COM-B components | TDF domains | Facilitators | Participants | Excerpts |
---|---|---|---|---|
Psychological Capability | Knowledge | Having knowledge on the recommendations for the management of recurrences of LBP | PT5 | “How to manage the pain, if they should move, which movements to perform… when they should seek a health professional, if they should seek them, well, it’s discussing these issues with the patient.” (PT5, FG1) |
Skills | Acquisition of skills through participation in the implementation of the intervention | PT3; PT4 | “(…) well, it will allow us to have more theoretical skills, in the sense of changing… as I said, I was just talking about this, about behaviour change. Lead patients to that change (…)” (PT8, FG2) | |
Memory, attention and decision processes | The interventions is aligned with current practice | PT9; PT10 | “(…) I think that for those who have been in primary healthcare for a few years, promoting physical activity habits, this is already a little bit of what we do.” (PT10, FG2) | |
Positive past experiences related to participation in exercise interventions | PT3; PT4; PT6 | “I think that the knowledge that we’ve previously acquired through the implementation of other exercise interventions can also help us now with this new one (…)” (PT6, FG1) | ||
Behavioural regulation | Ability to organise and manage work activities according to the needs and availabilities | PT1; PT6; PT7 | “(…) if I know exactly who has priority to enter in, in this new intervention, right? For example, which patients do I have to prioritise? I may have to prioritse this one, next week I’ll prioritise two other people.” (PT6, FG1) | |
Social Opportunity | Social influences | Therapeutic relationships previously established | PT6 | “(…) I think there will be a lot of patient adherence (…) They already trust us, and many patients already know us… no, I think that adherence will be easier.” (PT6, FG1) |
Professional relationships and collaboration between physiotherapists | PT6 | “(…) as long as we’re not… isolated, each one doing different things (…) I think we need this structure and being more together and having more strength together (…)” (PT6, FG1) | ||
Relationship with and involvement of the multidisciplinary team | PT4; PT6; PT8; PT10; PT11 | “(…) I know that an intervention of this nature will create even more trust from the other professionals in us, trust that we are capable…” (PT6, FG1) “Since the patients also see their doctors more often, maybe, having a partnership with the doctor (…) to again transmit this message that’s important to continue performing exercise (…).” (PT8, FG2) | ||
Physical Opportunity | Environmental context and resources | Context provides the necessary time to implement the intervention | PT1; PT6; PT12 | “This on the assumption that I would have 2 hours a week dedicated to this intervention, right? Or I can have more, right? It depends on our ability to manage or if our management is flexible, which it is in my case (…)” (PT6, FG1) |
Having organisational support, that consider the intervention a priority | PT10 | “I’d just like to say that here in my ACES this intervention has a high priority at the organisational level (…)” (PT10, FG2) | ||
The intervention’s principles are aligned with primary healthcare’s principles | PT14 | “(…) we already are in a context that is based on this principle of delegating competences to the patients over their own health.” (PT14, FG2) | ||
High number of referrals | PT8 | “I’m in a unit where I have lots of referrals and I even have a wait list for patients for other interventions.” (PT8, FG2) | ||
Need for few resources | PT12 | “… in terms of resources (…) it’s not something that involves having a lot of things. So, having us, the person, and a place to do the exercises is enough.” (PT12, FG2) | ||
High incidence of recurrences of LBP, which justified the need for the interventiona | PT2 | “(…) here in our context it’s a common condition… low back pain is very recurrent, we have many referrals… especially many referrals which are a first episode, which are already recurring episodes.” (PT2, FG1) | ||
Reflective Motivation | Social/professional role and identity | Benefits for the physiotherapists and for the profession | PT1; PT2; PT3; PT4; PT5; PT6; PT9; PT10; PT12 | “Our work is very under-recognised in primary care, and we must grab on to something that makes us different from the others and united to each other. I think that’s very important. (…)” (PT3, FG1) |
The intervention aligns with physiotherapists’ professional identity and role in primary healthcare | PT1; PT5; PT9; PT10 | “This type of interventions (…) we have a role of changing behaviours, which is something that I also identify with and me working in primary healthcare is exactly for this… to change behaviours (…)” (PT9, FG2) | ||
Beliefs about capabilities | High confidence levels for the implementation of the intervention | PT6; PT10; PT11; PT14 | “(…) on the assumption that we will have training, right? So, my confidence level is based on that assumption. I think my confidence level is very high.” (PT6, FG1) | |
Optimism | Optimism about the implementation of the intervention | PT6; PT11; PT13 | “(…) I believe that after the person starts seeing the benefits, it will certainly be easier for them to continue” (PT11, FG2) | |
Beliefs about consequences | Beliefs about the potential patient benefits and improvement of quality of care | PT2; PT6; PT8; PT9; PT10; PT11; PT12; PT13; PT14 | “I think that the main benefit would be… them gaining exercise habits. It’s that this intervention will help them gain exercise habits on a regular basis.” (PT10, FG2) “(…) also, in terms of medication, if they know the strategies that they can do to… to prevent recurrences, they can also reduce medication. It’s another benefit, for example.” (PT8, FG2) | |
Intentions | Willingness to change clinical practice | PT1; PT3; PT4; PT5; PT6; PT7; PT9; PT10; PT13 | “(…) I think that I really consider it to be a top priority for me (…) to find a way in my schedule to fit this type of intervention (…)” (PT6, FG1) | |
Automatic Motivation | Reinforcement | Joint development of the interventions with higher education institutions | PT5; PT13 | “First because we have these education institutions supporting the program (…) Credible, in several places at the same time, with well-studied, well-structured data… I think this isn’t very common in physiotherapy and we really needed it.” (PT13, FG2) |
Continuity of care | PT8; PT11 | “I think that it’s very relevant to implement this intervention, because it’s also the reinforcement of what has been done before (…)” (PT8, FG2) | ||
Emotion | Positive emotions about the implementation of the intervention | PT13 | “Because it’s an area that I like (…) I’ve worked a lot with patients with low back pain before, not now, but… I would like to do it again” (PT13, FG2) |