Introduction
Theoretical domain | Definitions |
---|---|
Knowledge | An awareness of the existence of something |
Skills | An ability or proficiency acquired through practice |
Social/professional role and identity | A coherent set of behaviours and displayed personal qualities of an individual in a social or work setting |
Beliefs about capabilities | Acceptance of the truth, reality or validity about an ability, talent or facility that a person can put to constructive use |
Optimism | The confidence that things will happen for the best or that desired goals will be attained |
Beliefs about consequences | Acceptance of the truth, reality, or validity about outcomes of a behaviour in a given situation |
Reinforcement | Increasing the probability of a response by arranging a dependent relationship, or contingency, between the response and a given stimulus |
Intentions | A conscious decision to perform a behaviour or a resolve to act in a certain way |
Goals | Mental representations of outcomes or end states that an individual wants to achieve |
Memory, attention, and decision processes | The ability to retain information, focus selectively on aspects of the environment and choose between two or more alternatives |
Environmental context and resources | Any circumstance of a person’s situation or environment that discourages or encourages the development of skills and abilities, independence, social competence and adaptive behaviour |
Social influences | Those interpersonal processes that can cause individuals to change their thoughts, feelings, or behaviours |
Emotion | A complex reaction pattern, involving experiential, behavioural, and physiological elements, by which the individual attempts to deal with a personally significant matter or event |
Behavioural regulation | Anything aimed at managing or changing objectively observed or measured actions |
Methods
Design
Participants
Interview topic guide
Procedure
Analysis
Stage 1: Coding into theoretical domains
Stage 2: Identifying specific beliefs and overarching themes
Stage 3: Identifying relevant domains
Ethics
Results
Participants
Key themes identified within relevant domains
Domain | Overarching theme | Example belief statements |
---|---|---|
Knowledge | Knowledge and awareness of LBP radiography guidelines and indications for imaging. (Enabler) | I know the limitations of X-rays and when it would be appropriate to choose X-ray as an imaging modality |
I am aware of guidelines and/or indications for LBP and imaging | ||
I agree with the content of the guidelines for imaging and LBP | ||
I think the guidelines are evidence-based | ||
My knowledge of indications for imaging comes from school | ||
Lack of awareness and/or knowledge of LBP radiography guidelines. (Barrier) | I do not follow a guideline | |
I have limited knowledge/awareness of guidelines for imaging | ||
Skills | Adequate training is required to manage LBP without imaging. (Enabler) | A lot of expertise and training is needed in order to manage someone with LBP (and determine if they need an X-ray) |
Having good communication skills is important for managing LBP without imaging. (Enabler) | Good communication skills are required for managing LBP without X-rays | |
Social/professional role and identity | Chiropractors’ responsibility to manage LBP without imaging. (Enabler) | It is my responsibility as a clinician to manage someone’s LBP without taking an X-ray |
Chiropractors should not be routinely taking X-rays | ||
Other healthcare providers’ responsibility to manage LBP without imaging. (Barrier) | It is the medical doctor’s role to order imaging | |
Beliefs about consequences | Negative consequences to imaging for LBP. (Enabler) | Radiation is a negative consequence of taking X-rays |
Cost to the healthcare system is a negative consequence of taking X-rays | ||
Delayed treatment (waiting for results) is a negative consequence of taking X-rays | ||
Exposure to infectious diseases is a negative consequence of sending a patient for an X-ray | ||
Patient worry is a negative consequence of taking an X-ray | ||
Negative consequences to not using imaging for LBP. (Barrier) | Missing a diagnosis is a potential negative consequence of NOT taking an X-ray | |
Neutral consequences to not using imaging for LBP. (Enabler) | The plan of management does not change with taking an X-ray | |
Memory, attention, and decision processes | Decision for LBP imaging is based on a patient’s clinical presentation. (Enabler) | I decide whether a patient needs an X-ray based on their clinical presentation |
Decision for LBP imaging is based on gut feeling. (Barrier) | I would decide to order an X-ray (instead of following the guidelines) if I have a gut feeling that there is something else going on | |
Able to remember indications for LBP imaging. (Enabler) | I can remember indications for when a patient needs imaging/needs a referral | |
Behavioural regulation | Communication is a strategy that can be used to reduce imaging for LBP. (Enabler) | I manage LBP without X-rays by explaining to my patients why they do not need X-rays |
Continuing education requirements is a strategy that can be used to reduce imaging for LBP. (Enabler) | Continuing education in radiology helps me manage LBP [with or without X-rays] | |
Having access to a patient’s previous imaging is a strategy that can be used to reduce imaging for LBP. (Enabler) | Being able to access previous X-rays/reports helps me manage LBP without taking an X-ray | |
A better health system organisation that facilitates better communication amongst health care professionals would help with reducing imaging for LBP. (Enabler) | Having a system to easily communicate with physicians and access previous imaging would help me better manage LBP [without X-rays] |
Domains less likely to inform intervention design to change target behaviours
Domain | Overarching theme | Example belief statements |
---|---|---|
Beliefs about capabilities | Confidence and control of LBP imaging ordering behaviours. (Enabler) | I am confident that I can manage LBP without X-rays |
I feel that I have control over the decision to manage LBP with or without X-rays | ||
It is easy for me to decide if I should order an X-ray or not | ||
Lack of confidence in the patient’s case presentation. (Barrier) | When I am not confident, I am more likely to refer for X-rays | |
Optimism | None identified | None |
Reinforcement | Previous clinical experiences help to reduce use of imaging for LBP. (Enabler) | My previous experiences with diagnosing pathology does not influence my decision to always use X-ray with future patients with LBP |
My previous experiences with patients not needing X-ray influences my decision to NOT always use an X-ray for patients with LBP | ||
My previous clinical experiences help with deciding whether or not a patient requires an X-ray | ||
Intentions | Positive intentions to managing LBP without imaging. (Enabler) | I want to manage patients with LBP without imaging |
Goals | Imaging is low priority for management of patients with LBP. (Enabler) | Taking X-rays is low priority compared to taking a history and conducting a physical examination |
Environmental context and resources | Many available resources (e.g., time, patient’s previous imaging) to help manage LBP without imaging. (Enabler) | Most patients have had X-rays that I can have access to |
My decision to take an X-ray is not influenced by time constraints | ||
There are clinical resources available to help manage LBP without X-rays | ||
Social influences | Not influenced by others’ views on imaging for LBP. (Enabler) | I am not influenced by patients wanting X-rays for their LBP |
My decision to take an X-ray is not influenced by my colleagues | ||
I am not influenced by campaigns supporting reducing unnecessary imaging (and would still take an X-ray if necessary) | ||
My decision to take an X-ray is not influenced by patients in lots of pain | ||
Emotion | Not influenced by fear or worry. (Enabler) | Fear does not influence my decision to take an X-ray |
Not using imaging does not make me worried that I missed a diagnosis | ||
Feel comforted with having ability to order X-rays if needed. (Barrier) | It gives me comfort knowing that I can take an X-ray if I need to |