Skip to main content

Advertisement

Table 3 Thematic content analysis based on the TDF for chiropractors

From: Professional barriers and facilitators to using stratified care approaches for managing non-specific low back pain: a qualitative study with Canadian physiotherapists and chiropractors

TDF DomainQuestions (N)Utterances (N)Specific beliefs (N)Specific beliefs (Number of utterances)Increasea
N (%)
Decreaseb
N (%)
No Influencec
N (%)
Themes
Knowledge4514I am aware of existing SCA (13)40 (78)9 (18)2 (4)Awareness of SCAs; Knowledge of evidence
My understanding about the use of SCA is: to classify patients into groups to provide effective treatment for each group (9), It can streamline different professionals' work (1), it has different types (1), and it is not understood for me (1).
I do (11)/ do not necessarily (2) agree with the recommended use of SCA for LBP patients.
I know (7)/ don't know (2)/ know but not necessarily (4) use SCA to target the management of non-specific LBP patients
Belief about consequences3583I believe the dis (7)/advantages (27) of using SCA include management of patients and evidence-based practice51 (88)7 (12)0Consequence of managing patients with/without
SCAs
I believe the disadvantages of not using SCA include poor management of patients and not evidence-based practice (12)
Expected outcomes: less pain, better function, faster recovery, higher satisfaction, and less medication (12)
Belief about capabilities1172I am confident (11)/not confident (4) in assessing NSLBP patients using SCA & determining the targeted treatments11 (65)6 (35)0Acceptance, capabilities
Decisions based on my experience is more important than using SCAs (2)
Behavioural Regulation3313I do (11)/ don't (1) have strategies to monitor changes in patients’ health status21 (68)5 (16)5 (16)Assessing readiness for change; Intentional planning behaviour
It would help if SCAs were: more available and understandable (1), specifically designed for chiropractic (1), summarized in one that is adopted and widespread (1), computerized records to ease tracking (1), and clinicians use tools to monitor pain and disability (1)
I have (10)/ don't have (4) a clear plan under what circumstances I will use SCA in my practice
Skills4534I have (8)/ haven’t (5) been trained to use SCA34 (64)6 (11)13 (25)Clinical training; Clinician-Patient and clinician –clinician communication skill
I feel that I have the necessary skills to use SCA (12)
Skills required to treat patients with high risk of disability are: ability to screen, good communication, psychosocial training, teamwork, and strong training (12), not sure (1), no course required (1)
Communication skills are extremely important for the management of LBP patients using SCA (14)
Intention1162I will (9)/ won't (4) manage all of the next 10 patients using SCA12 (75)4 (25)0Majority will manage patients using SCAs
I would manage only who needs SCA (3)
Goals1131The goal of managing NSLBP patients with SCA is not incompatible with achieving another objective. (13)13 (100)00Compatibility with achieving other objectives
Memory, Attention & Decision2243Deciding if a patient should be managed using SCA is easy (11)21 (87.5)3 (12.5)0Ease of decision
The rule of thumb I use is: the clinical presentation of the patient (7), guidelines (2), simplicity (1)
I do not use a rule of thumb (3)
Reinforcement1131I would manage NSLBP most of the time using the SCA because rewards are greater and patients are satisfied. (13)13 (100)00Better outcomes reinforce the use of SCAs
Environmental Context and Resources3465Barriers to using SCA include lack of time and training; seeing fewer patients; and cost. (13)23 (50)21 (46)2 (4)Environmental resources
Facilitators to using SCA include having: certified colleague in the team and simplicity (3)
No barriers to using SCA. (2)
Onsite rehabilitation may be required (6)/ not required (8)
There are (11)/ no (3) resources available that help me manage patients using the SCA
Social Influences4514I would (8)/ would not (5) consider consulting more experienced practitioners32 (63)17 (33)2 (4)Influence of colleagues and researchers ; psychological cases influence
decision
The views of other researchers influence (10)/ don't influence (2)/ may or may not influence (1) my decision to manage patients using SCAs.
Having an acute patient in apparent distress would (6)/ wouldn't (5)/ not sure if would (1) influence my decision to manage such patients using the SCA.
Having a chronic patient with important psychological overlay would (4)/ wouldn't (9) influence my decision to manage with SCA.
Optimism1121I am generally optimistic regarding the added value of using SCA in my daily practice. (12)12 (100)00Positive attitude
Social Professional identity2262I consider (12)/ don't consider (1) using SCA to be part of my work as a chiropractor.25 (96)1 (4)0Professional role;
Professional agreement
I think it is appropriate that my role should include managing patients with non-specific LBP using the SCA. (13)
  1. aStatements perceived to increase use of stratified care approaches (facilitators). b Statements perceived to reduce use of stratified care approaches (barriers). c Statements perceived to neither increase/decrease the use of stratified care approaches. SCA stratified care approach, LBP low back pain