavioral change techniques.


The needs assessment identified 13 gaps, each with one or more underlying determinant(s). Overall, these determinants were mapped to 9 of the 14 TDF domains. The Beliefs about Consequences domain was identified as a contributing determinant to 7 of the 13 challenges. Five of the gaps could be related to the Skills domain, while three were linked to the Knowledge domain.


The TDF categorization of the needs assessment findings allowed recommendation of appropriate behavior change techniques for each underlying determinant, and facilitated communication and understanding of the identified issues to a broader audience. This approach provides a means for health education researchers to categorize gaps and challenges identified through educational needs assessments, and facilitates the application of these findings by educators and knowledge translators, by linking the gaps to recommended behavioral change techniques.

Theoretical domains framework; Application of educational research; Needs assessment; Mixed–methods; Behavioral change techniques; Knowledge translation; Endocrinology; Adult growth hormone deficiency; Acromegaly; Pediatric growth disorders