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Table 5 Mapping behavior change techniques on identified barriers, suggested KT intervention components and delivery methods

From: Developing theory-informed knowledge translation strategies to facilitate the use of patient-reported outcome measures in interdisciplinary low back pain clinical practices in Quebec: mixed methods study

Step 1: Review the Barriers Step 2: Mapping the barriers to TDF domains Step3: Mapping the barriers on BCTs Step 4: Proposed all possible interventions Step 5: Selected the appropriate interventions
Lack of knowledge and skills, new skills needed to acquire to use PROMs in clinics
- ability to score and interpret the PROM data - link the scores to the patient prognosis
Aim: to improve the HCPs’ skills in scoring and interpreting PROMs data and using it in the clinical practice.
Knowledge/ Skills • Self-monitoring;
• Monitoring;
• Reward/Incentives
• Graded tasks (start easy);
• Increasing skills (problem solving; decision making, goal setting);
• Rehearsal of relevant skills;
• Modeling, demonstration of behavior by others;
• Homework
• Continuing education: offer HCPs courses on pain management that emphasize the importance of using PROMs in clinical setting.
• Workshop: educational and training workshop (Interactive workshops) in small groups led by the research team to coach the HCPs on using PROMs in clinical practice.
• Distributing educational/instructional materials to the HCPs to improve their skills on LBP PROM scores interpretation, understanding the minimal clinically important change, and linking it to the treatment components that should be implemented
• Webinar and video to provide information about scoring and interpreting a wide range of PROMs in LBP area.
• Mass Media: social media to provide information about scoring and interpreting a wide range of PROMs in LBP area
• Opinion Leader: identifying and training an opinion leader in each clinic to facilitate the using of PROMs (one to one coaching)
• Educational outreach visits: send a trained person (e,g, champion clinician) to the clinic to coach, monitor, and provide feedback on PROM use to HCPs in person.
Lack of professional role clarity in using PROMs
- the role of HCPs in using PROMs in clinical practice is not clear
Aim: to introduce and instruct the HCPs about how PROMs relate to their roles in the clinical setting.
Social/Professional Role and Identity • Social processes of encouragement, pressure, and support;
• Instruction;
• Persuasive communication
• Workshop: educational workshop (interactive workshop) to introduce participants on the clinician’s role about the use of PROMs within their clinical practice.
• Opinion Leader: identifying and training an opinion leader in each clinic to facilitate the using of PROMs and to deliver the key messages to the HCPs (i.e. HCPs’ role).
• Distributing educational materials to the HCPs on their role in using PROMs score within their clinical setting.
• Educational outreach visits: send a trained person (one of the research member) to the clinic to give information and feedback on the PROMs to the HCPs
• Webinar to provides information about the roles of HCPs in using PROMs
It is not clear how to use PROMs in the clinical setting.
- the implementation process of using PROMs in the clinical practice is not clear for some HCPs
Aim: to clarify the implementation process of PROMs
Goals • Behavioral information;
• Social processes of encouragement, pressure, and support;
• Increasing skills (problem solving; decision making, goal setting);
• Reward/Incentives;
• Motivational Interviewing
• Developing and using PROM scores reports that includes the patients’ scores, interpretation, and the treatment algorithm (first proposed action plan)
• Developing and implementing an electronic platform that includes the patients’ scores, interpretation, and the treatment algorithm (alternative proposed action plan)
• Workshop: introduce and coach the HCPs on the PROMs scores report and/or the electronic platform
• Distributing instructional materials explaining the use of the proposed PROM scores report or electronic platform.
• Opinion Leader: identifying and training an opinion leader in each clinic to facilitate the using of PROMs and help the HCPs to use the scores report and/or electronic platform.
• Educational outreach visits: send a trained person (one of the research member) to the clinic to coach the HCPs in person to implement PROMs using scores report/electronic platform.
•Webinar to provide information on the scores reports and electronic platform.
