Table 8 Example of behaviour change techniques that could be combined to form a multifaceted intervention to target the 3 identified TDF barriers with a high level of confidence related to imaging

1. Social influence

(Social pressure)

and

The patient asks for an image (in some cases because they want a diagnosis) and the GP feels pressured to request one.

BCT: 6.1 Modelling or demonstrating the behaviour

Example: Provide a video* or similar method that demonstrates their peers (respected members of their peer group) dealing with this situation; i.e. having a conversation with a patient about not ordering the image.

2. Beliefs about consequence

(Outcome expectancy)

and

GPs believe scans will reassure patients that nothing is wrong.

BCT: 5.1 provision of information about health consequences

Example: provide information* about:

• the negative consequences of ordering an image (i.e. delayed recovery, exposure to radiation, incidental findings, additional healthcare tests)

• the comparative effectiveness of imaging on patient reassurance and recovery compared to other strategies

3. Environment context and resources

Resources

GP’s do not have enough time to negotiate or explain the diagnosis so they order an x-ray.

BCT: 12.5 adding objects to the environment

Example: provide an evidence-based leaflet and/or prescription pad* that provides information on back pain, diagnosis, prognosis, need for tests and self-management strategies specific to the patient.