Step 2: Using a theoretical framework, which barriers and enablers need to be addressed? | Step 3: Which intervention components could overcome the modifiable barriers and enhance the enablers? | ||
---|---|---|---|
Barrier or enabler | TDF domain | Behavioural change technique | Modes of delivery and content |
A. Patient | |||
Understanding about OA and its management | Knowledge | Instructions on how to perform behaviour | Personalized OA treatment plan |
Information about health consequences | Written information and education through one-on-one AT visits about the interaction between OA and T2DM and the consequences of untreated symptomatic OA | ||
Capability to engage in exercise with joint pain | Beliefs about capabilities | Problem solving | ATs help deconstruct physical activity barriers and co-develop goals |
Instructions on how to perform behaviour | Written and verbal advice on engaging in OA care | ||
Graded tasks | Individualized goal setting and titration of physical activity | ||
Expecting OA treatment will help | Optimism | Review outcome goal(s) | Personalized OA care plan, including physical activity goals |
Feedback (internal or external) that OA treatment is helping | Reinforcement | Feedback on behaviour | AT to develop a monitoring plan with patient for OA care, including PA |
Prompts/cues | AT to develop individualized reminder plan (emails, use of wearable device) | ||
Support from health professionals | Environmental context and resources | Prompts/cues | – |
Social support (practical) | ATs to help the patient determine community supports to meet goals, in addition to communicating care plan to the health care team | ||
Restructuring of physical environment | Longitudinal relationship with AT to support necessary behavioural change | ||
Access to facilities, programmes and resources | Environmental context and resources | Prompts/cues | – |
Social support (practical) | – | ||
Restructuring of the physical environment | Diabetes & Osteoarthritis Program provides comprehensive OA care at no out-of-pocket costs | ||
Social support to encourage engagement in OA treatment | Social influences | Social support (practical) | ATs to help connect patients with potential sources of support at home and in their community, including access to Arthritis Society Canada social workers as needed |
Peer influence on OA therapies | Social influences | Social support (practical) | Welcome package for Diabetes & Osteoarthritis Program to include peer stories and experiences |
Sources of accountability | Behavioural regulation | Goal setting | ATs to deploy a wide range of BCTs to help patients set, titrate, troubleshoot their goals and progress and provide sources of accountability |
Graded tasks | |||
Problem solving | |||
Prompts/cues | |||
B. Health professional | |||
Knowledge about OA diagnosis and treatment | Knowledge | Instructions on how to perform behaviour | Electronic educational materials providing information on how to screen for knee OA, including patient screening questions |
Information about health consequences | Electronic educational materials describing health consequences of untreated symptomatic knee OA | ||
Skills in joint examination | Skills | Instructions on how to perform behaviour | Electronic education materials providing screening questions for knee OA that remove the need for physical exam |
Information about health consequences | – | ||
Role in OA management | Social and professional role and identity | Credible source | Educational materials from the study team that include input from endocrinologists and family physicians |
Priority of OA care | Intentions | Information about health consequences | Electronic educational materials describing health consequences of untreated symptomatic knee OA |
Information about others’ approval | Each referral to Diabetes & Osteoarthritis Program accompanied by a confirmation note to referring provider with approval and appreciation for referral | ||
Resources for OA care, including access to physical therapy | Environmental context and resources | Prompts/cues | Use of various methods to remind clinicians of Diabetes & Osteoarthritis Program (modification of diabetes flow sheets, clinic posters) |
Conserving mental resources | Efficient referral process with little time of referring provider required | ||
Restructuring the physical environment | Creation of Diabetes & Osteoarthritis Program as a resource to refer to for timely OA care at no cost to the patient | ||
Perception rheumatologists do not want to manage OA | Social influences | Information about others’ approval | Each referral to Diabetes & Osteoarthritis Program accompanied by a confirmation note to referring provider with approval and appreciation for referral |
C. Arthritis therapist | |||
Paucity of specific diabetes knowledge | Knowledge | Instructions on how to perform behaviour | Workshop for ATs to increase T2DM-specific knowledge |
Information about health consequences | |||
Variability in skills in behaviour change techniques | Skills | Instructions on how to perform behaviour | Workshop for ATs to increase confidence in the use of BCTs |
Information about health consequences | |||
Variability in perceived role in optimizing overall health | Social and professional role and identity | Credible source | Arthritis Society Canada leadership supporting a focus on whole-person health |
Social support | |||
Variable intention to consider comorbidity in OA management plan | Intention | Information about health consequences | Workshop for ATs to increase knowledge about the impact of OA on other chronic conditions, including T2DM and importance of physical activity |
Information about others’ approval | Arthritis Society Canada leadership supporting a focus on whole-person health | ||
Goal setting | |||
Existing AREP programme limits the provision of longitudinal OA care | Environmental context and resources | Prompts/cues | Physical goals and plan sheet for ATs to complete with patients |
Restructuring of the physical environment | Through the creation of Diabetes & Osteoarthritis Program, follow-up visits scheduled over 6 months |