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Table 7 Factors related to “Opportunity” 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
Social influencesFeeling influenced by interpersonal processes with patients“I would say that the majority of [patients] that come into the waiting room are on their own phones and computers and are not really looking around. We have a TV. We have a lot of educational things about just general health and I feel like the [patients] are not tuned into that because they are just on their phone or on their computer or reading their books.” (Participant 27, Clinic 5, Clinical role, All interventions)
“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. I do not know. We’re pretty open and a safe space for people to do whatever the heck, say whatever the heck they want. But nobody was writing anything.” (Participant 15, Clinic 2, Clinical role, Decision aids + training)
Environmental stressorsFeeling influenced by clinic workflow, time, or physical space“Sometimes the patient would take the iPad back, like, into one of the back rooms, and they would finish watching it, while the back HCA [Health Care Associate] was getting their information into the computer. And then I had to be, like, ‘Okay, so where’s the iPad?’ It just kind of added another thing to our plate that, we already do not have a lot of time … We’ve got a lot going on … so I would say that’s mostly it. It just kind of made things a little bit clunkier.” (Participant 5, Clinic 6, Administrative role, Video + Prompt card)
“I think it changed our workflow for our administrative staff the most. It really did not change my workflow at all because there was going to be counseling anyway for birth control. I mean it made it a little bit quicker in terms of people already having those sheets and being able to look them over and things like that, but I think the front staff had more of the workflow changes because they had to implement the video and then the survey at the end, and getting that into patient’s hands was a little bit trickier than our portion.” (Participant 20, Clinic 9, Clinical role, All interventions)
Resources/material resourcesSupplementing the interventions with other resources“I think the study materials are beautiful. Like they were easy to read. They were, you know, they were bright and I think very attractive … and I think that with our goals around patient access and our goals around efficiency, you know, the added layer of an additional paper form I think was cumbersome. And so the ones we did put out on the desk were the study forms. So it was, you know, when someone came in and they were looking at whether they wanted to go on pills or a Nuva or something like that, they would pull out the appropriate forms and they’d leave those out on the desk for the patient, review the pertinent information of each and leave those on the desk. But when they would go through like the contraceptive counseling, you know, reviewing the benefits, the risks, the alternatives, the warning signs, they would use our materials because they were in line with our talking points.” (Participant 28, Clinic 12, Both clinical and administrative roles, All interventions)
Organizational culture/climateFeeling influenced by the clinic’s organizational cultureStaff person: We did not really have any conversations after [implementation]. There was, “This what we are using,” and just we went for it and used them.
Interviewer: Why do you think it was so easy?
Staff person: I think because [reproductive health organization], like I said, really follows the same guidelines and expectations, that it was just easy and natural. It flows very naturally for us.”
(011, Clinic 3, Clinical role, Decision aids + Training)