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Table 4 Mapping of important barriers and enablers (grouped by TDF domains) for prospectively measuring post-traumatic amnesia using the Abbreviated-Westmead tool to behaviour change techniques and intervention components

From: Developing a targeted, theory-informed implementation intervention using two theoretical frameworks to address health professional and organisational factors: a case study to improve the management of mild traumatic brain injury in the emergency department

TDF domains BCTs advocated by Theory-Technique Matrix (including definitions) [2] Additional BCTs (including definitions) suggested in Cane et al. [48] Desirable intervention components Proposed intervention components (including notes to justify omission of intervention components)
Knowledge 1. Information regarding behaviour, outcome 2. Antecedents 1. Information and training/education on what PTA is, the importance of assessing PTA in the ED, i.e. provide information on outcome and how to use the A-WPTAS tool 1,3. Information and training/education on what PTA is and how to use the A-WPTAS tool. Information on the importance and consequences of performing a PTA assessment
3. Health consequences 2. Information on environmental situations, events that predict performance of the behaviour (i.e. when PTA is and is not measured) 2. Information on environmental situations, events that predict performance of the behaviour
4. Feedback on behaviour 3. Include in (1)—consequences of performing behaviour NOTES
  4. Incorporate in education feedback on the EDs performance (how many patients are assessed for PTA—informed by audit 4. Not feasible to undertake audit.
Environmental context and resources 1. Environmental changes (e.g. object to facilitate behaviour) 2. Restructuring the physical environment 1. Make available A-WPTAS tool and clinical pathway to staff—Intranet and hard copy 1. Make available A-WPTAS tool and clinical pathway to staff—Intranet and hard copy. Incorporation of PTA training materials in staff initiation materials, on the Intranet
NOTES
3. Restructuring the social environment 2. Change patient medical records to include amnesia recording 2. Not feasible to change patient medical records to include amnesia assessment (forms committee can take over a year)
4. Prompts/cues 3. Reduce workload by increasing number of ED staff 3. Not feasible to increase staffing to reduce workload
4. Prompts in the system/clinical pathway to undertake PTA assessment on all mTBI patients 4. Not feasible to include prompts in the system/clinical pathway to undertake PTA assessment on all mTBI patients
Skills 1. Goal/target specified: behaviour or outcome None relevant. 1. Set goals to undertake PTA assessments on all mTBI patients 1. Set goals to undertake PTA assessments on all mTBI patients
2. Monitoring 2–4. Monitoring (auditing) of behaviour and feedback to staff, e.g. review of patient records for number who have had an A-WPTAS assessment completed and how many were completed correctly 5–7. Training course including: skill development (how to do an A-WPTAS), modelling/demonstration by nurses, graded tasks (including scenarios ranging from simple to more complex), behavioural rehearsal with participants role playing, problem solving (how this will work in their hospital, how will they deal with pressures from doctors/wards)
3. Self monitoring
4. Rewards; incentives (inc self evaluation)
NOTES
5. Graded task, starting with easy tasks 5–7. Training course including: skill development (how to do an A-WPTAS), modelling/demonstration by nurses, graded tasks (including scenarios ranging from simple to more complex), behavioural rehearsal with participants role playing, problem solving (how this will work in their hospital, how will they deal with pressures from doctors/wards) 2–4. Audit data may be difficult to attain depending on the local patient record system in use. The level of details may be site specific
6. Increasing skills: problem solving, decision making, goal setting
7. Rehearsal of relevant skills
8. Modelling/demonstration of behaviour by others
Beliefs about consequences 1. Self monitoring 5. Emotional consequences 1. Monitoring (auditing) of behaviour and outcomes, e.g. review of patient records for number who have had an A-WPTAS assessment completed and how many were completed correctly 2. Persuasive communication from credible sources/opinion leaders to reinforce the benefits of performing a PTA assessment using the A-WPTAS
