Table 5 Quotes for each theme
Theme | Subtheme | TDF domain | Quote |
|---|---|---|---|
Theme 1: Knowledge and previous practice patterns influence prescription | Subtheme 1: Awareness of cardio-renal benefits | knowledge | 1: It is strongly recommended to be used in a patient with confirmed IHD…and renal involvement and proteinuria.(B2) |
2: I think it has a benefit, but I am not sure to what extent it can lower A1C or slow down the progression of renal impairment.(A2) | |||
Subtheme 2: Awareness of cardio-renal benefits independent of glycemic efficacy | knowledge | 3: I’m not sure if it’s worth keeping these medications if there is no improvement in A1C (S3) | |
goals | 4: For most of my cases, I use it in suboptimal DM control. (D4) | ||
intention | 5: Sometimes the diabetes control is so poor, such as the A1C level is already more than 10. In these cases, I thought prescribing this medication [SGLT2 I] would only help a little. (B2) | ||
intention | 6: If the patient’s diabetes is well controlled, I will not prescribe this medicine because his A1C is already well-controlled. (P9) | ||
Subtheme 3: Perceived safety profile of SGLT2 I | memory | 7: I think the good thing about SGLT2 is that it seldom has any side effects. For the most worrisome side effects, DKA, I have not seen once so far. Maybe it is rare. (T3) | |
belief about capabilities | 8: I rarely take the initiative to prescribe a new drug. (A2) | ||
intention | 9: I have reservations about any new medicine, even though it has many benefits. I trust the evidence, but these patients are under my care for my practice, so I would prefer to be more cautious. (K7) | ||
Theme 2: Balancing risks and benefits | Subtheme 1: Where benefits are obvious | beliefs about consequences | 10: Many patients in our clinics have high A1C and high body weight. I think it is a good choice as it has a weight control benefit. (A2) |
intention | 11: I would actively consider prescribing it if BP is suboptimal. (Q7) | ||
Subtheme 2: Concerns about use in the elderly | beliefs about consequences | 12: Those older patients ...might have many complications and will not have too many days left. I prefer to use traditional methods to help them ..., so I will not prescribe this medicine to them. (K7) | |
beliefs about consequences | 13: My concern is people with old age. They may have many comorbidities… and not feel possible side effects. (D4) | ||
beliefs about consequences | 14: Some older people live alone and get no visitors, .... I will be cautious as they might not understand what I say, therefore easily developing adverse effects.(E3) | ||
Subtheme 3: Concerns about use in patients with renal impairment | intention | 15: I will only prescribe SGLT2 I for the patient with normal renal function with the creatinine level is not elevated. (P9) | |
emotion | 16: Some patients... have already developed renal impairment. I will be worried as I am unsure whether the renal function will gradually deteriorate to the level that I need to stop. (B2) | ||
Subtheme 4: Patients’ perceptions and preferences | beliefs about consequences | 17: The patient is opposed to it. “I don’t like it. I don’t want to take so many medicines. I don’t think I have any problems. I am happy with my current status. “Then I have no methods. (F2) | |
beliefs about consequences, emotion | 18: Their usual reasons for refusing medications are: “I don’t think I have a problem.” “I am afraid of taking medicine.” “I am afraid of having adverse effects.” (U12) | ||
Theme 3: Doctor’s professional responsibilities | role and identity | 19: It is reasonable for us to prescribe this drug because, as family doctors, we manage many diabetic patients. (N5) | |
20: I want to protect patients from recurrent cardiovascular events and slow down renal function deterioration, but I find it difficult to witness their outcome improvement. (T3) | |||
Theme 4: System barriers | Subtheme 1: Clinic operation constraints | environmental constraints | 21: Sometimes I feel a rush due to limited consultation time. (P9) |
22: I was unable to consult with the same patients. As a result, I am unable to monitor the medication’s impact. (W1) | |||
Subtheme 2: Cost | environmental constraints | 23: We have to consider the cost in the Hospital Authority setting as it is not cheap, so it is better to use it if other drugs do not work. (D2) | |
24: The most important concept is prevention is better than treatment of complications. In the end, the cost will be lower. (Q7) |