The scope of clinical pharmacy practice and research has expanded to encompass behavioural, economic and humanistic dimensions alongside clinical responsibilities. The influence of behaviour on the efficacy of clinical services justifies the application of behaviour change theories to clinical pharmacy and practice research. This facilitates a deeper understanding of human behaviour in relation to health interventions and the provision of clinical pharmacy services. This commentary provides a summary of key concepts that researchers need to consider when using behavioural and/or social theories to underpin their research, outlining: (1) why this is important to support development of the pharmacist's role in patient care; (2) definitions of theories, models and frameworks; (3) a description of the UK Medical Research Council Framework; (4) an overview of the most commonly used behavioural theories, models and frameworks (supplemented by implementation, communication and other relevant humanistic and social theories); (5) lessons for clinical pharmacy and pharmacy practice researches. The comment aims to assist pharmacy practice and health research colleagues to improve the quality and rigour of theory underpinned research. The guidance in this paper is part of the commitment of the European Society of Clinical Pharmacy to stimulate innovative and high-quality research in all areas of clinical pharmacy.

Department of Clinical Pharmacy Faculty of Pharmacy Marmara University Istanbul Turkey

Department of Clinical Pharmacy Innsbruck University Innsbruck Austria

Department of Clinical Pharmacy Yeditepe University Istanbul Turkey

Department of General Practice and Nursing Science Julius Center for Health Sciences and Primary Care University Medical Center Utrecht University Utrecht The Netherlands

Department of Internal Medicine and Geriatrics 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Pharmacy Faculty of Medicine and Surgery University of Malta Msida Malta

Department of Pharmacy University of Copenhagen Copenhagen Denmark

Department of Social and Clinical Pharmacy Faculty of Pharmacy in Hradec Králové Charles University Hradec Králové Czech Republic

Hospital Pharmacy Uni S Chiara General Hospital APSS Trento Italy

School of Pharmacy and Pharmaceutical Sciences Trinity College Dublin Dublin Ireland

Trinity College Dublin Dublin Ireland

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Garcia-Cardenas V, Rossing CV, Fernandez-Llimos F, et al. Pharmacy practice research—a call to action. Res Soc Adm Pharm. 2020;16(11):1602–8. https://doi.org/10.1016/j.sapharm.2020.07.031 . DOI

Loh ZW, Cheen MH, Wee HL. Humanistic and economic outcomes of pharmacist-provided medication review in the community-dwelling elderly: a systematic review and meta-analysis. J Clin Pharm Ther. 2016;41(6):621–33. https://doi.org/10.1111/jcpt.12453 . PubMed DOI

Nørgaard LS, Traulsen JM, Bissell P. Arguments for theory-based pharmacy practice research. Int J Pharm Pract. 2000;8(2):77–8. https://doi.org/10.1111/j.2042-7174.2000.tb00989.x . DOI

Stewart D, Klein S. The use of theory in research. Int J Clin Pharm. 2016;38:615–9. https://doi.org/10.1007/s11096-015-0216-y . PubMed DOI

Mount JK. Contributions of the social sciences. In: Wertheimer AI, Smith MC, editors. Pharmacy practice—social and behavioral aspects. Philadelphia: Williams & Wilkins; 1989. p. 1–15.

Fernandez-Llimos F, Desselle S, Stewart D, et al. Improving the quality of publications in and advancing the paradigms of clinical and social pharmacy practice research: the Granada statements. Int J Clin Pharm. 2023;45:285–92. https://doi.org/10.1007/s11096-023-01550-8 . PubMed DOI PMC

Alves da Costa F, Fernandez-Llimos F, Desselle S, et al. The International Collaboration of Pharmacy Journal Editors (ICPJE) formally constituted to foster quality around clinical and social pharmacy practice research publications. Int J Clin Pharm. 2025;47:4–7. https://doi.org/10.1007/s11096-024-01833-8 . PubMed DOI

Grol RP, Bosch MC, Hulscher ME, et al. Planning and studying improvement in patient care: the use of theoretical perspectives. Milbank Q. 2007;85(1):93–138. https://doi.org/10.1111/j.1468-0009.2007.00478.x . PubMed DOI PMC

Nørgaard LS, Traulsen JM. Philosophical perspectives and theories applied in pharmacy practice research: Filosofiske perspektiver og teorier appliceret på apotekspraksisforskning. In: Babar Z, editor. Encyclopedia of pharmacy practice and clinical pharmacy, vol. 1–3. Hoboken: Elsevier; 2019. p. 150–61.

