Table 3 Comparison of key belief and attitude themes for high and low implementers

Congruence with clinician role

▪Risk factors perceived to be relevant to the presenting issues and types of clients seen.

▪Opportunity to address as part of routine care.

▪Risk factors perceived to be less relevant to the clinicians' role and reason for seeing the client.

▪Confusion over role boundaries, uncertainty about whether risk factors should be addressed by another health professional.

Perception of client acceptability

▪Opportunity to develop rapport with clients.

▪Linked discussion of risk factors to the presenting issue.

▪Undertook screening for risk factors as part of standard assessment.

▪Flexible approach to intervention.

▪Less able to link discussion of risk factors to presenting issue.

▪Concerned about being seen as judgemental, receiving a negative reaction from clients and damaging clinician-client relationship.

Beliefs about capabilities

▪High perceived confidence and comfort in addressing risk factors.

▪Expressed a lack of knowledge, skills or confidence in addressing risk factor issues in an appropriate way.

Perceived Effectiveness of risk factor intervention

▪Low perceived effectiveness but responsibility to provide intervention as part of the role.

▪Value of intervention recognised but difficulty in assessing and measuring outcomes.

▪Low perceived effectiveness of risk factor intervention.

Clinicians' own lifestyle

▪Own lifestyle habits acted as an enabler for some (eg ex-smoker) or did not influencing risk factor management practices

▪Own lifestyle habits identified as a barrier for some in addressing risk factor issues with clients.