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Table 1 Summary table of relevant domains

From: Barriers and facilitators of evidence-based management of patients with bacterial infections among general dental practitioners: a theory-informed interview study

Domain (descriptions) of the TDF [25] Sub-themes Frequency (utterances/participants) Sample quote (with participant number)
Behavioural regulation CPD programmes are required. 56/29 I think perhaps it might be good to have a course whereby we can probably get a better understanding of the actual, the guidelines (SDCEP), I think that would useful in the first place. (11360)
I suppose a course on time management I might consider. I would heartily endorse TRiaDS setting up an online course for it, on both antibiotic prescribing and an online course on time management, especially as it relates to that, and having it that you get an education allowance for doing it, and that you sit and do it yourself at home. (10841)
Updated SDCEP or other guidelines are required. 35/23 I tend to follow the SDCEP books to be honest when it comes to prescribing. I tend to find it’s the easiest thing to hand, it’s short, it’s succinct, it’s clear so I always go with that one. (10469)
If they (SDCEP) publish a guideline, like a flowchart, this is what walks in the door; this is what the gold standard would be. That would be quite useful actually. (10968)
Audit can reduce antibiotics prescribing practice. 8/7 I use prescriptions when I think they’re necessary. I’m not likely to change that drastically. (11355)
Yes, I think it (audit and feedback) probably can change prescribing practice, yes. I have participated in one before, I think that certainly helps. (10545)
Arranging appropriate emergency slots would be difficult. 11/9 I mean, you could put time aside each day to see emergency patients, but sometimes it’s difficult to fill in and it’s empty. Yes, we should have a time during the day, and say, “Right, that’s where emergency goes, that’s when we do these sorts of things”, but in practice, you know, what you set out to do in, doesn’t always happen. It’s always changing. (11006)
I suppose if you … we’ve tried it, with a lack of success, is where you actually create some times of a day for emergencies and so that you’ve got that time available to do it, but we found it quite unsuccessful. (10841)
Social influence Patient behaviour or demands influence my prescribing behaviour. 81/25 While on paper it sounds like a very good thing to refuse giving them an antibiotic if the patient actually is absolutely adamant they are not having actually any active treatment carried out it’s very difficult not to give them an antibiotic. (10968)
I tend to find where I get frustrated with the prescribing when you feel that you can’t do the treatment that is best for the patient but, again, if you’ve not got consent then what can you do? (10469)
Reinforcement There are no incentives to conducting local measures. 39/24 I would say minimal, but the time taken to do it will probably outweigh the actual fee that we get. (13602)
In fact it’s (financial factors) one of the few times you don’t ever have to really think about it. If somebody’s got a really nasty infection I think it’s one of the few times you don’t think about it because if you can get it right it’s the one time people go out and say, “Thanks very much”. (10390)
Environmental context and resources Lack of time plays a big part in managing bacterial infections. 58/20 It can depend with being in a busy general dental practice I think you are sometimes under time pressure and I’m going to be honest there have been times where you’ve been totally backed up and I think to be able to give the patients the best treatment instead of diving in and doing what could be deemed a difficult surgical extraction; I have prescribed so that I can rebook the patient for a time that I would manage the situation to the best of my abilities. (10469)
Well, I would attempt to persuade them to have the treatment carried out, but some of these patients will not respond to that, and given the time constraints that we have treating patients, I often resort, I have myself resorted to just giving them the antibiotics that they’re looking for. (10545)
Beliefs about consequences Local measures involve a lot of time to conduct it successfully. 24/16 … the fact that you’re going to run late and make other people wait so people get angry. (106000)
Well, the downside is obviously the time factor. It takes a lot more time to carry out a local measure in comparison to writing a prescription for antibiotics. (11095)
  Local measures occasionally make things worse. 36/16 Occasionally local measures makes situation worse. I’ve certainly seen that. If you’re doing root canal work and you open it up and if it’s been dead for a long time and you open it all up the infection actually can get much more painful over the next few days. And, of course, then they (patients) blame it on us for doing the root canal work. (10968)
