Table 4 Summary of findings regarding physician-reported barriers to providing activity advice
TDF domain | TDF sub-domain | Specific theme from the study | Studies (participants) | Confidence in the evidence | Explanation |
|---|---|---|---|---|---|
Knowledge | Knowledge (scientific rationale) | Unsure about how, why and when exercise might be helpful “Views about activity were informed by guideline recommendations, but there was uncertainty as to how or why exercise might be helpful” | 4 (114) | Moderate3 | No or very minor concerns regarding methodology, coherence, and relevance. Moderate or serious concerns regarding adequacy. |
Procedural | Knowledge of what activity to advise on based on patient factors/circumstances “Much of the advice which participants reported conveying to patients contained mixed messages and reinforced the need to be active and protective at the same time.” | 2 (21) | Moderate3 | No or very minor concerns regarding methodology, coherence, and relevance. Moderate or serious concerns regarding adequacy. | |
Social influence | Intergroup conflict | Conflict between patient and physician wishes in which the physician felt the patient perceived physical activity to be counter intuitive and considered rest to be the best option or perception that patients did not want activity advice. “Changing the belief of patients who considered rest to be the best treatment could be challenging” | 5 (131) | Moderate3 | No or very minor concerns regarding methodology, coherence, and relevance. Moderate or serious concerns regarding adequacy. |
Skills | Skills | Lack of skills to negotiate why activity is ok when the patient considered rest to be the best treatment “GPs reported that they felt patients perceived physical activity as counter-intuitive to the ‘warning sign’ that pain signified stress to the body, and therefore, one needed to rest.” | 2 (21) | Moderate3 | No or very minor concerns regarding methodology, coherence, and relevance. Moderate or serious concerns regarding adequacy. |
Environment context and resources | Resources | Lack of time to give advice “Limited time to explain why patient does not need an x-ray and explain advice to stay active” | 1 (42) | Low 2,3 | No or very minor concerns regarding methodology and relevance. Moderate or serious concerns regarding coherence and adequacy. |
Memory | Memory | Forget to give advice “GPs forget to give advice to stay active in standard consultation” | 1 (42) | Low 2,3 | No or very minor concerns regarding methodology and relevance. Moderate or serious concerns regarding coherence and adequacy. |