Table 4 Themes related to ‘Barriers and facilitators impacting use of the intervention’
Theme | Facilitator or barrier | Quotes |
|---|---|---|
Storage location and remembering to use the booklet | Facilitator: Storing the booklet in a visible location with convenient access | “Yes I did find the booklet OK to use, and because it was somewhere where I can reach it, it was good” (GP2) |
Facilitator: Patient requesting imaging | “I only tend to think of it [the booklet] when people ask for imaging, so that’s probably a positive” (GP10) | |
Barrier: Nowhere to store the booklet with good visibility or convenient access | “In offices you just lose pieces of paper and little booklets and all of the rest. You don’t have room to store everything” (GP4) | |
Barrier: Forgetting to use the booklet | “I only used the one and I think that’s probably not the booklet, but because it’s difficult to remember” (GP1) | |
Clinician having the necessary knowledge/skills to use the booklet | Facilitator: Training or clinician prior knowledge was sufficient to use the booklet | “I think it [the training] was absolutely fine, the booklet’s quite self-explanatory, it’s quite clearly laid out so that was fine” (GP1) |
Barrier: Some points were missed in the training session, and the booklet was not used completely | “Yes, I think I missed a few points [in training] so that’s what I failed to explain fully to my patients” (GP14) | |
Perceived usefulness of the booklet within a consult | Facilitator: The information in the booklet is appropriate, useful for patient education, and helps to reinforce practitioner confidence and recommendations | “I actually found the booklet really comprehensive. I found it really helpful [to reduce unnecessary imaging], so I don’t think you need, I mean I wouldn’t use other things” (GP2) “It [the booklet] probably backs me up, makes me feel more confident, and I think I’ve got some research backing me up and then I can counter it [patient request for imaging], and I can say well look there’s this and they’ve done this, and they’ve looked at this, and if you’re worried then this can be our plan” (GP3) “I think the booklet was, for me, a quick way of explaining the rationale behind not imaging, and the patient seemed to appreciate this to a greater depth when given the booklet” (GP5) “It [the booklet] also helped me, remind me of a few things which I forget sometimes because I can’t necessarily always remember all these things or sometimes I just focus more on one thing or the other” (GP7) “I think giving people written data, you know like a written pamphlet, gives a bit more credibility to what you say, so you can educate people about not needing imaging” (GP11) |
Facilitator: The booklet was used because the clinician felt the patient required more education or reassurance | “I think for instance I felt [in the patients that did use the booklet with] there was an expectation that was either voiced or implied of imaging, and so to sort of counter that view the booklet was handy” (GP5) “I think if you did have someone who was quite adamant to want imaging it [the booklet] would be then more useful for those certain patients” (GP6) | |
Barrier: Booklet was not needed as current clinician method of managing clinical consults sufficient | “I think it [the booklet] would be reassuring for lots of clinicians but for me personally I think I can communicate my confidence to the patient and I might be wrong but I feel they’re OK with me just explaining why they don’t need anything” (GP1) “I’m pretty confident that I don’t need to do the imaging in the first place, so I don’t know whether it [using the booklet] makes a tremendous difference for me really” (GP7) | |
Barrier: Clinician felt the patient did not require more education or reassurance | “Not everybody comes and asks for an X-ray, some of them understand it’s muscular not underlying bone pathology there you know” (GP13) | |
Barrier: Low back pain an uncommon presentation for the clinician | “I might see a back pain patient you know, maybe only once a fortnight because I don’t have that big throughput” (GP3) | |
Time efficiency of using the booklet in a consult | Facilitator: Use of the booklet improved time efficiency in the consult | “I think also at least in a couple of cases [when used the booklet] that I recall, I was very much pushed for time. It’s handy to say, here it is, have a read” (GP5) |
Barrier: Not enough time in a consult to use additional resources | “The time factor [why didn’t use the booklet with other patients], because if lots of patients are waiting, if you don’t have a lot of time, then I didn’t go into this much detail” (GP13) | |
Barrier: Using the booklet took additional time in the consult | “I mean it [using the booklet] did add time for me. I could imagine that there could be ways to do it that it wouldn’t, but that’s just not how I, I suppose, talk to people” (GP9) | |
Perceived receptiveness of the patient to receiving the booklet | Facilitator: Clinician felt the patient would be receptive to receiving the booklet | “Yes they [the patients] liked it [the booklet], I think patients always like to go away with something, so yes I think they liked it” (GP9) |
Barrier: Clinician felt the patient would not be receptive to receiving the booklet | “I guess it [the booklet] helps reinforce the message for people who are accepting the message, but I think the people that really have come in with an agenda and you can’t sway them, the booklet’s not going to sway” (GP4) “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” (GP6) |