Table 10 Interview topic guide

How familiar are you with these recommendations?

Can you tell me what your general views are on these recommendations?

Do you agree with them?

We would like to find out more about what you think makes it easy or difficult to follow these recommendations. What factors do you think exist that might make them easy or difficult to follow?

Anything else?

We have some questions about more specific factors that we think might play a role in the extent to which recommendations are followed.

Nature of the behaviour

 - What do you normally do in relation to this?

 - To achieve these recommendations, what needs to be done differently? (e.g. others need to do something? Something new is needed?)

Knowledge

 - Can you tell me about this recommendation?

 - How familiar are you with this?/What do you know about this already?

 - Are there any gaps in what you know about it?

Social/professional role and identity

 - What is your role in following this? And the role of others?

 - To what extent is following this recommendation part of your professional role?

 - Is it your job to do this?

Skills

 - How easy or difficult would you find acting on these recommendations?

 - Do you think there are any particular skills required / involved in achieving this?

 - Do you have the skills to follow these recommendations?

Beliefs about capabilities

 - How confident are you that you can follow these recommendations?

  - (if confidence low: what would make you feel more confident? Is there anything that would increase your confidence?)

  - (if not doing it: how confident are you that you could change to doing this more routinely?)

  - (if already doing it: how confident are you in maintaining or enhancing your existing practice?)

  - How well equipped are you to do it?

Beliefs about consequences

 - What do you think will happen if you do this?

 - What do you think are the benefits of doing this, for A. You? B. Patients? C. Your practice?

 - What do you think are the costs of doing this, for A. You? B. Patients? C. Your practice?

 - In your opinion, do the benefits of following these recommendations outweigh the costs?

Motivation and goals (customise items based on individual responses)

 - How much do you want to act on the recommendations?

 - What are the incentives for following them?

 - Tailored questions could be:

 - What would need to happen for you to follow these recommendations?

 - What would need to happen for you to increase the extent to which you follow them?

 - This is something you are doing already. Is it something that you would be willing to adhere to more highly, if possible?

 - You’ve indicated that this is something you do occasionally, would you be willing to increase how often you follow this?

Memory, attention and decision processes

 - Is following these recommendations something you usually do?

 - Will you remember to do this in future?

Environmental context and resources

 - What environmental factors or resources help or hinder following these recommendations?

 - Do the systems in place support you to do it?

Social influences

 - Do people you work with do this (e.g. other GPs/nurses)?

 - Do others you work with support you to do this?

 - Do you feel under pressure from anyone to do this? Or not to do it?

 - How about staff at other practices outside of this one—do they do this?

Emotion (begin with open question and give examples if required. Try to use both positive and negative examples where possible)

 - We know that clinicians’ emotions can affect their practice. For example, you might feel uncomfortable about prescribing further medication for an elderly person who is already prescribed a number of drugs. Or, you might get some job satisfaction from knowing that you’ve taken action to reduce the risk of harm to a patient.

When you are with a patient and covering this topic, what feelings arise for you? (could prompt with examples from other interviews)

 - How do you feel about following these recommendations?

 - How do your feelings at the time (mood, feelings towards the patient, fatigue) affect whether or not you do it?

Behavioural regulation

 - Are there things you need to do before you can do this?

 - Are there things that help to prompt you to do it?

 - Are there particular types of patients for whom acting on these recommendations is more difficult?

 - Is there anything else that you would like to add?

 - Any other factors that you think might be important that we haven’t covered?