Luetsch K, Luetsch K, Maidment I, et al. Realist research to inform pharmacy practice and policy. Res Soc Adm Pharm. 2021;17(12):2075–81. https://doi.org/10.1016/J.SAPHARM.2021.06.026 . DOI

Stewart D, Al Hail M, Al-Shaibi S, et al. A scoping review of theories used to investigate clinician adherence to clinical practice guidelines. Int J Clin Pharm. 2023;45(1):52–63. https://doi.org/10.1007/s11096-022-01490-9 . PubMed DOI

Buchanan DR. Beyond positivism: humanistic perspectives on theory and research in health education. Health Educ Res. 1998;13(3):439–50. https://doi.org/10.1093/her/13.3.439 . DOI

Nazar Z, Naseralallah LM, Stewart D, et al. Application of behavioural theories, models, and frameworks in pharmacy practice research based on published evidence: a scoping review. Int J Clin Pharm. 2024;46:559–73. https://doi.org/10.1007/s11096-023-01674-x . PubMed DOI PMC

Scott J, Marshall G. A dictionary of sociology. Oxford: Oxford University Press; 2009.

Wacker JG. A definition of theory: research guidelines for different theory-building research methods in operations management. J Oper Manag. 1998;16(4):361–85. https://doi.org/10.1016/S0272-6963(98)00019-9 . DOI

Karnon J, Mackay M, Mills T, editors. Mathematical modelling in health care. In: 18th World IMACS/MODSIM Congress; 2009: Citeseer.

Nilsen P. Making sense of implementation theories, models and frameworks. Implement Sci. 2015;10:53. PubMed PMC

Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. New York: Sage Publications; 2017.

Hughes S, Davis TE, Imenda SN. Demystifying theoretical and conceptual frameworks: a guide for students and advisors of educational research. J Soc Sci. 2019;58(1–3):24–35.

Skivington K, Matthews L, Simpson SA, et al. A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ. 2021;30(374):2061. https://doi.org/10.1136/bmj.n2061 . DOI

Michie S, Van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6(1):1–12. https://doi.org/10.1186/1748-5908-6-42 . DOI

Madden TJ, Scholder Ellen P, Ajzen I. A comparison of the theory of planned behaviour and the theory of reasoned action. Personal Soc Psychol Bull. 1992;18(1):3–9. https://doi.org/10.1177/0146167292181001 . DOI

Ajzen I. From intentions to actions: a theory of planned behavior. In: Kuhl J, Beckmann J, editors. Action control. SSSP Springer series in social psychology. Berlin: Springer; 1985. https://doi.org/10.1007/978-3-642-69746-3_2 . DOI

Luder H, Frede S, Kirby J, et al. Health beliefs describing patients enrolling in community pharmacy disease management programs. J Pharm Pract. 2016;29(4):374–81. https://doi.org/10.1177/0897190014566311 . PubMed DOI

Tecen-Yucel K, Ozdemir N, Kara E, et al. Factors associated with intention of clinical pharmacists and candidates to provide pharmaceutical care: application of theory planned behaviour. BMC Med Educ. 2023;23(1):682. https://doi.org/10.1186/s12909-023-04658-7 . PubMed DOI PMC

Alhamad H, Donyai P. The validity of the theory of planned behaviour for understanding people’s beliefs and intentions toward reusing medicines. Pharmacy (Basel). 2021;9(1):58. https://doi.org/10.3390/pharmacy9010058 . PubMed DOI

