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Table 9 Identifying key domains to target in an intervention

From: A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems

Study title
 A cross-country comparison of intensive care physicians’ beliefs about their transfusion behaviour: A qualitative study using the theoretical domains framework.
Rationale for changing behaviour
 Transfusion of blood, a scarce and costly resource, is used for treating a variety of medical conditions. There is a wide variation in blood transfusion behaviour across different medical disciplines including intensive care physicians. A restrictive transfusion is, at least, equivalent and possibly superior to a more liberal transfusion. The aim of the study was to elicit beliefs about specified behaviour within each theoretical domain and role of the domain in influencing the behaviour in intensive care units across Canada.
Study design and materials
 Ten intensive care physicians throughout Canada were interviewed. Physicians’ responses were coded into theoretical domains, and specific beliefs were generated for each response. Theoretical domains relevant to behaviour change were identified if they included belief statements that might be potential barriers for changing transfusion behaviour and fulfilled the following criteria: (1) relatively high frequency of specific beliefs, (2) presence of conflicting beliefs, and (3) evidence of strong beliefs that may impact on the behaviour. All three criteria were considered concurrently to judge relevance of the domains. Beliefs within the domains were analysed for psychological constructs and were subsequently used to select psychological theories using the methodology proposed by Francis et al. [25].
Findings and conclusions
 Seven theoretical domains populated by 31 specific beliefs were identified as relevant to the target behaviour using all criteria. The relevant theoretical domains were Knowledge, Social/professional role and identity, Beliefs about capabilities, Beliefs about consequences, Motivation and goals, Social influences and Behavioural regulation. For example, Knowledge domain was identified as potentially relevant because majority participants reported the belief that there is not enough evidence to support watching and waiting in all patient populations. Motivation and goals was identified as a key domain because conflicting specific beliefs were elicited (e.g. Watching and waiting conflicts with other goals in opposition to Watching and waiting is compatible with other goals). When the belief that ‘emotion does not affect my decision to transfuse’ was consistently reported, it was concluded that the Emotion domain was not relevant to the transfusion behaviour. For greater detail please see the published article.
Study outputs
 Islam et al. [26]