I mean you are actually dealing with the infection which is there with local measures, as opposed to just prescribing antibiotics. I don’t think antibiotics ever work particularly well. (10935)
Beliefs about capabilities It is difficult to apply local measures in phobic patients. 13/10 I tend to find that difficulties comes part and parcel with the anxiety as well. Patients who are more anxious I think dentists struggle to get those numbed up more regularly than others so I would say that sometimes is an issue. (10469)
The non-attenders or infrequent attenders hate coming to the dentist and they tend to be more frightened, they tend to be more nervous. They’re the ones that are going to be resistant, they won’t allow you or they don’t want you to do local measures. So, you know, they tend to be a more difficult group to manage. (13474)
It is sometimes difficult to numb the patient and conduct local measures successfully. 16/10 It’s difficult when there is, you know, inflammation, if the gums are swollen and when there is a pulpitis it is difficult to numb the patient. (10320)
The lower jaw you can freeze up with a single injection; it’s called an alveolar block. It freezes it right at the very back so there doesn’t tend to be the same issues, so there’s no transmissions from the teeth, whereas with the upper teeth it is very much a localised injection round an infected area, which sometimes just doesn’t work. (11360)
Time allocated per patient is not long enough for conducting local measures. 6/5 Time management is much more of a problem, yes. Because most of the time when we get people with infection problems, they really don’t have any time allocated to treat them. It’s not always possible to allocate the time required to treat them when, at the correct time. (11355)
I see people sometimes, every five minutes, every ten minutes, you get less time than a GP does, to see somebody, to see what their problems is, to diagnose their problem and to try and treat them, you know? (13474)
Memory attention and decision process Patients co-operation, consent influence my decision. 25/14 It’s kind of assessing the patient, how much they’re going to put up with. It’s alright saying okay, well we’ll drain this abscess but if you’ve got a very, if you’ve got a very anxious patient then sometimes, I, you know, I might try antibiotics just to calm the area down first. (10560)
Just on the individual. If they can sit for the procedure and they’re happy to have something done that day then that’s absolutely fine. If I’ve got time then I’ll definitely do it and if they don’t want it then I’ll still try and persuade them that they should get this done. If they won’t sit, as in they can’t co-operate or they won’t co-operate, then it might be that I have to give them a prescription and get them back in when it’s all sorted out. (106000)
Types of patient influence my decision. 11/9 I have to say, quite often I will prescribe an antibiotic as a fallback, we’re quite a rural area and quite a lot of patients come quite a long distance, so I’m not averse to handing out a prescription and telling them to get it filled and to have it in reserve, and if, I don’t know, about a day or two, they either phone up to get advice or just start taking the antibiotic. I know that’s probably not the guidelines, but in a more remote area, I think it saves people possibly a round trip of 100 miles to come and see us, when they’re already systemically unwell, is probably a good idea. (13308)
Well one thing would be if it’s not my patient, if it’s somebody that I don’t know well, but my colleague does, who normally treats them. And this works both ways, and I’m sure that they’re more likely to prescribe an antibiotic in that case, when it’s somebody who usually sees one of our colleagues. (11156)
Optimism Not sure if local measures will solve the issues successfully on their own. 5/5 I think I get worried that the patient won’t respond as I would like to after doing local measures. I’m not worried that I’m not doing the right thing, I’m just worried that the patient won’t answer to the things that I’ve done …(13388)
I suppose that an antibiotic, you could argue, is like belt and braces, you know if it’s like a Friday or something then perhaps it’s not so good because, you know, if local measures don’t work over the weekend. (10868)
Emotion I feel anxious about letting somebody go without antibiotics. 8/5 Yes, the anxieties about letting somebody with a facial swelling go out without antibiotics… I felt that holistically it was better to make sure that he was okay for going to Dubai. (10841)
I don’t know but just around holiday times and that’ll be all the people that I get a bit worried about, they are heading off on their June holiday and I don’t want them to suffer, I want them to have something (antibiotics) in reserve, so I know, probably you’re not supposed to do that. (13308)
  1. Note: domains/sub-themes in italics are categorised as priority (high frequency or ≥50 % interviewees discussed) for future intervention efforts