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Table 2 Analysis of barriers/enablers, TDF domain, and corresponding interventions to change the three target behaviours

From: Using theory to improve low back pain care in Australian Aboriginal primary care: a mixed method single cohort pilot study

Barrier/enabler TDF domain Intervention
Imaging for LBP   
 GPs have a structural/anatomical orientation to LBP and belief that radiological imaging is useful for management Knowledge Educational workshops • Include biopsychosocial model of LBP (including HCP and patient beliefs) and epidemiology of LBP and imaging findings
 There is limited knowledge of LBP imaging guidelines Knowledge Education workshops • Include LBP Imaging guideline recommendations and use of clinical tools
 GPs are unsure how to advise patients that imaging is not needed Physical Skills Education workshops • Include skills rehearsal - patient explanation and advice
 GPs do not believe there are negative consequences of unwarranted imaging Beliefs about consequences Education workshops • Include consequences of inappropriate imaging
 There is a perception that patients expect to be investigated with imaging Social influences Develop appropriate patient information resource • Information scenarios where imaging is discouraged/not needed
 Having imaging guidelines available will aid memory Memory, attention & decision processes Introduce clinical tool – LBP management • Introduce LBP decision making tool that includes imaging recommendations
 Having imaging guidelines accessible are useful Environmental context & resources Introduce clinical tool – LBP management • Introduce LBP decision making tool that includes imaging recommendations
 There is a senior GP who is “on board” and a potential opinion leader Social professional role/identity Education workshops • Encourage GP leader to ‘have a voice’ during workshops
Undertake biopsychosocial assessment   
 There is limited understanding of the biopsychosocial model of LBP Knowledge Education workshops • Discuss biopsychosocial model of LBP
 GPs lack skills in undertaking b-p-s assessment Physical Skills Education workshops • Include skills rehearsal - questions during b-p-s assessment • Explain use of clinical tools
 There is inadequate time in a GP consult to undertake a b-p-s assessment Environmental context & resources Introduce clinical tool – b-p-s screening tool
 Clinical tools can aid assist GPs remember to assess biopsychosocial factors Memory, attention & decision processes Introduce clinical tool – b-p-s screening tool
Provide patient information   
 Most GPs would like to provide information however there is no patient LBP information available appropriate to the client group Environmental context & resources Develop appropriate patient information resource
 Not all GPs know what to advise patients Knowledge Education workshops • Patient information • Explain patient information resource
Overall enablers to facilitating change in LBP care   
 LBP is seen as a challenging condition to manage and staff are motivated to improve care Intentions Education workshops • Acknowledge and reinforce staff motivation to improve care
 There is a culture within the organisation of improving practice Social professional role/identity Align program with other quality improvement initiatives
 Educational program that accrue CPD points are valued Reinforcement Accredit educational workshops for CPD points with professional organisations.
 The clinic has an integrated patient records system that could host tools to improve practice Environmental context & resources Introduce clinical tools that align with integrated patient records system