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Table 4 Substantive Theories Underpinning the Revised Program Theory. This table presents the substantive theories that are incorporated into the revised program theory, and believed to underpin the SDM process

From: Development of a program theory for shared decision-making: a realist synthesis

Formal theoryArea of program theory which the theory underpinsImpact of theoretical underpinning on SDM
Theory of Planned Behaviour (TOPB)Anxiety, Trust, World view, Self-efficacy, Perception of capacity to access external support, Pre-existing relationship, Recognition of Decision, Engagement in SDMThe TOPB combines one’s attitude toward behaviour, subjective norms of the individual, and the individual’s perceived behaviour control to form the individual’s intention to conduct a certain behaviour. In SDM, someone can enter a consultation process with a predetermined idea of how they foresee the process going, and it can bias the success of the engagement process. For example, one may have norms engrained in their world view that create the behavioural intent to disengage from Western medicine, thus blocking the engagement process.
Feeling of Rightness (FOR)Trust, World view, Self-efficacy, Perception of other party capacity, Pre-existing relationshipPatients and health care providers will make an initial assessment based on their previous knowledge and similar experiences from which they will conclude a feeling of rightness based on the fluency of recall, familiarity, and metacognitive beliefs. This will cause an individual to either accept their initial judgement or re-evaluate.
Expected Utility TheoryDifficulty of decisionIf outcome probabilities of a given treatment are known, then individuals will have an easier time engaging with the decision-making process than if the impact is uncertain.