Skip to main content

Table 2 TDF domains and subthemes identified as barriers and/or enablers in each included study

From: Barriers and enablers for deprescribing benzodiazepine receptor agonists in older adults: a systematic review of qualitative and quantitative studies using the theoretical domains framework

Qualitative analysis themes Studies conducted in the NH setting Studies conducted in ambulatory setting
Anthierens, 2009 [36] Bourgeois, 2014 – study a [37] Bourgeois, 2014 – study b [38] de Souto Barreto, 2015 [13] Evrard, 2020 [39] Lambson, 2003 [40] Maclagen, 2020 [41] Mestres Gonzalvo, 2018 [42] Allary, 2020 [43] Barter, 1996 [44] Bell, 2011 [45] Chen, 2010 [46]
Beliefs about capabilities: Perceived capability of stakeholders to perform BZRA deprescribing and the problems they face
  Patients’ self-efficacy          E    
  Deprescribing is challenging    B        B   
  Perceived efficacy or lack of efficacy    B    B   B   B;E   
Beliefs about consequences:What stakeholders think could happen from performing BZRA deprescribing
  No perceived benefit    B    B   B   B   B
  Return of primary condition   B B    B       
  Withdrawal symptoms    B    B       B
  Increase in care burden    B          
  Avoiding adverse effects of long-term BZRA    E    E     E   E
Environmental context and resources:Influence of the environment on stakeholders’ behaviour
  Tool implementation      E        E
  Favourable/unfavourable moment   B B        B   
  Lack of resources             
  Difficulty of alternatives    B          
  Heavy workload B            
  Inheritance of prescribing culture             
  BZRA deprescribing not prioritised by the healthcare system B            
  NH specific requirements B   B    B       
  NH characteristics     B;E B;E        
  BZRA cost            E  
Intention: How inclined stakeholders are to perform BZRA deprescribing
  Level of willingness   B B    B   B   B   E
  No intention to use non-pharmacological approaches    B          
Goals:How important is BZRA deprescribing for stakeholders
  Competing goals    B          
  Patients’ attachment to these medicines    B        B   B
  Perceived need of sleep B          E   
  Having a more natural sleep           E   E
Social influences: How others influence stakeholders’ behaviour
  Expected patient resistance   B B    B   B     
  Pressure for continuous prescribing       B       
  Belief that GP’s prescription equals safety and approval for continuous use       B     B   
  Patient’s trust in GP           B   
Memory, attention and decision process: Habits factors and decision process regarding BZRA deprescribing
  BZRA as an easy solution       B       
  Routine approach B   B    B     B   
  Preference for status quo             
Knowledge: What stakeholders know on BZRA deprescribing
  Nurses‘ lack of knowledge B   B          
  Patients’ lack of knowledge             B
Skills:What stakeholders know about how they should perform BZRA deprescribing
  GPs’ lack of systematic strategy             
  Nurses’ lack of skills regarding non-pharmacological approaches B            
Social, professional role and identity: Perception of who stakeholders are (as healthcare professionals)
  Nurses perceived ideal role B;E            
  Scarce and difficult multidisciplinary work B   B          B
  Perceived expectation of prescribing             
Reinforcement: Influence of stakeholders’ past experiences with BZRA deprescribing
  Previous attempts and failure   B B    B   B   B   
Emotion:How stakeholders feel about BZRA deprescribing
  Various patient emotions             E
  GP frustration             
Patient characteristics
  Older age    B     E     E  
  Woman     B    B      
  Depression          E    
  Anxiety             
  Psychiatric history   B           
  Dementia      E        
  Aggressive behaviour        E      
  Low orientation score             
  Parkinson or extrapyramidal symptoms      E        
  Comorbidities        B      
  Hospitalisation in past 3 months      E        
  Higher number of medications     B         
  Antidepressant use     E         
  Medical cause of sleeplessness   B           
  Poorer quality of sleep          E    
  Low income        B      
  Widowed men        E      
BZRA prescribing patterns
  Lower dose          E    
  Lower frequency of intake             
