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Table 1 Utilization of the theory of planned behavior (TPB) to understand barriers to having psychiatrists ordering and managing metabolic labs (target behavior)

From: Utilization of the Behavior Change Wheel framework to develop a model to improve cardiometabolic screening for people with severe mental illness

Domains Constructs Barriers to target behavior
 Social/professional role and identity Identity It’s not my role to manage diabetes if I find an abnormality.
 Motivation and goals Goal setting My patients are so sick, diabetes screening is low on the priority list
 Beliefs about capabilities Control of behavior and environment My patients are too cognitively impaired to make it to the lab
Self-confidence I don’t know how to prescribe medications to treat metabolic abnormalities like diabetes
 Beliefs about consequences Outcome expectation What if these medications to treat metabolic abnormalities cause serious adverse side effects?
Subjective norms
 Social influences Social/group norms Nobody else is managing diabetes!
 Environmental context and resources Resources/materials The electronic systems are separate, so why bother?
My medical director won’t want me to do this because we won’t be able to bill for the treatment
Perceived behavioral control
 Knowledge Knowledge I don’t know exactly what the ADA/APA guidelines recommend
 Skills Skills I don’t know how to initiate medications if there are abnormalities
 Environmental context and resources Resources/materials I don’t have reminders to get the HgA1c.
I can’t access primary care, so why bother?