Table 3 Themes related to ‘How general medical practitioners used the booklet’

Used as designed throughout the consult to (1) show patients why they do not require imaging, (2) demonstrate key educational messages, and (3) provide a customised patient management plan

“I go through it [the booklet] together with them [patients], so I actually use it as an educational tool” (GP2)

“I like the diagrams that are in there [decision tree at beginning] that I can sort of go through and say, well you don’t have all these symptoms, so you don’t need any imaging” (GP2)

“Yes, that’s not bad [to have somewhere to write patient management] because you’re not giving them necessarily a prescription for prescription drugs, so it doesn’t hurt to write something down, some instructions, and when to come back in for review” (GP8)

Used at the end of the consult only, by customising the management plan and providing it to the patient

“Mostly at the end of the consultation, I’d talk to them about it all and then at the end I’d remember to use it [the booklet], and go through it then and fill in some information” (GP9)

No customisation, given to the patient as a hand-out to read at home at the end of the consult only

“If I thought that someone didn’t need imaging, I simply, towards the end of the consult, gave it [the booklet] to them. I gave it to them to take and read, and in our practice, there was a follow-up appointment made at the time, and at that time we discussed the content of the book“ (GP5)

Used throughout consult to discuss the key messages, but not customised or given to the patient

“Whilst I did go through it [the booklet] with a few patients who were half-interested in looking at it, they didn’t want to take it away, they just thought that they didn’t want the material but were happy just to talk about it” (GP6)