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

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