Table 2 GPs perceived barriers and facilitators for assessing and addressing vulnerability, according to TDF-domains
Behavioral domains | Behavior area 1: Assessing vulnerability in pregnancy | Behavior area 2: Addressing vulnerability in pregnancy | ||
|---|---|---|---|---|
TDF domains | Barriers | Facilitators | Barriers | Facilitators |
Theme I: Knowledge and attention | ||||
Knowledge | Uncertainty of levels of antenatal care | Uncertainty of collaborative opportunities | ||
Skills | Lacking training in how to manage vulnerable pregnant women Losing overview in the pregnancy record | Coping skills, assessing vulnerability guided by the pregnancy record | Communication skills, being honest and trustworthy | |
Memory, attention and decision processes | Inattention to vulnerability due to the patient’s normal visual appearance | Attention to the patient’s social life and living conditions | ||
Theme II: Professional confidence | ||||
Social/professional role and identity | Judged a meaningful task for GPs | Ethical dilemmas, balancing the needs of the patient versus the needs of the coming child | Keeping professional obligations in mind Sharing personal experience and attitude | |
Beliefs about capability | Absence of doctor-patient relation, No trust in gut-feeling Poor confidence in assessing vague indicators of vulnerability | Existing strong doctor- patient relation Professional confidence, trusting their gut feeling | Durable patient-alliance from existing strong doctor-patient relation | |
Beliefs about consequences | Fear of breaking the patient-alliance | |||
Optimism | No coding | |||
Intentions | Blind to problems due to long standing relations, not asking | |||
Goals | No coding | |||
Emotion | Empathy and trust from longstanding relation | Having sympathy Feeling sorry for the patient | ||
Theme III: Incentives | ||||
Reinforcement | Lacking economic compensation for the use of extra time | Desired changes to the collective agreement | Desired changes to the collective agreement | |
Theme IV: Working conditions | ||||
Environmental context and resources | Missing information in medical records, Time constraints Lacking continuity Delegating ANC to staff/GP trainees No home visits for vulnerable families Patient conditions | Time constraints limit proper sensitive addressing of vulnerability | ||
Social influences | Influences from relatives and colleagues who know the patient | |||
Theme V: behavioral regulations | ||||
Behavioral regulations | Local prompts and structure changes facilitating vulnerability assessment | Local structure changes ensuring time for proper addressing of vulnerability | ||