  Shorter duration of treatment         E     
  Indication other than sleeping issues   B           
Qualitative analysis themes Studies conducted in ambulatory setting Studies conducted in hospital setting
Chen, 2014 [47] Cook, 2007 – study a [48] Cook, 2007 – study b [49] Cook, 2007 – study c [50] Iliffe, 2004 [51] Joester, 2010 [52] Kuntz, 2018 [53] Lasserre, 2010 [54] Martin, 2017 [55] Williams, 2016 [56] Yokoi, 2014 [57]
Beliefs about capabilities: Perceived capability of stakeholders to perform BZRA deprescribing and the problems they face
  Patients’ self-efficacy          E   
  Deprescribing is challenging   B   B B   B B    
  Perceived efficacy or lack of efficacy   B   B B;E   B    B  
Beliefs about consequences:What stakeholders think could happen from performing BZRA deprescribing
  No perceived benefit   B   B B   B   B B  
  Return of primary condition   B    B   B   B B  
  Withdrawal symptoms     B B    B    
  Increase in care burden      B   B     
  Avoiding adverse effects of long-term BZRA   E    E   E   E   
Environmental context and resources:Influence of the environment on stakeholders’ behaviour
  Tool implementation     B    B   E   
  Favourable/unfavourable moment        B;E   B;E   
  Lack of resources        B B    
  Difficulty of alternatives     B    B B    
  Heavy workload     B    B     
  Inheritance of prescribing culture        B     
  BZRA deprescribing not prioritised by the healthcare system        B     
  NH specific requirements            
  NH characteristics        B     
  BZRA cost            
Intention: How inclined stakeholders are to perform BZRA deprescribing
  Level of willingness   B   B B E B    E  
  No intention to use non-pharmacological approaches   B   B        
Goals:How important is BZRA deprescribing for stakeholders
  Competing goals   B   B    B   B   
  Patients’ attachment to these medicines   B   B    B B B B  
  Perceived need of sleep          E B  
  Having a more natural sleep            
Social influences: How others influence stakeholders’ behaviour
  Expected patient resistance     B B   B B    
  Pressure for continuous prescribing         B    
  Belief that GP’s prescription equals safety and approval for continuous use   B        B B  
  Patient’s trust in GP          B;E E  
Memory, attention and decision process: Habits factors and decision process regarding BZRA deprescribing
  BZRA as an easy solution     B        
  Routine approach   B      B    B  
  Preference for status quo   B          
Knowledge: What stakeholders know on BZRA deprescribing
  Nurses‘ lack of knowledge            
  Patients’ lack of knowledge      B   B B B B  
Skills:What stakeholders know about how they should perform BZRA deprescribing
  GPs’ lack of systematic strategy     B        
  Nurses’ lack of skills regarding non-pharmacological approaches            
Social, professional role and identity: Perception of who stakeholders are (as healthcare professionals)
  Nurses perceived ideal role            
  Scarce and difficult multidisciplinary work            
  Perceived expectation of prescribing     B    B     
Reinforcement: Influence of stakeholders’ past experiences with BZRA deprescribing
  Previous attempts and failure   B   B    B    B  
Emotion:How stakeholders feel about BZRA deprescribing
  Various patient emotions   B          
  GP frustration     B    B     
Patient characteristics
  Older age B           
  Woman E           
  Depression            
  Anxiety    B         
  Psychiatric history            
  Dementia            
  Aggressive behaviour            
  Low orientation score            E
  Parkinson or extrapyramidal symptoms            
  Comorbidities B           
  Hospitalisation in past 3 months            
  Higher number of medications            
  Antidepressant use            E
  Medical cause of sleeplessness            
  Poorer quality of sleep            
  Low income            
  Widowed men            
BZRA prescribing patterns
  Lower dose E           
  Lower frequency of intake    E    E      
  Shorter duration of treatment            
  Indication other than sleeping issues            
  1. BZRA benzodiazepines receptor agonists, GP general practitioner, NH nursing home, TDF theoretical domains framework [B] stands for an identified barrier and [E] for an identified enabler