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Table 3 Mapping of important barriers and enablers (grouped by TDF) to behaviour change techniques and intervention components developed

From: Development of targeted, theory-informed interventions to improve bronchiolitis management

TDF Domain Selected BCTs as intervention components
Beliefs about consequences Persuasive communication; Information regarding behaviour, outcome1: Clinical leads (nursing and medical) will continually educate to reinforce the benefits of adhering to the 5 bronchiolitis guideline recommendations.
Feedback1: Provide historical data on hospital and Australasian bronchiolitis compliance, with monthly individual hospital audit data being disseminated to clinicians by clinical leads.
Pros and cons2: Clinical leads to discuss positive impact of following guideline in reducing therapies known to be of no benefit.
Vicarious reinforcement2: Clinical leads will use reinforcement messages in education of following guideline recommendations.
Social and environmental consequences2; Salience of consequences2: Clinical leads will reinforce consequences for infants/families and hospital in following guideline e.g. length of stay, cost, reducing harm.
Knowledge Information regarding behaviour, outcome1: Clinical leads will continually educate to reinforce the benefits of adhering to guideline recommendations and use evidence information sheets to reinforce (salbutamol; CXR and antibiotics).
Antecedents2: Clinical leads to educate clinicians on situations or events that predict increased therapy use e.g. time and family pressure, reduced senior support.
Health consequences2: Clinical leads will reinforce consequences for infants/families and hospital in following guideline e.g. length of stay, cost, reducing harm.
Feedback on behaviour2: As per Feedback (Beliefs about consequences).
Social professional role and identity Social processes of encouragement, pressure, support1: Clinical leads are respected clinicians who continually reinforce and role model guideline recommendations in practice.
Environmental context and resources Environmental changes1: The Australasian Bronchiolitis guideline will be available in hard copy, electronic and via intranet to all clinicians. All teaching materials will be provided in hard and electronic copy. Clinical leads requested to incorporate guideline recommendations in staff induction sessions.
Prompts/cues2: Clinical leads will be encouraged to use posters, screen savers, electronic prompts, email as reminders.
Skills Goal/target specified: behaviour or outcome1: Hospitals will be encouraged to set improvement targets for guideline recommendations.
Monitoring1: As per Feedback (Beliefs about consequences).
Increasing skills: problem solving, decision making, goal setting1: Clinical leads will continually educate to increase knowledge, skills and confidence in diagnosing bronchiolitis, assessment and management.
Modelling/demonstration of behaviour of others1; Rehearsal of relevant skills1; Behavioural rehearsal/practice2: Clinical leads will show clinicians a video of a clinician describing bronchiolitis to a family (for clinician teaching) and model this in clinical practice.
Social influences Social processes of encouragement, pressure, support1; Modelling demonstration of behaviour by others1; Social support or encouragement2; Modelling/demonstration of behaviour2: Hospitals will receive a bronchiolitis information sheet for families/caregivers to support clinicians discussions with families.
Vicarious reinforcement: As per Vicarious reinforcement (Beliefs about consequences)
Beliefs about capabilities Self-monitoring1; Increasing skills: problem solving, decision making, goal setting1; Rehearsal of relevant skills1; Social pressures of support, encouragement support1 (as per Social professional role and identity); Feedback1 (as per Beliefs about consequences); Focus on past success2.
Clinical leads will provide encouragement on adherence to guideline recommendations using monthly audits to feedback on performance.
  1. TDF Theoretical Domains Framework
  2. BCT Behaviour Change Technique
  3. 1Michie et al. [4]
  4. 2Cane et al. [12]