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)
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 |
| Â | 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 Complexity | - | 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 | Prompts/cues 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 Reimbursement |
| Â | Â | Â | 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 | Skills 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 Knowledge | 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 Knowledge | 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 | MADP Knowledge Emotion | 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 Emotion | 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 Compatibility | 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. |