Table 3 Themes from qualitative interviews on possible change in behaviour with use of the clinical resource (iteration 2)

General practitioner

 Booklet would help to decrease imaging pressure from patients

  “Yeah [help decrease pressure felt to refer patients for imaging] because I mean it’s got the resources, the references at the back and the websites that they can look up for more information to see why it’s not necessary, rather than just coming from my word of mouth” (GP10)

 Booklet provides a reminder of correct imaging decisions for the GP

  “…[algorithm] also helpful for the doctor as a reminder maybe for someone who doesn’t, just as a reminder you know, think of those sort of red flags that need to be screened for” (GP8)

 Potential negative consequences of not referring for imaging when a patient really wants it

  “if people are hell-bent on getting imaging you’re pretty dumb not to give it to them, because it’ll be the one that you don’t that’ll be the one that has some bizarre weird tumour or something” (GP5)

  “I think if someone was adamant that they wanted an x-ray I think that they would be unhappy leaving the room without an x-ray request form, whether you give them this paperwork or not” (GP10)

Health consumers

 Information in the booklet is reassuring

  “I found it quite reassuring you know that quite a lot of people who have imaging might show up you know some kind of change which isn’t actually going to be problematic in terms of effect to their life” (MoP2)

  “I guess it’s reassuring to know that everyone will get back pain, or most people will get back pain, but the what you can do to decrease it is super helpful” (MoP6)

 Useful to receive the booklet from the GP to give appropriate information and management

  “I think it would be helpful [to receive the booklet from the GP] because I think different people approach GPs with a different pace of knowledge and different set of expectations” (MoP1)

  “it [having the GP go through the booklet] highlights that you are going through and thinking about it and that you’ve got a booklet telling you the same thing and a GP telling you the same thing which sort of reinforces the message” (MoP1)

  “I should think so [feel reassured]. I know I mean again a lot of people are different but I think the fact that you’re getting it through the GP I think for a lot of people that gives it extra credibility” (MoP3)

 Booklet demonstrates why the GP made their decision not to refer for imaging

  “that little the thing on page 2 [flowchart] makes it very clear on which way, which pathway you need to go basically” (MoP8)

 Booklet provides a reminder of management advice

  “I think it’s good that GPs told me things but I might get distracted by other things happening in life as well, so if I had a booklet I could always refer back and so it’s like a dictionary – if I need to look up something I can always refer to this booklet” (MoP5)

 Booklet can be used to by patients to monitor their progress and when they need to go back to the GP

  “If you haven’t been to the doctor for a while and you think hang on what should I do again, like what should I do, should I go back - that whole when should I return for further medical advice [in the booklet] that I think that’s really good” (MoP4)

  “Yes [would feel reassured back pain being managed correctly]; that sort of makes you feel that you know what to do if it gets worse. So you know it’s been managed at the level it’s at and then if it gets any worse you can look here and go, oh yeah, that happens, probably should go get that checked” (MoP7)

 Reading booklet changed beliefs on the importance of imaging

  “I think a lot of people believe, and I certainly believed, that this [imaging] would give you that answer” (MoP1)

  “[the booklet states] that you should always look to solve pain with the least amount of surgery, doctors, x-rays, things as possible first” (MoP4)

  “I do think it [the booklet] would have changed the way I thought about imaging at first” (MoP2)

  “Yeah, yeah for sure [booklet change beliefs]. Now I know that imaging won’t necessarily show anything or it will only show something that most people will also have but not necessarily have pain for. I didn’t know that at all” (MoP7)

 Booklet unlikely to change beliefs on the importance of imaging

  “Not to me [booklet help change beliefs], I think, I would still, I would still get an x-ray or something at the start just to make sure” (MoP9)

  “I believe in a pain threshold if it’s really painful then generally it’s a sign something serious is wrong so that then you should probably consider getting imaging more strongly” (MoP1)