Table 4 TDF domains identified to contain facilitators and barriers mapped to nine intervention functions and BCTs with APEASE

Intervention Functions and comments around APEASE criteria

Education is affordable and practical within existing roles and orientation processes, however Excessive educational focus may lead to neglect in other domains. Educational meetings alone are unlikely to effectively change complex behaviours [26]. This was the main intervention in initial implementation that had suboptimal uptake

Using persuasive communication to induce positive feelings to stimulate use of EDWHAT by senior staff, managers and peers all existing roles. But need to consider method of persuasion not to be construed as “pushy”. Needs to be conducted equitably – not single out particular staff

Creating an expectation of award (incentive) is a crucial characteristic for the intervention, given the competing demands on nurse time, and the lack of existing recognition for use of the tool. Financial incentives are not affordable or practical, however awards, recognition and positive feedback may be effective. Can be seen as “core business so shouldn’t need incentive”. Care must be taken that the incentive chosen must be widely available – all staff have opportunity for acknowledgement

Creating expectation of punishment or cost through coercion while affordable and possible within existing roles, is not appropriate

Imparting skills is affordable and practical within existing roles and orientation processes but staff need opportunity and motivation to use them

Using rules to increase staff using the tool by reducing competing behaviours is possible within existing resources and structure. Particular care to be taken to ensure equitable reinforcement for all staff

Changing the physical context is crucial. It can be conducted with existing IT and senior nursing staff roles. Additional computers are not an onerous budget item and a priority

Providing an example for people to aspire to or imitate by modelling is affordable, practical, effective, acceptable and equitable within existing roles and orientation processes.

Increasing the means and reducing barriers to increase capability and opportunity for staff to use the tool through enablement Affordable, practical, effective, acceptable and equitable within existing roles and orientation processes.

2.1 monitoring of behaviour by others without evidence of feedback; 2.2 feedback on behaviour; 3.1 social support (unspecified); 4.1 instruction on how to perform a behaviour; 5.1 information about health consequences; 5.2 salience of consequences; 5.3 information about social and environmental consequences; 6.1 demonstration of the behaviour; 6.2 social comparison; 7.1 prompts/cues; 9.1 credible source; 10.4 social reward; 10.5 social incentive; 12.1 restructuring the physical environment; 12.5 adding objects to the environment; 13.1 identification of self as role model; 15.1 verbal persuasion about capability.