Table 6 Barriers and facilitators for accomplishing the intended behavioral changes

Time investment, gathering endpoints, and patient needs: the length and total volume of the MDS for patients with NSLBP, gathering endpoint measures in the absence of patients, not meeting patient expectations

External pressure: the need to meet external requirements regarding scores on process and outcome indicators, stimulating inappropriate ways of collecting data; noticeably formalized to just ‘fulfill’ these demands

Financial aspects: narrow additional insurance, limited time available within these budgets is preferably spent treating the patient at the expense of collecting data

Population characteristics: lack of digital skills and low (health) literacy of patients constrain legitimate data collection

Irrelevant content, overlap between and scope of questionnaires: inappropriateness of questions and applicability for every treatment profile, existence of overlay in questions and measures of the MDS regarding physical activity and functioning

EHR system specifications: lack of a well-functioning EHR system and specifications to guide online data collection, lack of external reminders for data collection

Lack of knowledge and skills: how to interpret (clinical relevance) and how to apply data to support clinical behavior

Facilitators

Goal-setting; functional, specific, and concise instruments: relevant aspects for the patient, short and easy to apply questionnaires, dynamic questionnaires; computer-assisted testing (CAT)

External reminder for data collection (future assurance): external reminder to complete data collection in open treatment episodes, through a quality manager or the EHR system

Awareness of the added value of data collection to improve quality of care: more knowledge of the why and relevance of data collection may stimulate behavioral change, including communicating the value of data collection to patients

Education on how to handle the collected data to support clinical behavior: more attention paid to data collection routines (including EHR aspects) and handling data in routine practice during the undergraduate education of physical therapists

Overview of results: making the most relevant and eye-catching outcomes of completed questionnaires clearly visible (EHR system)

Peer assessment atmosphere: open and safe environment and incentives to reflection through open-ended questioning

Rapid improvement nature of the program: enhanced involvement and awareness regarding the transfer-of-learning