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Table 5 Factors related to “Capability” and representative quotations

From: Investigation of factors influencing the implementation of two shared decision-making interventions in contraceptive care: a qualitative interview study among clinical and administrative staff

ConstructRight For Me implementation factorQuotations
KnowledgeBeing aware of the interventions“I think that the videos were about different birth control options. But I am not entirely sure.” (026, Clinic 8, Clinical + administrative roles, Video + Prompt Card)
Procedural knowledgeKnowing how to use the interventions correctly“Patients did not take the learning tools [decision aids] and write notes on them like it was suggested in the [training] video. I do not think I had but maybe one or two people do that. I do not know if people just did not want to. I do not know if people were not asking in a way that they felt comfortable … It makes me think that perhaps the staff stopped even utilizing that aspect of that suggestion over time because people were not taking them up on it.” (015, Clinic 2, Clinical, Decision aids + Training)
CompetenceHaving the proficiency to use the interventions, acquired through training or practice“So if someone comes in and says, ‘I know I want birth control. I’ve never tried anything before. Where do we start?’ I’d say like, ‘Okay.’ We would grab the all methods tool … Because some of our patients have never used a birth control method before. They say ‘birth control’ and they think of the pill. And I go, ‘Well there are many more options out there. There’s not just the pill.’ We get that sheet out and sort of do a general overview. If a patient then identifies what they are looking for in a method, whether it’s something that’s long-term or something that has a really high effective rate. Or maybe they do not want any hormones. Or maybe they think they might want to be pregnant within the next year and they want something that’s going to be shorter acting because they know it’s not right now. Based on wherever that conversation goes … I would then grab the next tool [method-specific decision aid].” (013, Clinic 11, Clinical role, Both interventions)
MemoryRemembering to use the interventions“Oh and there were some other cards actually now that I remember that had the questions. There were like the five questions or the three questions—this was a long time ago, I’m really sorry if my brain is kind of fuzzy—that I probably could have utilized those more. But patients aren’t really psyched about taking anything material to be totally honest. I mean you hand them something and you see it in the trash in the hallway.” (019, Clinic 5, Clinical role, Video + Prompt card)
Action planningThe action or process of forming a plan regarding implementing the interventions“The biggest thing was I think creating the space for the tool, so like physically and mentally. So rearranging the rooms in a way so that we have those sort of stackable file holders, and putting all of the tear-off sheets in those in an order and in a way that made sense. Physically creating the space for cards, and where we were going to set up the iPads and the chargers. And then also just mentally sort of—we have a workflow, and just reviewing that and going over, okay, so where are you going to ask this? When a patient is checking in, at what point are you going to say we are participating in this study? Are you interested in watching a short video? How do we build that into the vocab? Because a lot of what we say is somewhat scripted, obviously in the room depending on the patient need, it’s not. But the initial introductions are, and that’s often times where the information needed to come in, so is just working with the staff to figure out what feels the most natural, how do we implement this into our everyday language routine.” (016, Clinic 9, Administrative role, Both interventions)
Behavioral regulationChanging one’s behaviour to engage in the new practice of using the interventions“I mean I think the biggest challenge is just changing the behavior of the people who are interacting with [patients] to incorporate one more thing. There’s a lot of things that we are always asked to remember—to screen for depression and screen for this and look for that and do all these things—and so to have one more thing to sort of hand them. Everybody out there sort of wants you to hand [patients] one more thing, and that’s the most challenging part—is sort of triaging those and changing. Like I said, we all sort of get into our routines, and so to try to remember a new thing.” (Participant 19, Clinic 5, Clinical role, Video + prompt card)