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