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Table 6 Summary of the evidence, application of TDF and COM-B and proposed interventions

From: Barriers and enablers to delivery of the Healthy Kids Check: an analysis informed by the Theoretical Domains Framework and COM-B model

Evidence TDF COM-B Proposed intervention
Capability
GPs did not always know how to assess aspects of development Knowledge Capability-Psychological Education and training which incorporates:
PNs did not know how to do HKCs (until they had received training) Knowledge about “Early Intervention”
GPs did not always remember how to assess overall development Memory Physical examination techniques
GPs conducting HKCs were uncertain about which tests to use and how to do them Physical skills Capability-Physical Structured developmental assessment and evidence behind this
Interpersonal skills training
PNs wanted training on skills required for HKCs Tools appropriate to primary care
PNs did not know how to manage parent reactions to possibility of abnormality in child’s development. Interpersonal skills Capability-Psychological
Variable quality of HKCs Behavioural regulation
  Opportunity
Equipment barriers Environmental context and resources Physical opportunity Funding for equipment and tools, including information technology
Supportive health promotion brochures
Space in clinic to accommodate the HKC examinations Provision of health promotion literature
Medical contact with children especially vaccinations Social influences Social opportunity Education and training which incorporates:
Practice structure
Employing a PN Office systems including recall and reminder
Having staff responsible for managing a recall system Tools appropriate for use in general practice (time saving)
Having a “HKC Champion”
The professional mix in the practice
Competing interests of practice population healthcare needs
Practitioners had insufficient time
“Healthy Start for School”-Tax incentive to complete HKC Strengthen government support for delivery of early childhood intervention across services
Increase in Medicare rebate
Belief that general practice competes with other service providers to provide HKCs
  Motivation
Belief that MCHNs have ownership and expertise in preventive healthcare for young children Professional role and identity Reflective motivation Education and training which address capability and professional roles with task delegation
GPs find process tedious and place HKCs low priority
Alternative model of developmental assessment with early childhood educators playing primary role
Developing the role of the PN in Australian general practice Professional role and identity & Beliefs about capabilities
PNs expressed low levels of self-confidence with some of the components of the HKC
PNs preferred clear boundaries when delivering HKCs
PN personal drive for professional development Goals, intentions and motivation & Positive beliefs about consequences Opportunity to build capacity in early childhood development involving other professionals
HKCs used by some practitioners to develop professional expertise
PNs more confident about their abilities were more satisfied with outcomes Centralisation and dissemination of information about community resources
Outcomes and referral pathways are important to practitioners beliefs
GPs expressed low confidence with evidence behind HKCs Negative beliefs about consequences
Belief that timing of HKC is too late for early intervention