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Table 4 Theoretical domains constructs identified from studies included in analysis

From: A systematic review of electronic audit and feedback: intervention effectiveness and use of behaviour change theory

Study Intervention arm Control arm
Domain Support statement/action Domain Support statement/action
Linder et al. 2010 [38] (1) Knowledge (1) CDCa recommendations (statements having factual or procedural knowledge) Usual care
(4) Nature of the behaviours (4) Targeted behaviour was reduction of inappropriate antibiotic prescribing;
(5) Beliefs about consequences; (5) Included billing data to provide a sense of a financial incentive to clinicians; incorrect beliefs that antibiotics are necessary to treat acute respiratory infections
(6) Motivation and goals;
(9) Social influences;
(6, 9) View displayed a clinician’s performance against his or her clinic peers and against national benchmarks;
Peiris et al. 2015 [41] (1) Knowledge (1) Synthesis of recommendations from several screening and management guidelines for cardiovascular diseases, kidney disease and diabetes mellitus Usual care
(2) Skills
(8) Environmental context and resources;
(2, 8) Practices received an average of 48-min support per month comprising on-site training, remote clinical webinars and helpdesk access;
(6) Motivation and goals
(9) Social influences
(6, 9) Health services could view peer-ranked performance data benchmarked against other participating trial sites;
(7) Memory, attention and decision process;
(11) Behaviour regulation
(7, 11) Tool to allow health services to audit health records, identify performance gaps rapidly and establish recall/reminder prompts rapidly. Provided point of care recommendations based on cardiovascular diseases risk
(11) Identification of screening and management gaps for the whole patient population built into a commonly used audit tool
(12) Nature of behaviours (12) Shifting prescribing behaviours
Thomas et al. 2007 [39] (1) Knowledge
(2) Skills
(1, 2) Dashboard information was organised by evidence-based guidelines, highlighting relevant data; received usual clinic education consisting of faculty review of diabetes care among patients supervised with the resident.
(1, 2) Two 1-h sessions introducing registries, describing their value in practice improvement, and providing instruction on registry use
(1) Knowledge;
(2) Skills
(8) Environmental context and resources
(1, 2, 8) Received usual clinic education consisting of faculty review of diabetes care among patients supervised with the resident and linked to access to the ‘electronic curriculum for diabetes care’;
(6) Motivation and goals;
(9) Social influence;
(6, 9) Feedback comparing their diabetes performance metrics to aggregate resident performance;
(8) Environmental context and resources; (8) Access to the ‘electronic curriculum for diabetes care’ linked to electronic registry feedback;
(11) Behaviour regulation (11) Registry-generated lists identifying patients not in compliance with guideline recommendations
Carney et al. 2011 [33] (1) Knowledge;
(2) Skills;
(8) Environmental context and resources;
(1,2,8) Continuous medical education modules Usual care
(5) Beliefs about consequences (5) Profiled breast cancer risk in each radiologist’s respective patient population; Information on the possible impact of medical malpractice concerns on recall rates
(6) Motivation and goals (6) Awarded 2 h of category I continuous medical education credit;
(7) Memory, attention and decision process (6, 7) Radiologists were able to insert their goals for changes;
(9) Social influences (6, 9) Audit data individualised for each participating radiologist with comparisons to both national benchmarks and to peers for the same measures during the same time period.
(11) Behaviour regulation (11) Illustrating the metrics in clinical performance that could be improved; reinforce change by assisting radiologists to develop goals that would improve their performance;
(12) Nature of behaviours (12) Reduce unnecessary recall from memory practice
Carlhed et al. 2006 [34] (1) Knowledge (1) Educational on the content of National Acute Myocardial Infarction guidelines (1) Knowledge (1) Educational on the content of National Acute Myocardial Infarction guidelines
(4) Belief about capabilities
(6) Motivation and goals
(4, 6, 9) During and between learning sessions, the teams were requested to come up with action plans for appropriate local changes;
(6, 9) Local performance feedback with comparisons to other centres and national average
(4) Belief about capabilities
(6) Motivation and goals
(4, 6, 9) During and between learning sessions, the teams were requested to come up with action plans for appropriate local changes;
(8) Environmental context and resources (8) Education training partly managed at a web-based portal and linked with the registry web tool. (9) Social influences
(11) Behaviour regulation
(9, 11) Frequent collaborative approach meetings to solve common problems between teams and results and lessons learnt were shared with other team members;
(9) Social influences
(11) Behaviour regulation
(9, 11) Frequent collaborative approach meetings to solve common problems between teams and results and lessons learnt were shared with other team members;   
Guldberg et al. 2011 [36] (1) Knowledge (1) Guidelines concerning treatment and control of type 2 diabetes in general practice  
(5) Beliefs about consequences; (5) Graphic treatment history of the individual patients by each variable
(6) Motivation and goals; (6) To provide an overview of the patient population as a basis for planning interventions if needed
(7) Memory, attention and decision process (7) Option to use data in patient consultations
(9) Social influences; (6, 9) Graphic presentations comparing each clinic with the other participating clinics by each variable
Gude et al. 2016 [35] (1) Knowledge (1) Ineffectiveness partly explained by the fact that professionals were not able to translate their intentions into completed actions, i.e. the second step of the mechanism, before the study end. a Exact replica of the intervention arm
(6) Motivation and goals (intention)
(11) Behaviour Regulation
(6) The intervention successfully encouraged teams to define local performance improvement goals
(6, 11) Educational outreach visits were held with the local multidisciplinary team to set goals and plan actions and update existing action plans
(7) Memory attention and decision processes (7) Educational outreach visits were held with the local multidisciplinary team to reflect on the feedback. The team discussed and reflected upon their most recent feedback report and created or updated their QI plan.
(8) Environmental context and resources (8) Some of the persisting organisational barriers were related to lack of resources (e.g. budget ceilings imposed by insurers), competing interests between managers from different clinical disciplines, and poor attendance of clinical leadership (cardiologists and managers) at outreach visits.
(8) Implementation of web tool to be used to develop a quality improvement plan by selecting indicator areas for improvement (related to quality indicators in the feedback report)
(9) Social influences (9, 6) Performance scores based on the centre’s performance score relative to peer performance was implemented using the concept of achievable benchmarks.
(12) Nature of behaviours (12) Update existing action plans following a continuous audit and feedback improvement cycle
  1. Note: In the ‘support statement/action column’, the preceding number(s) in the brackets represent the numbered domain in the ‘domain’ column and reference number for domain explanations found in Additional file 2. a CDC Centre for Disease Control, USA. In Gude et al. [35], both arms received the e-A&F intervention, whilst serving as each other’s control