2. Persuasive communication 6. Threat 2. Persuasive communication from credible sources/opinion leaders to reinforce the benefits of performing a PTA assessment using the A-WPTAS 3. Information/education on the importance of assessing of PTA in the ED and how to use the A-WPTAS tool
3. Information regarding behaviour, outcome 7. Pros and Cons 3. Information/education on the importance of assessing of PTA in the ED and how to use the A-WPTAS tool 7. Include pros and cons of undertaking PTA assessment in training, persuasive messages
4. Feedback 8. Vicarious reinforcement 4. Feedback to the nurses on performance, e.g. monitoring data and ways to improve 8. Include reinforcement messages from staff who are already using PTA
9. Comparative imagining of future 7. Include pros and cons of undertaking PTA assessment in training, persuasive messages 13. Provide information on the consequences on the ED environment by undertaking PTA assessment—reducing discharge time. Include in education the benefits of undertaking an assessment of PTA using the A-WPTAS to patient flow, appropriateness of discharge and time (realistically) it takes to undertake one
   NOTES
10. Outcomes 8. Include reinforcement messages from staff who are already using PTA 1. Audit data may be difficult to attain depending on the local patient record system in use. The level of details may be site specific
11. Covert sensitisation 13. Provide information on the consequences on the ED environment by undertaking PTA assessment—reducing discharge time. Include in education the benefits of undertaking an assessment of PTA using the A-WPTAS to patient flow, appropriateness of discharge and time (realistically) it takes to undertake one 4. Without audit data it will be difficult to provide staff with feedback
12. Covert conditioning 5, 6, 9, 10, 11, 12, 14—not relevant
13. Social and environmental consequences
14. Anticipated regret
15. Salience of consequences
Social professional role and identity 1. Social processes of encouragement, pressure, support No additional techniques listed in paper 1. Include persuasive messages from senior nurses/ED Director to convince that an A-WPTAS assessment is needed and it is part of their role 1. Include persuasive messages from senior nurses/ED Director to convince that an A-WPTAS assessment is needed and it is part of their role
Beliefs about capabilities 1. Self monitoring 10. Verbal persuasion to boost self efficacy 1. Monitoring (auditing) of behaviour, e.g. review of patient records for number who have had an A-WPTAS assessment completed, how many were completed correctly and number discharged in PTA 2,3,4. Training course including: skill development (what PTA is, how to incorporate A-WPTAS findings in discharge decision making), modelling, demonstration by doctors, graded tasks, rehearsal/role play with actors, problem solving (how this will work in their hospital, how will they deal with pressures from wards). Include difficult situations and ways to cope with these
2. Graded task, starting with easy tasks 11. Focus on past success 2,3,4. Training course including: skill development (what PTA is, how to incorporate A-WPTAS findings in discharge decision making), modelling, demonstration by doctors, graded tasks, rehearsal/role play with actors, problem solving (how this will work in their hospital, how will they deal with pressures from wards) 5. Include persuasive messages from senior doctors/ED Director to convince that an A-WPTAS assessment is needed rather than just using clinical experience
3. Increasing skills: problem solving, decision making, goal setting Include difficult situations and ways to cope with these 11. Include in training the importance of focusing on previous successes
NOTES
4. Rehearsal of relevant skills 5. Include persuasive messages from senior doctors/ED Director to convince that an A-WPTAS assessment is needed rather than just using clinical experience 1. Audit data may be difficult to attain depending on the local patient record system in use. The level of details may be site specific
5. Social processes of encouragement, pressure, support 6. Feedback to the nurses on performance, e.g. monitoring data and ways to improve 6. Without audit data it will be difficult to provide staff with feedback
6. Feedback 11. Include in training the importance of focusing on previous successes
7. Coping skills 7,8,9,10—not relevant
8. Self talk
9. Motivational interviewing
  1. BCTs in italics are those deemed by the research team as particularly relevant for this particular behaviour