Table 3 Barriers and enablers for innovation, inner setting, and outer setting CFIR domains
CFIR Domain | CFIR Construct | Theme | Barrier Subtheme | Enabler Subtheme |
|---|---|---|---|---|
Innovation STs: 7B and 5E | Innovation relative advantage | Relative benefit of NDI in health management STs: 2B and 1E | aRelative ease of medication (HCP) [18] aDon’t see role of NDI as relevant to health management (HCP, P) [40,41,42,43,44] | Clear utility of NDI (HCP) [18] |
Innovation adaptability | Flexibility of intervention characteristics and delivery STs: 1B and 1E | aGeneralised or “one size fits all” interventions perceived as impersonal or patronising (HCP, P) [37, 38, 40, 45] | aFlexible, tailored or personalised interventions facilitate acceptability of and engagement in intervention (HCP, P) [35, 37, 38, 40,41,42,43, 45,46,47,48,49,50,51] | |
Innovation complexity | NDI content is complex STs: 2B | Intervention contains mixed messages or counterintuitive information (P, HCP) [35, 37, 38, 44] Intervention difficult to apply for patients with multiple conditions (HCP) [43] | NR | |
Innovation design | Intervention delivery logistics STs: 1B and 3E | Characteristics of group intervention not acceptable (P, HCP) [45, 50] | Remote or online delivery is acceptable, cost effective, convenient and reduces stigma (P, HCP) [40, 42, 46, 50] Group intervention in community setting (P, HCP) [37,38,39, 47, 50, 52] Monitoring during intervention supported accountability (P) [46, 52] | |
Innovation cost | Costs associated with intervention ST: 1B | aActual or perceived cost associated with intervention (P) [37, 38, 40, 46, 52,53,54,55] | NR | |
Outer setting STs: 9B and 7E | Local attitudes | Attitudes and awareness towards medical condition in local community STs: 2B and 1E | aNegative societal attitudes or pressures (P) [18, 38, 39, 43, 45, 54, 55] Perception that support is only available for some individuals (P) [37] | Societal awareness of medical condition (P) [38] |
Local conditions | Access to facilities and services STs: 4B and 2E | aLack of available goods or services to access NDI (P) [36, 38, 44, 46, 53] Difficulties with transport (e.g., long distances to access suitable facilities) (P) [38] | aEase of access to spaces and places (e.g., activities, green space) to participate in NDI (P) [46, 56] Public transport available to access NDI (P) [38] | |
Policies and Laws | Guidelines and legislation STs: 1B and 2E | Attitudes towards, awareness of, and complexity of guidelines (P, HCP) [40, 41, 57] | Guidelines are useful to inform views about NDI (HCP) [40, 44] Legislation against harmful health behaviour (P) [41] | |
Financing | Authority support for NDI programs ST: 1E | NR | Financial assistance and support from authorities for NDI programs (P) [41, 46] | |
External pressure | Sociocultural pressures STs: 2B | aSociocultural pressure related to diet, culture or gender roles (P) [18, 46, 53, 55, 58] Medicolegal concerns (HCP) [43] | ||
Societal pressure | Information in media ST: 1E | NR | ||
Inner setting STs: 20B and 21E | Structural characteristics | see below subconstructs | see below subconstructs | see below subconstructs |
Physical infrastructure | Physical accessibility of facilities ST: 1B | Accessibility of facilities, including parking [NDI facility] (P) [37,38,39] | ||
IT infrastructure | Availability of software to adequately support NDI delivery ST: 2B and 1E | Lack of IT support or suitable software [health service] (HCP) [41] Issues when things go wrong with technology [health service] (P) [42] | Availability and integration of software, including software support, patient records, appointments [health service] (HCP) [41] | |
Work infrastructure | Availability of staff to provide NDI support STs: 2B and 2E | Lack of clarity around staffing levels and qualifications [health service] (HS) [18, 41] Poor leadership (HCP) [41] | Role of nurses to support NDI activities [health service] (HCP) [18, 40, 41, 52, 58] Availability of female GPs [health service] (HCP) [41] | |
