Table 2 Application of the Theoretical Domains Framework for the Development of the Cardiovascular Assessment Screening Program (CASP)
Barriers or Facilitators, or Strategies | Within which theoretical domain do the barriers, facilitators and strategies operate? | Which intervention components (behaviour change techniques (BCT) and modes of delivery (Mode) (Michie et al., 2013) [14] could overcome the modifiable barriers and enhance the facilitators and strategies to promote behavioural change associated with the content? (BCT, Mode, Contenta) |
|---|---|---|
Barrier Lack of knowledge and skills for comprehensive CVD screening using the C-CHANGE guideline | Knowledge | BCT: Shaping knowledge; instruction on how to perform a behaviour |
Skills | Mode: Webinar, Online education module, CASP Website with online tools, resources, and C-CHANGE guidelines. Cardiovascular Access Database used as the online documentation system | |
Content: Background information on CVD screening, and access to clinical practice guidelines (C-CHANGE). NP Toolkit (Provided resources and materials for NP behaviour change related to the screening process during intervention implementation) | ||
Barrier Ambiguity and uncertainty around responsibility for CVD screening | Professional role and identity | BCT: Goals and planning-discrepancy between current behaviour and standard of practice |
Mode: Webinar; One-on-one facilitator support; Online education module | ||
Content: NP role in CVD screening, health promotion, adherence to clinical practice guidelines, and access to relevant nursing research. ARNNL NP Standards of Practice state the role of NPs to integrate health promotion at the individual and community level in clinical practice and research | ||
Barrier Questioning the necessity of CVD screening in light of the Choosing Wisely Campaign | Motivation and goals | BCT: Goals and planning-Action planning (including implementation intentions) |
Mode: CASP materials were in congruence with the Choosing Wisely Campaign recommendations. Feedback questionnaires sent to NPs | ||
Content: CASP contained information that was in congruence with the Choosing Wisely recommendations | ||
Barrier Lack of time and commitment for CVD screening | Beliefs about consequence | BCT: Commitment; Social support |
Mode: Email and phone calls; Webinar; Online access to facilitator and technical support during research study | ||
Environmental context | Content Streamlined the process of CVD screening, management, and documentation through online resources for easy access and to reduce time and costs associated with NP participation in screening process. Ongoing support from CASP facilitator and technical support during intervention implementation | |
Barrier Lack of dedicated resources and organizational supports for CVD screening | Beliefs about consequences | BCT: Commitment; Social support |
Mode: Email and phone calls; Webinar; Online access to facilitator and technical support during research study | ||
Environmental context | Content Streamlined the process of CVD screening, management, and documentation through online resources for easy access and to reduce costs associated with NP participation in screening process within organizations. Ongoing support from CASP facilitator and technical support during intervention implementation | |
Barrier Changing behaviour is difficult for patients | Beliefs about capability | BCT: Repetition and substitution-Behaviour rehearsal/practice |
Mode: Online educational module containing PowerPoint presentation | ||
Content: Focused on behaviour change of NPs and behaviour change of patients. Focused on the application of the Trans Theoretical Model and motivational interviewing techniques for NP behaviour change. Access to My Heart Healthy Plan focused on a patient-centred approach where the onus is on patient self-management and patient control of decision-making and goals for behaviour change in collaboration with the NP | ||
Barrier Lack of access to services | Environmental context | BCT: Antecedents; restructuring the physical environment |
Mode: Online CASP website accessible to HCPs and separate access for members of the public | ||
Content: The CASP intervention and other resources for NPs and patients in urban and rural remote areas of NL. Resources to promote heart health for screening and management and self-management | ||
Facilitator Utilize components and tools identified from other successful provincial screening programs | Environmental context | BCT: Goals and planning-problem-solving |
Social influences | Mode: Access to resources for providers and patients through the CASP Website, HCP Toolkit, online links to other resources | |
Content: Use of the CASP resources such as Heart Health Pamphlet, diabetes quick sheets, patient education materials, and screening tools for NPs to use in daily practice | ||
Strategy Training of health care providers for implementation of a comprehensive screening intervention to reduce stress of fitting this program into daily clinical practice | Knowledge Skills Emotions Environmental context | BCT: Shaping knowledge-instruction on how to perform a behaviour; Repetition and substitution behavioural rehearsal/practice; Social support emotional |
Mode: Webinars, online educational module, support from researchers through various means. Online support from CASP Website, online support through Educational module, online CVD Database | ||
Content: Introduction of the educational module and other resources to be used during CASP implementation. Educational module contained videos on correct technique on how to do skills correctly according to CPGs. Support available to NPs participating in by CASP facilitator through email, phone, or in-person during CASP study implementation and availability of online resources | ||
Strategy Making the public aware of the importance of CVD screening | Beliefs about consequences Environmental context | BCT: Antecedents-restructuring the physical environment, changing exposure to the cues for the behaviour |
Mode: HCP Toolkit, Send materials to various RHAs, posters, pamphlets, media campaigns | ||
Content: Distribution of Heart Healthy Posters in regional health authorities across the province of NL. NPs advertising specific days for CVD screening |