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Table 1 Interview guide for surgeon interviews with rationale for questions

From: Surgeons and preventive health: a mixed methods study of current practice, beliefs and attitudes influencing health promotion activities amongst public hospital surgeons

Domain Relevant quantitative findings Interview question Rationale for the question
Overview of clinical practice NA 1. Using a category 2 or 3 patient (expected wait to surgery between 90 and 365 days) as an example, can you please give an overview of a routine clinical consult? Elicit from the surgeons, in their own words, what constitutes routine practice in the non-admitted setting.
   2. We are particularly interested in the steps between telling the patient they need the procedure and the end of the consultation- do you spend any time discussing what the patient could do in this waiting time? Elicit from the surgeons whether preventive health discussions arise with patients in non-admitted practice.
Exploration of survey results How important surgeons felt it was to address lifestyle changes with patients was independently associated with preventive health practice rates (p = 0.006).
This factor did not contribute to the model that best predicted preventive health practice (p = 0.056).
1. From the clinical survey of practicing surgeons, the vast majority of surgeons indicated that addressing behavioural risk factors is important for health. At the same time however, the rates of implementation amongst the sample was low to medium. Have you any thoughts about this? Elicit opinion from surgeons as to why, despite acknowledging the importance of addressing lifestyle changes with patients, preventive health practice was predominantly undertaken at low levels.
  Independent associations were observed between with preventive health practice rates and surgeons’ confidence (p = 0.008) and knowledge (p = 0.029) at addressing lifestyle changes.
Neither confidence (p = 0.184 and knowledge (p = 0.543) contributed to the model that best predicted preventive health practice.
1. Again from the survey, surgeons indicated medium to high levels of confidence/knowledge in addressing behavioural risk factors; what we found interesting was, despite this perceived confidence/knowledge, a very low number of respondents carried out preventive health interventions.
Have you any thoughts about this?
Elicit opinions from surgeons as to why, despite reporting medium to high levels of confidence/knowledge in addressing behavioural risk factors, preventive health practice is predominantly undertaken at low levels.
Attitudes to preventive health How much of a work priority surgeons place on addressing lifestyle changes with patients significantly predicted tendency to undertake preventive health interventions (β = 1.22, p = 0.008). 1. Do you think it is an appropriate part of your job to be spending time with patients on preventive health? Elicit opinions from surgeons as to the association between work priority and preventive health practice.
  The GEE model found two factors that together, significantly predicted tendency to undertake preventive health interventions, including number of years of clinical practice (β = 0.26, p = 0.041) and work priority (β = 1.22, p = 0.008). 1. What are some reasons for deciding to engage in preventive health practice with your patients? Elicit rationale from surgeons for their engagement in preventive health.
  2. On the other side, what are some reasons for deciding not to engage in preventive health practice with your patients? Elicit rationale from surgeons for their non-engagement in preventive health.
Working environment NA 1. Time is a known barrier to undertaking health promotion in routine work, this is well established. The Specialist Clinic is extremely busy, and unlikely to see changes in time demands.
At the same time public health institutions continue to call on doctors to do more.
In the absence of more time, what can be done to facilitate this?
Elicit opinions from surgeons in relation to the call for hospitals to integrated preventive health into routine care.
Future directions N/A 1. What might need to be done differently in order to increase delivery of health promotion interventions? Elicit opinions from surgeons as to the potential to change preventive health practice rates in non-admitted settings.