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Table 2 TDF domains

From: Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: a systematic review using the COM-B system and Theoretical Domains Framework

COM-B component—TDF domain Theme name Definition of the theme Study type—no survey/interview/focus group/mixed methods/other No. of data items
Barriers/facilitators
Capability—knowledge Alcohol-related knowledge Doctors’ and nurses’ knowledge about specific concepts related to alcohol screening and brief interventions (e.g. drinking limits, definition of heavy drinking, guidelines, screening questionnaires, content of brief interventions) 26/6/5/2/2 58/19
Disease model training An approach to the patient in that health providers ask about alcohol only when the patient present with specific symptoms and/or signs 2/2/1/0/0 5/0
Patients’ receptiveness to alcohol interventions The extent to which doctors and nurses think patients are open to be asked and advised about their drinking 1/3/1/1/0 3/4
Doctors and nurses own drinking habits The use of doctors and nurses own drinking behaviour as a benchmark to define whether or not a patient drinks excessively 0/2/1/0/0 3/0
Alcohol being perceived as having health benefits The extent to which doctors and nurses believe that drinking moderately improves health in general 2/1/0/0/0 3/0
Knowledge of support services Doctors’ and nurses’ knowledge of alcohol services where they could refer the patient to 2/0/0/0/0 2/0
Capability—skills Training The extent to which doctors and nurses agree they have received/need training in screening and advising at-risk drinkers 28/4/2/3/3 51/25
Role adequacy The extent to which doctors and nurses believe they have sufficient knowledge and skills to manage drinkers 16/4/2/3/4 45/0
Demographical characteristics of the PHC professionals Doctors’ and nurses’ demographical characteristics influencing their screening and advice performance 2/0/0/0/0 3/0
Capability—memory, attention and decision processes Demographical characteristics of the patient Patients’ demographical characteristics influencing doctors’ and nurses’ screening and advice performance 1/3/1/0/0 6/0
Feedback on the results of delivering SBI Information about doctors’ and nurses’ performance concerning screening, advice and/or effectiveness of their actions 0/1/1/0/1 1/2
Remembering Doctors’ and nurses’ perception of how easy/difficult it is to remember to ask about alcohol 0/1/1/0/0 2/0
Capability—behaviour regulation Organization for preventive counselling Doctors’ and nurses’ perception of the presence or absence of organization/systematic strategies to implement alcohol screening and brief advice 5/4/7/0/2 6/19
Motivation—beliefs about capabilities Beliefs about the ability to deliver SBI and in helping patients to cut down Doctors’ and nurses’ beliefs about, and/or confidence in, the effectiveness of their skills to screen and advise patients to reduce their alcohol intake 23/5/4/2/6 60/6
Time Time-related factors doctors and nurses believe to affect their capability to implement alcohol screening and brief interventions 9/7/10/3/3 31/14
Difficult task Difficulties perceived by doctors and nurses when asking and advising patients about alcohol 13/6/6/2/4 30/24
Therapeutic commitment Doctors’ and nurses’ predisposition to working therapeutically with people who have excessive alcohol consumption 3/0/0/0/2 5/0
Self-esteem when working with at-risk drinkers Doctors’ and nurses’ perceived self-worth when working with at-risk drinkers 4/0/1/0/0 4/3
Disease model training An approach to the patient in that health providers ask about alcohol only when the patient present with specific symptoms and/or signs 0/1/0/0/0 1/0
Patients’ beliefs about alcohol Doctors’ and nurses’ perceptions of the conceptions patients have about the effects of alcohol, either beneficial or detrimental 0/1/0/0/0 1/0
Demographical characteristics of the patient Patients’ demographical characteristics influencing doctors’ and nurses’ screening and advice performance 0/1/0/0/0 2/0
Motivation—beliefs about consequences Effectiveness of SBI Doctors’ and nurses’ beliefs about the effectiveness of asking and advising patients about their alcohol consumption 13/3/4/1/4 24/14
Patients’ feelings when asked about their drinking Doctors’ and nurses’ beliefs about how patients would feel if asked and advised about alcohol 5/6/6/1/0 22/3
Therapeutic relation with the patient The therapeutic alliance that is established between a healthcare professional and a patient 1/4/5/1/2 12/4
Reliability of the answers of the patients when asked about alcohol The degree to which doctors and nurses believe in the accuracy of the answers provided by patients concerning their alcohol consumption 1/5/2/0/1 9/0
