Table 3 Thematic content analysis based on the TDF for chiropractors
TDF Domain | Questions (N) | Utterances (N) | Specific beliefs (N) | Specific beliefs (Number of utterances) | Increasea N (%) | Decreaseb N (%) | No Influencec N (%) | Themes |
|---|---|---|---|---|---|---|---|---|
Knowledge | 4 | 51 | 4 | I 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 consequences | 3 | 58 | 3 | I believe the dis (7)/advantages (27) of using SCA include management of patients and evidence-based practice | 51 (88) | 7 (12) | 0 | Consequence 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 capabilities | 1 | 17 | 2 | I am confident (11)/not confident (4) in assessing NSLBP patients using SCA & determining the targeted treatments | 11 (65) | 6 (35) | 0 | Acceptance, capabilities |
Decisions based on my experience is more important than using SCAs (2) | ||||||||
Behavioural Regulation | 3 | 31 | 3 | I do (11)/ don't (1) have strategies to monitor changes in patients’ health status | 21 (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 | ||||||||
Skills | 4 | 53 | 4 | I have (8)/ haven’t (5) been trained to use SCA | 34 (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) | ||||||||
Intention | 1 | 16 | 2 | I will (9)/ won't (4) manage all of the next 10 patients using SCA | 12 (75) | 4 (25) | 0 | Majority will manage patients using SCAs |
I would manage only who needs SCA (3) | ||||||||
Goals | 1 | 13 | 1 | The goal of managing NSLBP patients with SCA is not incompatible with achieving another objective. (13) | 13 (100) | 0 | 0 | Compatibility with achieving other objectives |
Memory, Attention & Decision | 2 | 24 | 3 | Deciding if a patient should be managed using SCA is easy (11) | 21 (87.5) | 3 (12.5) | 0 | Ease 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) | ||||||||
Reinforcement | 1 | 13 | 1 | I would manage NSLBP most of the time using the SCA because rewards are greater and patients are satisfied. (13) | 13 (100) | 0 | 0 | Better outcomes reinforce the use of SCAs |
Environmental Context and Resources | 3 | 46 | 5 | Barriers 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 Influences | 4 | 51 | 4 | I would (8)/ would not (5) consider consulting more experienced practitioners | 32 (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. | ||||||||
Optimism | 1 | 12 | 1 | I am generally optimistic regarding the added value of using SCA in my daily practice. (12) | 12 (100) | 0 | 0 | Positive attitude |
Social Professional identity | 2 | 26 | 2 | I consider (12)/ don't consider (1) using SCA to be part of my work as a chiropractor. | 25 (96) | 1 (4) | 0 | Professional role; Professional agreement |
I think it is appropriate that my role should include managing patients with non-specific LBP using the SCA. (13) |