Social Change UK. A guide on the COM-B Model of Behaviour. 2019. https://social-change.co.uk/files/02.09.19_COM-B_and_changing_behaviour_.pdf . Accessed 14 Mar 2025

Jatau AI, Peterson GM, Bereznicki L, et al. Applying the capability, opportunity, and motivation behaviour model (COM-B) to guide the development of interventions to improve early detection of atrial fibrillation. Clin Med Insights Cardiol. 2019;13:1179546819885134. https://doi.org/10.1177/1179546819885134 . PubMed DOI PMC

Keller MS, Carrascoza-Bolanos J, Breda K, et al. Identifying barriers and facilitators to deprescribing benzodiazepines and sedative hypnotics in the hospital setting using the theoretical domains framework and the capability, opportunity, motivation and behaviour (COM-B) Model: a qualitative study. BMJ Open. 2023;13(2):66234. https://doi.org/10.1136/bmjopen-2022-066234 . DOI

Maxwell-Smith C, Breare H, Dominguez GA, et al. Pharmacists’ perceptions and delivery of health behaviour change recommendations: mapping the COM-B model. Res Soc Adm Pharm. 2024;20(2):115–23. https://doi.org/10.1016/j.sapharm.2023.10.008 . DOI

Michie S, Johnston M, Abraham C, et al. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14(1):26–33. https://doi.org/10.1136/qshc.2004.011155 . PubMed DOI PMC

Cane J, Oonnor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37. https://doi.org/10.1186/1748-5908-7-37 . PubMed DOI PMC

Atkins L, Francis J, Islam R, et al. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implement Sci. 2007;12:77. https://doi.org/10.1186/s13012-017-0605-9 . DOI

Isenor JE, Minard LV, Stewart SA, et al. Identification of the relationship between barriers and facilitators of pharmacist prescribing and self-reported prescribing activity using the theoretical domains framework. Res Soc Adm Pharm. 2018;14(8):784–91. https://doi.org/10.1016/j.sapharm.2017.10.004 . DOI

Hussein R, Whaley CRJ, Lin ECJ, Grindrod K. Identifying barriers, facilitators and behaviour change techniques to the adoption of the full scope of pharmacy practice among pharmacy professionals: using the theoretical domains framework. Res Soc Adm Pharm. 2021;17(8):1396–406. https://doi.org/10.1016/j.sapharm.2020.10.003 . DOI

Courtenay M, Rowbotham S, Lim R, et al. Examining influences on antibiotic prescribing by nurse and pharmacist prescribers: a qualitative study using the theoretical domains framework and COM-B. BMJ Open. 2019;9(6): e029177. https://doi.org/10.1136/bmjopen-2019-029177 . PubMed DOI PMC

Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12(1):38–48. https://doi.org/10.4278/0890-1171-12.1.38 . PubMed DOI

Imeri H, Toth J, Arnold A, et al. Use of the transtheoretical model in medication adherence: a systematic review. Res Soc Adm Pharm. 2022;18(5):2778–85. https://doi.org/10.1016/j.sapharm.2021.07.008 . DOI

Ravi K, Indrapriyadharshini K, Madankumar PD. Application of health behavioral models in smoking cessation: a systematic review. Indian J Public Health. 2021;65(2):103–9. https://doi.org/10.4103/ijph.IJPH_1351_20 . PubMed DOI

Levoy K, Salani DA, Buck H. A systematic review and gap analysis of advance care planning intervention components and outcomes among cancer patients using the transtheoretical model of health behavior change. J Pain Symptom Manag. 2019;57(1):118-139.e6. https://doi.org/10.1016/j.jpainsymman.2018.10.502 . DOI

Andersen RM, Newman JF. Societal and individual determinants of medical care utilization in the United States. Milbank Mem Fund Q Health Soc. 1973;51:95–124. PubMed

Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36:1–10. https://doi.org/10.2307/2137284 . PubMed DOI

Bradley EH, McGraw SA, Curry L, et al. Expanding the Andersen model: the role of psychosocial factors in long-term care use. Health Serv Res. 2002;37(5):1221–42. https://doi.org/10.1111/1475-6773.01053 . PubMed DOI PMC

