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Table 3 Final intervention components mapped to the barrier or enabler to be targeted, TDF or CFIR domain in which the barrier or enabler operates, BCT (s)

From: Development of an intervention to facilitate implementation and uptake of diabetic retinopathy screening

Barrier (–) or enabler (+) TDF/CFIR BCT Operationalised components mapped to implementation strategies [76]
(–) HCP lack knowledge on service uptake in their practice Knowledge
Access to information and knowledge
Feedback on behaviour Audit and provide feedback
Practice audit of patients with diabetes
  Conduct educational meeting (briefing)
Added as a delivery mode for HCP messages*
(+) HCP feel that patient attendance at the screening programme facilitates follow-up care with patients and means patients can access screening closer to home Beliefs about consequences
Relative advantage
Info. about social and environmental consequences Explain registering and ensuring patient attends the programme will mean they know their patients’ status and patients will be able to get routine care closer to home
(+) HCP register patients and encourage attendance because they believe in quality diabetes care Social prof. role/identity Compatibility Framing/reframing Encourage HCPs to see influencing patients to attend as part of their role in delivering good diabetes care
(–) The process of checking the register/registering patients (online or via phone) is lengthy and too resource intensive Environ. context
- Provide technical support
Added to accommodate the fact a new staff resource could not be introduced to conduct the audit
1. Audit and intervention manual and laminated reminder script for face-to-face or phone encounters
2. Researcher-led training for the staff member conducting audit
(+) HCP who attended diabetes courses know that registering patients to attend screening is part of their role Knowledge
Memory, attention, decision processes (MADP)
Access to information and knowledge
Restructuring physical environment
Remind clinicians
Electronic prompts
(+–) Length of time taken to register patients or to check the register; patient registration depends on practice resources
(–) HCPs felt there was ‘no money’ in tracking/encouraging patient attendance
Environ. context
External policies and incentives
- Use other payment schemes
    Intervene with patients
(–) Patients forget to respond to the consent letter and/or forget appointment MADP Prompts/cues Reminder messages (face-to-face, phone or letter) in which GP/nurse…
(+) HCP recommendation Social influences Social support (unspecified)
Providing info. about others’ approval
Credible source
…provides general encouragement to attend appointment
(–) Patients find it difficult to consent via phone process
(+) HCPs support patient attendance: they register patients, check registration, facilitate consent
Environ. context
Social support (practical)
Restructuring the social environ.
…advises people how they can arrange appointment and specify they should ask GP/nurse for help if needed
    Information leaflet which…
(–) Patients find it difficult to consent via phone Skills Instruction how to perform the behaviour …explains how they can arrange an appointment
(–) Patients confused between screening and routine eye tests; think they do not need to attend the new screening programme MADP
Info. on health consequences …clarifies difference between screening and routine checks, that screening is part of their care, and routine checks are not a substitute
(+) Some patients recognised screening as a routine part of their diabetes care MADP
Framing/reframing …encourages patients to adopt a different perspective on retinal screening; not extra but part of routine/optimal self-management
(–) Patients do not have symptoms
(–) Patients do not link symptoms to diabetes
(–) Patients unaware of the link between diabetes and eye damage
(–) Patients confident they are not at risk
Salience of consequences
Info. about health consequences
…communicates information about risk; (1) that everyone with diabetes is at risk, (2) there may be no symptoms, and (3) screening applies to them too
(–+) Some patients are disengaged with diabetes care while others are in a routine of going for tests and feel ownership or responsibility over their diabetes Beliefs about capabilities
Social prof. role/identity
Verbal persuasion to boost self-efficacy …encourages them to charge of their health
(–+) Some patients believe screening service is ‘looking for money’ while others know the service is free Beliefs about consequences
Environ. context
External policies and incentives
Info. on social and environmental consequences …emphasises the programme is free
(–) Some patients lack awareness of the importance of screening or generally do not perceive the necessity of screening
(+) Others believe screening provides valuable information on their eye health status, facilitates early detection of problems and provides reassurance or consequences are salient; patients have experienced complications or know others who have
(–) Patients anticipate negative outcome of screening and fear a bad result
(–) Patients are afraid of the harmful effect of screening procedure
(+) Fear or anxiety about vision loss
Beliefs about consequences
Beliefs about consequences
Info. about health consequences
Info. about emotional consequences
…reassures patients that after their appointment they will be fine or can be treated early to stop things getting worse
(–) Patients dislike the drops administered during appointments Environ. context
Non-modifiable …emphasises the effects of the drops are short term vs. the benefits of screening
(+) Service flexibility, the ability to ring the programme and reschedule appointment helped people to attend
(–) Competing demands (e.g. unable to take time off work or have family dependents)
Environ. context
External policies and incentives
Non-modifiable …highlights it is possible to reschedule their appointment to a time which suits them best.
  1. Environ. context environmental context, Social prof. role/identity, social professional role and identity, MADP Memory, attention and decision processes
  2. *Some components were added to accommodate the additional organisational challenges, to encourage participation, aid the roll out of the intervention, and enhance some enablers but are not necessary or core for the intervention to work
  3. Also included as part of face-to-face reminder message