Relational connections | Personal relationships STs: 2B and 2E Therapeutic relationships STs: 1B and 2E Professional relationships STs: 1B and 1E | aLack of social support from family or friends [home environment] (P) [35,36,37,38,39,40,41, 49, 51, 54, 55, 57] aLack of connection to others with the same health condition [community] (P) [38, 50] aPoor relationship between patient and HCP due to care provision, disagreement or lack of trust [health service] (P, HCP) [18, 37, 40,41,42,43, 51, 55,56,57,58] Poor or fragmented connections between different healthcare providers, including referral pathways [health service] (HCP, HS) [18, 41, 51] | aSupport and encouragement from family and friends [home environment] (P) [37,38,39,40, 42, 46,47,48,49, 54,55,56,57,58] aEngagement with and support from others with the same condition [community] (P) [37,38,39,40, 43, 45,46,47, 49,50,51, 56,57,58] aHigh quality relationship between patient and clinician [health service] (P, HCP) [18, 37,38,39,40,41,42,43, 45, 47, 54, 55] External support from advocacy groups or support worker [community] (P) [40] Good relationships between healthcare providers [health service] (HCP, HS) [41] | |
Communication | Communication between HCP and patient STs: 2B and 4E | Poor or ineffective communication between patient and HCP [health service] (P, HCP) [39,40,41, 51, 58] Difficulty accessing information on patients [health service] (HCP) [41] | Ongoing communication between patient and HCP [health service[(P, HCP) [37, 38, 42] Respectful, empowering communication from HCP to patients [health service] (P) [40, 46, 50, 52] Opportunity to talk about experience in consultation [health service] (P) [50] Timely, clear and simple communication about NDI [health service] (P, HCP) [18, 38, 46, 48] | |
Culture | Primary care as a key setting for NDIs STs: 1B and 1E | Primary care seen as not responsible to for providing NDI [health service] (HS) [41, 52] | Primary care is a key appropriate setting for prevention activities [health service] (HS) [41, 43, 52] | |
Recipient-Centredness | HCPs attitudes towards patient STs: 1B and 1E | Poor or discriminatory HCP attitude of towards patient [health service] (P) [18, 43, 44, 48, 52, 55] | Non-judgemental HCP attitude towards patient [health service] (P) [18] | |
Compatibility | Opportunity to conduct NDI activity in consultation STs: 1B and 1E | NDI not acceptable to clinicians due to impracticality/time [health service] (HCP) [40, 41] | Option to do NDI in context of health checks and prevention activities [health service] (HS) [41] | |
Incentive systems | Incentivisation ST: 1E | NR | Provide incentives to motivate participation [health service] (P) [56] | |
Available resources | Access to NDI prescription STs: 2B | aInsufficient time or staff to adequately provide NDI intervention prescription [health service] (HCP) [18, 37, 38, 40, 41, 43, 44, 48, 51, 52, 54, 56, 58] aDifficulty accessing NDI prescription service due to availability or appointment times [health service] (P) [38, 40, 41, 44, 45, 52, 55] | ||
Space | Space available STs: 1B and 1E | Lack of space to complete NDI [NDI facility] (HS) [41] | Availability of space to complete NDI [NDI facility] (P) [37, 38] | |
Materials and equipment | Education material available STs: 1B and 1E Facilities available STs: 1B and 1E | aLack of patient education materials [health service] (P) [18, 39, 41] Facilities in NDI environment do not accommodate for needs associated with health condition (e.g., wait times, lack of resting places or hand holds) [NDI facility] [37,38,39] | aRelevant patient education materials [health service] (P) [40, 45, 47, 51, 57] Safe equipment and environment to complete NDI [NDI facility] (P) [37,38,39] | |
Access to knowledge and information | Training opportunities for staff STs: 1B and 1E Access to education material STs: 1E | Lack of time for or availability of training opportunities for staff about NDI [health service] (HCP) [18, 40] | Sufficient clinician training in NDI [health service] (HCP) [18, 43, 52, 56] aPatients have access to reliable education regarding health condition and NDI [health service] (P) [40, 46, 47, 50, 52, 54, 55] |