Using the Theoretical Domains Framework and the Behavior Change Wheel to Design a Tummy Time Intervention

This paper describes the application of an integrated theoretical framework that consists of behavioral change models to plan preventative educational programs and target interventions to facilitate parent implementation of tummy time (prone positioning) to promote infant development and prevent flattening of the infant's skull. A qualitative study design was used to explore tummy time barriers and facilitators and to gain an in-depth understanding of the behaviors that influence tummy time implementation. Twenty-three parent participants completed an open-ended survey designed to gain information on parental perspectives related to tummy time. Data were analyzed using thematic analysis. Physical Capability of the infant and Psychological Capability of the parent, Physical and Social Opportunity, Reflective Motivation, Automatic Motivation, Emotion, Memory, Attention, & Decision Processes, Skills, Environmental Context & Resources, Social Influences, Beliefs about Consequences, Beliefs about Capabilities, and Knowledge are components to target during intervention. Occupational therapists and other healthcare providers can use the comprehensive behavioral change models described in this paper to develop evidence-informed, theory-based interventions to promote parental implementation of tummy time.