Table 5 Mapping barriers to using the intervention to implementation strategies
Barrier | COM-B/TDF domain | Behavioural change techniques | Implementation strategy (EPOC taxonomy) | Implementation strategy (detail) |
|---|---|---|---|---|
Nowhere to store the booklet with good visibility or convenient access | Physical opportunity/environmental | Adding objects to the environment | Educational materials | Patient education booklet provided in both digital and hardcopy formats |
| Â | Â | Environment | Areas identified or created to place booklets (waiting room, office space) | |
Forgetting to use the booklet | Psychological capability/memory | Adding objects to the environment | Educational materials | Patient education booklet provided in both digital and hardcopy formats |
| Â | Â | Prompts/cues | Reminders | Automatic reminders to use booklet through practice management software |
| Â | Â | Information about social and environmental consequences | Educational outreach visit | Strategies to remember to use the booklet discussed in the individualised training session for the clinician |
Some points were missed in the training session, and the booklet was not used completely | Psychological capability/knowledge | Information about social and environmental consequences | Educational outreach visit | Individualised training session for clinician with discussion of key points and modelling use of the booklet |
| Â | Â | Â | Educational materials | Training resources provided for future clinician reference (low back pain guidelines, training video and sheets to use the booklet) |
Booklet was not needed as current clinician method of managing clinical consults sufficient | Reflective motivation/beliefs about capabilities | Feedback on outcomes of behaviour | Audit and feedback | Low back imaging referral audit, provided to the clinician (individual and population data) to show current imaging referral behaviour |
| Â | Â | Feedback on outcomes of behaviour | Educational outreach visit | Individualised training session for clinician with discussion of how the booklet may help in different scenarios |
| Â | Â | Credible source | Local opinion leader | Champion within each clinic to encourage active engagement with decreasing non-indicated imaging for low back pain |
Clinician felt the patient did not require more education or reassurance | Reflective motivation/beliefs about consequences | Information about social and environmental consequences | Educational outreach visit | Individualised training session for clinician with discussion of patient beliefs and need for reassurance |
Not enough time in a consult to use additional resources | Physical capability/physical skills Reflective motivation/Beliefs about consequences | Instruction on how to perform a behaviour Demonstration of the behaviour | Educational outreach visit | Individualised training session for clinician with modelling of how to use the booklet and educate the patient within a standard consult |
Clinician felt the patient would not be receptive to receiving the booklet | Reflective motivation/beliefs about consequences | Information about social and environmental consequences | Educational outreach visit | Individualised training session for clinician with discussion of patient receptiveness for educational resources |
| Â | Â | Credible source | Local opinion leader | Champion within each clinic to encourage active engagement with decreasing non-indicated imaging for low back pain |