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Table 1 Overarching considerations when using the intersectionality-enhanced TDF

From: Applying an intersectionality lens to the theoretical domains framework: a tool for thinking about how intersecting social identities and structures of power influence behaviour

ConsiderationExample
Though many TDF domains focus on the individual, individuals are impacted by systems and structures of power.Self-efficacy (i.e. one’s belief in their capability to exercise control over one’s own behaviour; beliefs about capabilities TDF domain) is associated with better health outcomes [39].
Self-efficacy varies across social identity categories (e.g. Black women have lower levels of self-efficacy than black men, Caucasian women and Caucasian men) [39].
This may be a reflection of power structures in society related to both race and gender. Thus, while self-efficacy is often viewed as a psychological factor, there are social structural factors that can influence individuals’ perceived capabilities.
Interventions to enhance self-efficacy may need to consider how some groups have been historically marginalized and disempowered and that their position in society may influence whether they feel they can take action to prevent or control their own health conditions.
Reflect on how the TDF domains intersect with each other.An individual’s intersecting social identity categories and professional role may be related to their experience of social influences. For example, a racialized Personal Support Worker may feel unable to speak up if they disagree with a Caucasian team member who is also a Registered Nurse.
Do those developing/delivering the intervention/policy reflect the diversity of those who will be impacted by it?Reflect on whether everyone who could be on the team has been asked if and how they would like to be involved. Think about how different perspectives that represent a range of intersecting categories have been examined.
Consider whether you team reflects the makeup of the patient, community, and health care providers that experiences the project topic.
Have those impacted by the intervention/policy been involved in its development?Consider the patient, healthcare provider, and community population affected by the project topic area. Develop a plan to get them involved.
Include multiple individuals to represent a particular group (e.g. five patient partners instead of one).
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