Table 3 Theoretical domains framework (TDF) illustrative quotes

Knowledge

I know that self-reported data is a lot … higher than actual data and as clinicians we get it wrong as well, we like, overestimate it. Erm, and that just that it’s so important for … maintaining their health so we know that like they’re likely to stay better if their adherence is better to their nebulisers.

S01F03

Skills

…I’m not sure I do really, (yeah), so I kind of think I do (yeah) and I try very hard to not be judgemental and I try very hard not to give peoples plans, but to help people make their own plans and to discuss ideas and habits with people rather than telling people what to do. But, I did think yesterday, when I was having this conversation maybe I ought to be doing this training because I’m not sure I’m as skilled as I ought to be.

S02F03

Memory, attention and decision-making processes

So on the ward is much more ad-hoc and it might come up in a ward round, and it might come just... I float round and stick my head round the door and talk to patients without the rest of the team sometimes... it could be completely ad-hoc or I could go with an agenda that is specifically to talk about adherence ‘cause they’re rubbish.

S01F02

Behavioural regulation

No, I don’t think we have a set way to remember to use it, I mean I know certainly that physios should be looking at that, and I think the doctors are but in terms of other clinicians, I’m not sure they necessarily are.

S02F05

Social/professional role and identity

I think particularly the physios, the doctors. I mean it’s helpful for everybody but, I think, in practice, we should all… all clinicians should look at it but I think in practice the ones who tend to look at it are the doctors the physios and the nurses.

S02F05

Beliefs about capabilities

I: How confident do you feel discussing adherence with patients?

P: Mm, well, people can be confident and be really bad at it (I laughs), but I’m increasingly confident about talking about it and increasingly surprised about the some of the discussions that I get into with even people who I thought they’re quite good at doing their treatment and sometimes you don’t get it on the first second, third, fourth attempt it suddenly spills out sometimes by mistake or sometimes they just fess up so I’m getting better at it for sure but whether I’m any good I couldn’t tell you.

S01F02

Optimism

I’d like to say I’m confident but I’m, I don’t know cause of you know people are people and well we all know that, you know, everyone has their lives… I don’t necessarily think, but I’d like to think that it would make some difference at least

S02F04

Beliefs about consequences

I think actually if the team don’t necessarily use it in the right way it could actually just be used as something to just tell patients off with.

S03F01

but if you can get people to sort of believe that actually it’s worth it because in the long run it actually will decrease your workload and actually make the patients better and probably using your service less…

S02F02

Intentions

I: Have, have you made a decision to use CFHealthHub and to discuss adherence? P: No, not particularly, as I said we didn’t have a lot of, I know something going on but as I said I won’t tell you, I know the importance of it but no probably not a lot done from my perspective.

S03F02

Goals

I think the aspiration has got to be that that is just normal. That’s just you know lung function, weight adherence data and it just something that we have that we look at automatically and it something that the patient’s own as well. That they have that information, so they have all those metrics together and there’s some way that we can react to that outside of a clinic setting…

S03F03

Reinforcement

I think, you know, if someone’s really struggled and then they’re suddenly on board, the I think the that’s that just makes you feel really pleased for them.

S01F04

Emotion

I think, yeh, it does spark a bit of an emotion, and I don’t even know all the patients that well as I’m quite new to the service. So but I think it is, you know, you feel a little bit, a bit shocked I suppose. Although it shouldn’t be shock, because I know patients do struggle, but you know, it is quite shocking. And I think the team will be really shocked when they do have access to CF Health Hub to actually see the scale of the problem.

S03F01

Environmental context and resources

Probably mainly staffing, and I say that because we have this electronic patient record so we needed to get our computer infrastructure sorted so we actually have enough computers to... to use HealthHub.

S01F02

Social influences

…we invited erm the lead for respiratory and a nurse matron and various other people to come and meet and speak about it and they didn’t take that up, we do discuss it regularly at our management meeting where we do have respiratory business management representation. But I think there is scope …you know for us to flag it at a higher level within the trust to sort of say you know, to shout about it really

S03F03