Table 4 The design process from the selected target behaviour to the final implementation programme
Target behaviour: Screening of psychosocial risk factors and offering patient education | |||||
|---|---|---|---|---|---|
Barriers | Strategies | Mechanism/content | BCT | Functions | COM-B |
Lack of education and knowledge | Webinar | Increase knowledge through education by providing information about the evidence, why the behaviour is essential, and how to perform the behaviour | Information about health + emotional consequences | Education/ Persuasion | Psychological Capability |
Credible source | Persuasion | ||||
E-learning video | Instruction on how to perform the behaviour | Education | |||
Demonstration of the behaviour | Modelling | ||||
Lack of skills and tools | E-learning videos | Improving skills by: Providing a demonstration of how to perform the behaviour | Demonstration of behaviour | Modelling | |
Instruction on how to perform the behaviour | Training | ||||
Communication exercise | Training the communication skills several times in small steps in a safe environment | Behavioural practice/rehearsal | |||
Social support | Enablement | ||||
Peer learning | Giving and receiving feedback on behaviour to facilitate further development of skills | Feedback on behaviour | Education/ Persuasion/ Training | ||
Feeling unconfident | E-learning videos | Increase confidence by: Providing a demonstration of the new behaviour and telling that they can successfully perform the behaviour | Instruction on how to perform the behaviour | Education | |
Demonstration of the behaviour | Modelling | ||||
Verbal persuasion about capability | Persuasion | ||||
Communication exercise | Training the communication skills in small steps in a safe environment where the performance is not yet necessary | Behavioural practice/rehearsal | Training | ||
Social support/ Exposure | Enablement/ Environmental restructuring | ||||
Lack of time and finances | E-learning videos | Educate the behaviour to sharpen the communication | Instruction on how to perform the behaviour | Education/ Enablement | Physical Opportunity |
Communication exercise | Training expectation to align the time spent on communication | Behavioural practice/rehearsal | Training | ||
Social support | Enablement | ||||
Group dialogue meetings | De-implement old habits to give more time for new behaviour + optimise patients' records | Habit reversal / substitution | Training | ||
Restructuring the social environment | Enablement/ Environmental restructuring | ||||
Biomechanical culture | Webinar | Changing culture by: Initiate a common understanding/knowledge and belief about performing the behaviour | Social support | Enablement | Social opportunity |
Framing/ reframing | Persuasion | ||||
Communication Exercises | Training skills together with colleagues in order to facilitate relatedness in performing the new behaviour | Restructuring the physical environment | Enablement/ Environmental restructuring | ||
Group dialogue meetings | Changing environment by creating a common terminology and experience being able to share knowledge about not only biomechanical issues but also psychosocial factors | Restructuring the social environment | |||
Social support | |||||
Biomechanical patient expectation | Webinar + E-learning videos | Education of how to address patient expectation | Instruction on how to perform the behaviour | Education | Social opportunity |
Demonstration of the behaviour | Modelling | ||||
Information about others’ approval | Persuasion | ||||
Communication exercise | Training of how to address patient expectation | Behavioural practice/ rehearsal | Training | ||
Peer learning | Providing information on behaviour facilitating a reflection of own behaviour and role | Feedback on behaviour | Education/ Persuasion/ Training | ||
Group dialogue meetings | Enhance relatedness by sharing successes of new behaviour | Social support | Enablement | ||
Focus on past success | Persuasion | ||||
Lack of readiness to change | Implementation support | Enable behaviour change by supporting new behaviour with planned activities, pre-printed materials, reminders and a person to ask questions | Action planning | Enablement | Automatic Motivation |
Social support | |||||
Restructuring the physical environment | Enablement/ Environmental Restructuring | ||||
Stepwise implementation | Setting easy-to-perform tasks and adding more tasks (new behaviour) slowly to make it applicable to practice | Graded tasks | Enablement/ Training | ||
Habits | Stepwise implementation | Change old habits by introducing new behaviour in small affordable steps | Graded tasks | ||
Communication exercises | Change habits by prompt rehearsal and repetition of the new behaviour | Habit formation | Training | ||
Biomechanical professional identity | Webinar + E-learning videos | Change professional identity by: Providing information about why and demonstrating how to perform the behaviour to initiate reflection on own role | Demonstration of the behaviour | Modelling | Reflective Motivation |
Instruction of how to perform the behaviour | Education | ||||
Communication exercises | Improving skills by practising the behaviour | Behavioural practice/ rehearsal | Training | ||
Peer learning | Giving and receiving feedback on behaviour initiating a reflection of own behaviour and role | Feedback on behaviour | Education/ Persuasion/ Training | ||
Discrepancy between current behaviour and goal | |||||
Social reward | |||||
Group dialogue meetings | Improve relatedness and facilitate acceptance of new behaviour. Also to provide practical help in carrying out the new behaviour by working together on journal standards | Social support (practical and emotional) | Enablement/ Environmental Restructuring | ||
Restructuring the social environment | |||||
Scepticism regarding evidence validity | Webinar | Increase belief about the importance by providing information about the evidence why the behaviour is essential, thereby increasing the motivation | Information about health + emotional consequences | Education/ Persuasion/ Modelling | Reflective Motivation |
E-learning video | Credible source | Persuasion | |||