Alkhawaldeh A, ALBashtawy M, Rayan A, et al. Application and use of Andersen’s behavioral model as theoretical framework: a systematic literature review from 2012–2021. Iran J Public Health. 2023;52(7):1346–54. https://doi.org/10.18502/ijph.v52i7.13236 . PubMed DOI PMC

Chen C, Gu D. Andersen model. In: Gu D, Dupre ME, editors. Encyclopedia of gerontology and population aging. Cham: Springer; 2021. https://doi.org/10.1007/978-3-319-69892-2_876-1 . DOI

Porteous T, Wyke S, Hannaford P, et al. Self-care behaviour for minor symptoms: can Andersen’s Behavioral Model of Health Services Use help us to understand it? Int J Pharm Pract. 2015;23(1):27–35. https://doi.org/10.1111/ijpp.12116 . PubMed DOI

Krzyż EZ, Antunez Martinez OF, Lin HR. Uses of Andersen health services utilization framework to determine healthcare utilization for mental health among migrants—a scoping review. Front Public Health. 2023;11:1284784. https://doi.org/10.3389/fpubh.2023.1284784 . PubMed DOI PMC

Ferrari RM, Atkins DL, Wangen M, et al. Patient perspectives on a proposed pharmacy-based colorectal cancer screening program. Transl Behav Med. 2023;13(12):909–18. https://doi.org/10.1093/tbm/ibad057 . PubMed DOI PMC

Holtzman CW, Shea JA, Glanz K, et al. Mapping patient-identified barriers and facilitators to retention in HIV-care and antiretroviral therapy adherence to Andersen’s behavioral model. AIDS Care. 2015;27(7):817–28. https://doi.org/10.1080/09540121.2015.1009362 . PubMed DOI PMC

Alohan DI, Evans G, Sanchez T, et al. Using the Andersen healthcare utilization model to assess willingness to screen for prep in pharmacy-based settings among cisgender sexually minoritized men: results from the 2020 American men’s internet survey. BMC Public Health. 2024;24(1):2349. https://doi.org/10.1186/s12889-024-19836-5 . PubMed DOI PMC

John R, Mohd Salleh NA, Nik Farid ND. Utilization of sexual reproductive health services among youths in Malaysia: a cross-sectional study applying Andersen’s behavioral model of healthcare utilization. Cureus. 2024;16(5): e60230. https://doi.org/10.7759/cureus.60230 . PubMed DOI PMC

Carey RN, Connell Bohlen L, Johnston M, et al. Behaviour change techniwues and their mechanisms of action: a synthesis of links described in published intervention literature. Ann Behav Med. 2019;53(8):693–707. https://doi.org/10.1093/abm/kay078x . PubMed DOI

BCT Theory. The Theory and Techniques Tool. 2025. https://theoryandtechniquetool.humanbehaviourchange.org/ . Accessed 18 Apr 2025

Human Behaviour Change Project with Aprict Ontology Tools. 2025. https://www.humanbehaviourchange.org/ . Accessed on 18 Mar 2025

Public Health England. Achieveing behaviour change: a guide for local government and partners. 2019. https://assets.publishing.service.gov.uk/media/5e7b4e85d3bf7f133c923435/PHEBI_Achieving_Behaviour_Change_Local_Government.pdf . Accessed on: 18 Mar 2025

Monash University. How do you select the most appropriate behaviour change intervention? How to apply the APEASE framework to your behaviour change interventions (2025). https://www.behaviourworksaustralia.org/blog/how-do-you-select-the-most-appropriate-behaviour-change-intervention . Accessed on: 18 Apr 2025

Wirth F, Cadogan CA, Fialová D, et al. Writing a manuscript for publication in a peer-reviewed scientific journal: guidance from the European Society of Clinical Pharmacy. Int J Clin Pharm. 2024;46(2):548–54. https://doi.org/10.1007/s11096-023-01695-6 . PubMed DOI PMC