Identifying factors likely to influence compliance with diagnostic imaging guideline recommendations for spine disorders among chiropractors in North America: a focus group study using the Theoretical Domains Framework

Table 1 Thematic content analysis based on the Theoretical Domains Framework (TDF)

TDF domains^a	Number of questions	Utterances	Reduce^b(%)	Increase^c(%)	No influence (%)	Specific beliefs	Themes
Nature of the behaviors	2	88	45 (51.1)	35 (39.8)	8 (9.1)	7	Lumbar x-ray utilization
Skills	3	1	0 (0)	0 (0)	1 (100)	1	None identified
Beliefs about capabilities	3	106	70 (66)	31 (29.2)	5 (4.7)	5	Capabilities; ease of ordering test
Motivation & goals	5	50	28 (56)	17 (34)	5 (10)	4	Intrinsic motivations
Beliefs about consequences	4	334	93 (27.8)	211 (63.2)	30 (18.9)	15	Consequence of ordering lumbar x-rays; attitudes
Environmental context and resources	2	41	16 (39)	25 (61)	0	3	Environmental resource; Signs within the clinic
Social influences	2	128	37 (29)	62 (48)	19 (13.3)	6	Influence of others’ opinions (colleagues, patients); influence of organization and new literature
Emotion	2	4	1 (25)	1 (25)	2 (50)	2	Own emotions
Knowledge	7	86	39 (45.3)	33 (38.4)	14 (16.3)	6	Awareness of the guidelines; knowledge of evidence
Memory, attention, and decision process	4	77	67 (87)	10 (13)	0 (0)	8	Factors that influence decision; ease of decision
Social/professional role &identity	4	133	39 (29)	67 (50.4)	27 (20.3)	12	Professional role; professional norms; professional agreement
Behavioral regulation	5	91	91 (100)	0 (0)	0 (0)	12	Ways to reduce testing; barriers; organizational changes; post intentional behavior
Total	43	1,139	526 (46.2)	492 (43.2)	109 (9.6)	88	23

^aTDF domains are presented in the order in which questions were asked in the focus groups. ^bUtterances perceived to reduce x-ray utilization (facilitators). ^cUtterances perceived to increase x-ray utilization (barriers).