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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