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Table 2 Themes and subthemes relating to Theoretical Domains Framework Implementation (TDFI) challenges

From: Process evaluation of a behaviour change approach to improving clinical practice for detecting hereditary cancer

Theme Subtheme Subtheme definition
Challenges related to using theory underpinning the TDFI approach Accessibility of theory Ease of which the theory can be understood and applied; access to support from theory experts.
Commitment to theory Issues relating to participants’ understanding of the value of theory in eliciting behaviour change, and subsequent adherence to the use of theory at the prescribed stages of the research project.
Problem complexity Issues around the processes leading to the outcome, here the processes leading to identification and referral of patients flagged at high risk of Lynch syndrome.
Practical (or context) challenges Navigating the system (and system changes) Issues around governance and ethical regulatory requirements; understanding of local politics and tacit behaviours/cultural factors
Constant changes affecting teams and processes, such as introduction of new IT systems.
Stakeholder management Issues related to multiple stakeholders across different disciplines and departments.
Perceptions of the problem Issues around the perceived effort one should invest in the identified problem; lack of awareness about generalisability of solutions across contexts.