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Table 2 Final intervention components mapped to the behavioural change technique (BCT) and theoretical domains framework (TDF) barrier or enabler being targeted, by participant group: (A) patients, (B) health professionals and (C) arthritis therapists

From: Improving diagnosis and treatment of knee osteoarthritis in persons with type 2 diabetes: development of a complex intervention

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

  1. “–” indicates not applicable