Patients’ receptiveness to alcohol interventions The extent to which doctors and nurses think patients are open to be asked and advised about their drinking 4/3/2/1/0 7/4
Patients’ reactions when asked about alcohol Doctors’ and nurses’ beliefs about how patients would react if asked and advised about alcohol 3/4/0/2/1 7/3
Frustrating task Doctors’ and nurses’ beliefs about how they would feel if they were to implement alcohol screening and brief interventions 2/2/0/1/1 5/1
Alcohol being perceived as having health benefits The extent to which doctors and nurses believe that drinking moderately improves health in general 2/1/0/0/0 3/0
Incentives Doctors’ and nurses’ beliefs about what they would gain by implementing alcohol screening and brief interventions 4/1/2/1/1 2/22
Time Time-related factors doctors and nurses believe to affect their capability to implement alcohol screening and brief interventions 1/4/4/0/1 2/14
Delivering SBI can make other patients suffer Doctors’ and nurses’ belief that implementing alcohol screening and brief interventions could harm other patients 1/0/0/1/0 2/0
Bad publicity Doctors’ and nurses’ belief that dealing with at-risk drinkers could give the practice a bad name 0/0/0/1/0 1/0
Demographical characteristics of the patient Patients’ demographical characteristics influencing doctors’ and nurses’ screening and advice performance 0/1/0/0/0 1/0
SBI delivery impedes caring for the patient Doctors’ and nurses’belief that bringing alcohol into the discussion impedes the comprehensive care of the patient 1/0/0/0/0 1/0
Uncomfortable task Doctors’ and nurses’ expectation of feeling unease or awkward when conducting alcohol screening and brief interventions 0/0/1/0/1 1/1
Patients with alcohol problems do not attend their appointments Doctors’ and nurses’expectation that patients with alcohol problems would not attend appointments to address their drinking 0/1/0/0/0 1/0
Motivation—social/professional role and identity Role legitimacy The extent to which doctors and nursesbelieve they have a legitimate role in addressing alcohol issues in their patients 15/4/4/1/2 41/0
Professional responsibility The extent to which doctors and nurses find addressing alcohol in their patients to be their responsibility 12/2/4/1/0 24/0
Disease model training An approach to the patient in that health providers ask about alcohol only when the patient present with specific symptoms and/or signs 7/2/4/1/0 14/0
Doctors and nurses own drinking habits The use of doctors and nurses own drinking behaviour as a benchmark to define whether or not a patient drinks excessively 4/2/3/0/0 9/0
Doctors’ and nurses’ permissiveness towards alcohol Doctors’ and nurses’ tolerance or acceptability towards their patients’ alcohol consumption 3/3/0/0/0 7/0
Role security The extent to which doctors and nurses feel secure in their role when addressing alcohol issues in their patients 3/0/0/0/2 5/0
Doctors’ and nurses’ attitudes towards discussing alcohol with patients The way doctors and nurses feel or think about asking and advising their patients about their drinking 1/0/1/0/1 3/0
Patients’ feelings when asked about their drinking Doctors’ and nurses’ beliefs about how patients would feel if asked and advised about alcohol 0/2/1/1/0 3/3
Demographical characteristics of the PHC professionals Doctors’ and nurses’ demographical characteristics influencing thier screening and advice performance 0/0/1/0/0 1/0
Demographical characteristics of the patient Patients’ demographical characteristics influencing doctors’ and nurses’ screening and advice performance 0/1/0/0/0 1/0
Therapeutic relation with the patient The therapeutic alliance that is established between a healthcare professional and a patient 1/0/2/1/1 1/4
Feedback on the results of delivering SBI Information about doctors’ and nurses’ performance concerning screening, advice and/or effectiveness of their actions 0/1/1/0/1 1/2
Motivation—emotion Satisfaction when working with at-risk drinkers The extent to which doctors and nurses feel rewarded when working with at-risk drinkers 13/0/1/0/0 19/0
Uncomfortable task Doctors’ and nurses’ expectation of feeling unease or awkward when conducting alcohol screening and brief interventions 5/6/3/0/3 16/1
Patients’ feelings when asked about their drinking Doctors’ and nurses’ beliefs about how patients would feel if asked and advised about alcohol 0/2/5/1/0 7/3
Frustrating task Doctors’ and nurses’ beliefs about how they would feel if they were to implement alcohol screening and brief interventions 2/2/0/1/1 5/1
Therapeutic commitment Doctors’ and nurses’ predisposition to working therapeutically with people who have excessive alcohol consumption 3/0/0/0/2 5/0
Self-esteem when working with at-risk drinkers Doctors’ and nurses’ perceived self-worth when working with at-risk drinkers 1/0/1/1/1 2/3