Lack of priority to use PROM tools
- using PROMs in clinical practice is not a priority for HCPs to support clinical decision making
Aim: to encourage use of PROM scores to support clinical decision making
Goals • Behavioral information;
• Social processes of encouragement, pressure, and support;
• Increasing skills (problem solving; decision making, goal setting);
• Reward/Incentives; Motivational Interviewing
• Workshop presents the benefits and advantages of using PROM scores in the clinical setting
• Distributing educational material presenting the benefits and the consequences of using PROMs in the clinical practice
• Opinion Leader: identifying and training an opinion leader in each clinic to facilitate the using of PROMs and introduce the advantages of using PROMs
• Educational outreach visits: send a trained person (one of the research member) to the clinic to discuss the advantages and the importance of using PROMs in clinical practice
• Webinar to present the advantages and the importance of using PROMs in clinical practice
• Feeding back the HCPs the outcome of their own use of PROMs (i.e. changes in patient outcomes after using PROMs)
It is difficult to use PROMs in making treatment decision
- using PROMs for the clinical decision making is difficult
Aim: to facilitate using use of PROM scores in the clinical practice in order to use for support clinical decision making
Decision Processes • Self-monitoring;
• Planning/implementation;
• Prompts/Triggers/Cues
• Using PROM scores report that includes the patients’ scores, interpretation, and the treatment algorithm options. Present an action plan to ease the use of PROMs in clinical decision making
• Implementing an electronic platform includes the patients’ scores, interpretation, and the treatment algorithm (alternative action plan)
• Workshop: introduce and coach the HCPs on the scores report and the electronic platform in making treatment decision
• Opinion Leader: identifying and training an opinion leader in each clinic to facilitate the using of PROMs and help the HCPs use the scores report/electronic platform in making treatment decision
• Educational outreach visits: send a trained person (one of the research member) to the clinic to coach the HCPs in person to use scores report/electronic platform in making treatment decision
• Webinar to provide information on the proposed scores reports and electronic platform and how to use them in making treatment decisions
Using PROMs in clinical practice is not necessary to improve patient health outcome
- Using PROMs in clinical practice is not necessary to improve patient health outcome and/or to improve the quality of patient’s care
Aim: to increase HCPs’ knowledge regarding the benefits of using PROMs in clinical practice.
Beliefs about Consequences and Reinforcement • Persuasive Communication;
• Information regarding behavior outcome;
• Feedback;
• Self-monitoring;
• Reward/Incentives)
• Workshop that presents the benefits of using PROM scores in the clinical setting
• Distributing educational material on the benefits and the consequences of using PROMs in clinical practice
• Opinion Leader: Identifying and training an opinion leader in each clinic to facilitate the using of PROMs and introduce the advantages of using PROMs
• Educational outreach visits: send a trained person (one of the research member) to the clinic to discuss the advantages and the importance of using PROMs in clinical practice
• Webinar to present the advantages and the importance of using PROMs in clinical practice
• Feeding back the HCPs the outcome of their own using of PROMs
Lack of time
- lack of time among HCPs is a barrier to use PROMs in clinical practice
Aim: developing a tool to facilitate and maximize using PROMs in clinical setting without time consuming
Environmental Context and Resources • Environmental Changes;
• Time management
• Using PROM scores report that includes the patients’ scores, interpretation, and the treatment algorithm. This the first proposed plan to facilitate using PROMs in making treatment decision
• Implementing an electronic platform along with the patients’ scores, interpretation, and the treatment algorithm (alternative proposed plan)
HCPs don’t assess patients’ motivation to complete PROMs
- patients’ motivation to use PROMs in clinical practice is not assessed by HCPs
Aim: developing an assessment tool to assess the patients’ motivation to use PROMs in the clinical practice as a stakeholder. This tool is administered at the first appointment only.
Behavioral Regulation • Monitoring; Environmental Changes;
• Prompt
• Developing measurement tools to assess patients’ motivation to comply with completing PROMs
• Providing HCPs with the motivational assessment tool to evaluate patient motivation.
HCPs don’t use PROMs automatically
 - using PROMs in clinical practice is not easily integrated into routine clinical practice by HCPs
Aim: helping HCPs to integrate and use PROMs in routine clinical practice
Behavioral Regulation and Memory • Self-monitoring; Contract;
• Planning/implementation;
• Prompts/Triggers/Cues;
• Use of imagery
• Using PROM scores report that includes the patients’ scores, interpretation, and the treatment algorithm. This the first proposed plan to facilitate using PROMs in making treatment decision
• Sending the HCPs a reminder to use PROMs in the clinical setting, through
 ▪ E-mail
 ▪ Decision support tool, or
 ▪ Opinion leader
Patients influence clinician PROMs practice
- patient’s view could influence their clinical practice in terms of using PROMs in the management of patients with LBP
Aim: increasing the confidence of HCPs to use PROMs in the management of patients with LBP
Social Influence • Social processes of encouragement, pressure, and support;
• Social Support;
• Modeling/ Demonstration of behavior by others
• Identifying and training an opinion leader in each clinic to facilitate the using of PROMs and to deliver the key messages to the HCPs
• Providing the HCPs with the effectiveness of using PROMs to be able to provide the patients with the PROMs effectiveness in clinical practice
• Workshop: educational and training workshop (Interactive Workshop) led by the research team to coach the HCPs in a group on using PROMs in clinical practice
• Encouraging collaborations between interdisciplinary team members to discuss the implementation of PROMs and the benefits of using them in practice
• Social media to provide information on the advantages of PROMs, with testimonials from HCPs and patients
  1. BCTs Behavioral Change Techniques, KT Knowledge Translation, LBP Low Back Pain, PROMs Patient Reported Outcome Measures, TDF Theoretical Domain Framework