Table 1 TDF domains, definitions, and an example interview question used for each domain
Name of TDF domain | Definition | Example of Question |
|---|---|---|
Knowledge | Existing procedural knowledge, knowledge about guidelines, evidence | Can you tell me what the key recommendations are of any clinical practice guidelines for the management of an episode of recent onset low back pain in the primary care setting? |
Skills | Competence and ability about procedural techniques required | When assessing a patient with an episode of low back pain to determine the need for imaging, what do you find most straightforward, and what is most challenging? |
Social professional role and identity | Boundaries between professional groups | Do you find that those professional colleagues approach low back pain management the same way that you do, particularly around the use of imaging? |
Beliefs about capabilities | Perceptions and competence and confidence in doing the behaviour (and how it influences) | Do you feel confident in your ability to accurately assess and diagnose a patient with recent onset low back pain without the use of imaging such as an x-ray / CT or MRI? |
Optimism | Participant’s optimism / pessimism about the behaviour influences actions | Do you think there are any instances where your avoidance of imaging would interfere or complicate your chiropractor-patient relationship? |
Beliefs about consequences | Perceptions about outcomes, advantages, disadvantages about performing the behaviour and how that influences whether they perform the behaviour | Generally, the guidelines recommend against routine imaging in this population. What is your opinion on this, and is this in line with your usual management of patients with low back pain? Hypothetically—what do you feel the consequences would be of imaging almost everyone with episodic low back pain? And what about the consequences of imaging almost no one with low back pain? |
Reinforcement | Previous experiences that have influence whether or not the behaviour is performed | Are there any incentives (financial or otherwise) for you to have imaging done, or to avoid having it done, for your patients with low back pain? |
Intention | A conscious decision to perform a behaviour or act in a certain way | Of the next 10 patients who present to you with an episode of recent onset low back pain, how many of these patients are you likely to refer for or undertake imaging? |
Goals | Priorities, importance, commitment to a certain course of actions or behaviours | Can you think of any situation other than the presence of “red flags” where you may decide to seek imaging? |
Memory, attention, and decision processes | Attention control, decision-making, memory | Do you feel that you generally have enough time in a typical consultation to conduct a thorough assessment of a patient with an episode of low back pain and give the patient information about their condition (including imaging)? |
Environmental context and resources | How factors related to the setting in which the behaviour is performed influence the behaviour | Pre-interview questionnaire |
Social influences | External influence from people or groups to perform or not perform the behaviour | When you first started your practice, did you have any mentors or advisors that provided you with guidance on appropriate patients for imaging? |
Emotions | How feelings affect (positive or negative) the behaviour | Can you share with me what it feels like to manage a patient’s expectations for their care, specifically about their requests for imaging, or need for more of your clinical time? |
Behavioural regulation | Ways of doing things that relate to pursuing and achieving desired goals, standards or targets | Are there any actions that you aim to improve or change regarding your current management of patients presenting with an episode of recent onset low back pain? |