Doctors and nurses own drinking habits The use of doctors and nurses own drinking behaviour as a benchmark to define whether or not a patient drinks excessively 0/2/0/0/0 3/0
Motivation to work with at-risk drinkers The extent to which doctors and nurses want to work with at-risk drinkers 4/2/1/0/1 1/16
Motivation—intentions Motivation to work with at-risk drinkers The extent to which doctors and nurses want to work with at-risk drinkers 15/2/2/2/1 18/16
Therapeutic commitment Doctors’ and nurses’ predisposition to working therapeutically with people who have excessive alcohol consumption 3/0/0/0/2 5/0
Motivation—reinforcement Incentives Doctors’ and nurses’ beliefs about what they would gain by implementing alcohol screening and brief interventions 7/1/4/1/2 13/22
Motivation—optimism Beliefs about the ability to deliver SBI and in helping patients to cut down Doctors’ and nurses’ beliefs about, and/or confidence in, the effectiveness of their skills to screen and advise patients to reduce their alcohol intake 3/2/1/1/1 4/6
Motivation—goals Importance / Priority given to alcohol issues Importance / priority given to alcohol issues by doctors and nurses when compared to other risk factors or tasks 5/5/3/0/0 13/1
Time Time-related factors doctors and nurses believe to affect their capability to implement alcohol screening and brief interventions 5/4/3/0/2 7/14
Opportunity—environmental context and resources Time Time-related factors doctors and nurses believe to affect their capability to implement alcohol screening and brief interventions 16/7/11/3/5 45/14
Support The extent to which doctors and nurses feel to be working in supporting environment to address alcohol problems 24/3/5/2/4 30/57
Resources The availability of materials, tools or any other thing that doctors and nurses feel they need to screen and advise at-risk drinkers 9/3/5/1/3 22/21
Patients’ denial of the problem and resistance to accepting treatment The extent to which doctors and nurses agree patient denial of the problem and resistance to treatment influence their decision to deliver screening and brief intervention 6/3/1/1/0 14/0
Patients’ feelings when asked about their drinking Doctors’ and nurses’ beliefs about how patients would feel if asked and advised about alcohol 5/3/3/1/0 12/3
Organization for preventive counselling Doctors’ and nurses’ perception of the presence or absence of organization/systematic strategies to implement alcohol screening and brief advice 6/4/7/0/3 9/19
Patients’ beliefs about alcohol Doctors’ and nurses’ perceptions of the conceptions patients have about the effects of alcohol, either beneficial or detrimental 1/3/1/0/0 8/1
Incentives for patients Something (e.g. reimbursement) doctors and nurses think would encourage patients to seek alcohol counselling 5/1/1/0/0 7/0
Patients with alcohol problems do not attend their appointments Doctors’ and nurses’ perception that at-risk drinkers are not interested and frequently miss follow-up consultations 0/2/0/1/1 4/0
Patients’ receptiveness to alcohol interventions The extent to which doctors and nurses think patients are open to be asked and advised about their drinking 0/2/1/1/2 4/4
Delivering SBI can make other patients suffer Doctors’ and nurses’ belief that implementing alcohol screening and brief interventions could harm other patients 1/0/0/1/0 2/0
Familiarity with the patient The level of acquaintance between the primary health care provider and the patient 0/1/1/0/0 1/1
Opportunity—social influences Patients’ feelings when asked about their drinking Doctors’ and nurses’ beliefs about how patients would feel if asked and advised about alcohol 5/4/5/1/0 17/3
Patients’ reactions when asked about alcohol Doctors’ and nurses’ beliefs about how patients would react if asked and advised about alcohol 3/5/1/2/1 10/3
Doctors’ and nurses’ permissiveness towards alcohol Doctors’ and nurses’ tolerance or acceptability towards their patients’ alcohol consumption 3/3/0/0/0 7/0
Patients seeking help Patients asking primary care doctors or nurses for help or advice about their drinking by their own initiative 4/4/0/0/0 4/6
Support The extent to which doctors and nurses feel to be working in supporting environment to address alcohol problems 11/3/5/2/2 3/57
Patients’ receptiveness to alcohol interventions The extent to which doctors and nurses think patients are open to be asked and advised about their drinking 0/2/1/1/2 4/4
Role legitimacy The extent to which doctors and nurses believe they have a legitimate role in addressing alcohol issues in their patients 0/1/1/0/0 2/0
Presence of third parties in the consultation Having relatives, friends or other persons attending the consultation with the patient 0/1/0/0/0 1/0