Table 3 Theoretical domains and sample quotes related to identifying needs

 Social professional role and identity

Perceived role in follow-up care influences approaches to identifying needs (M)

“I: So, do you see that a part of your role to ask about things like people’s social activities and their mood and cognition and the more holistic side?

IV: Yeah, I think it is part of our role…”

[H22, nurse, 13 Years of experience]

“Usually it’s pretty much a one-stop clinic so if they need a carotid scan they get it there. If they need a brain scan urgently they get it there. We give them the medication that they need to prevent further events, book any other tests which are non-urgent but still need to be done and then we discharge them. So it’s a one-stop medical clinic.”

[H24, consultant, 12 Years of experience]

Professional training influenced approaches to identifying needs (M)

“As an OT, obviously we’re dual trained in physical and mental health.”

[H14, AHP, 17 Years of experience]

 Knowledge

Knowledge/ lack of knowledge of potential patient needs (M)

“…but there might be a lack of education, medical education about the, yeah, the long-term consequences really.”

[H13, GP, 13 Years of experience]

“…and that can affect you, you know you can’t drive, you maybe can’t work, can’t watch TV, can’t read, it’s a very small minor stroke but it’s had a big effect.”

[H4, nurse, 37 Years of experience]

 Goal

HCPs had different perceptions on the goal of their follow-up (M)

“In the review clinic, we make sure two things, one, that all investigations have been completed. Secondly all the risk factors have been addressed and thirdly they’re on the right medications for the conditions. So, we just see them one more time after being seen in the TIA clinic.”

[H7, consultant, 20 Years of experience]

“And it’s quite a holistic type clinic so we look at them although obviously we’re focussing on the stroke, we’re looking at the whole person.”

[H4, nurse, 37 Years of experience]

“…so the follow up that I offer tends to be just checking that they’re ok, that they’re sort of getting on with their medications that they have recently been prescribed and just ensuring that they are kind of informed about you know what the process is and any further results that are coming back through and I guess sort of just general support about you know ongoing risk factors and risk reduction…”

[H8, GP, 17 Years of experience]

 Intentions

Active vs passive approach to identifying needs (M)

“I don’t actively ask for it, I don’t actively for sleep and emotional problems, not things that I tend to ask about…”

[H20, consultant, 22 Years of experience]

“So, there’s an element of tailoring. But we do always generally check mood, fatigue, confidence as well, as part of what we’re doing.”

[H22, nurse, 13 Years of experience]

 Social influences

Personal experience of TIA/minor stroke (E)

“…but it almost seems like there is a kind of post TIA syndrome and certainly I probably first became aware of that through personal experience really rather than in the practice.”

[H8, GP, 17 Years of experience]

 Beliefs about capabilities

Confident/ not confident in identifying needs (M)

“I: Do you feel quite confident in being able to identify what their [patients’] needs are?

IV: Yeah. yeah, I think I definitely…”

[H16, AHP, 4 Years of experience]

 Environmental context and resources

Checklists/ screening tools used/ not used to facilitate identification of needs (M)

“We use formal mood screens in [location]… the HADS, the DISC, those types of things. In terms of fatigue we use self-rating scales for fatigue. Obviously, cognition we’ve got a whole host of standardised assessments that we use, alongside functional assessments as well. Anxiety again, would be self-rating. And fear of falling would be self-rated. We don’t use every single one with every single patient but we have those.”

[H14, AHP, 17 Years of experience]

We don’t, at the moment, do a formal mood assessment and we don’t do a formal cognitive screen within clinic.”

[H3, AHP, 23 Years of experience]

Lack of time to use screening tools (B)

“…in a clinic setting, there isn’t really time to do lots of formal screening.”

[H3, AHP, 23 Years of experience]

 Beliefs about consequences

Checklist/ screening tools considered useful/ not useful (M)

“I mean the screen tools don’t always pick up on these things and sometimes we’ve found that, you know, at home they answer that everything’s alright on the PHQ’s but actually when you see them they are clearly upset about something.”

[H8, GP, 17 Years of experience]

“It [checklist] just gets a good, overall idea of what they’re doing and then identifies then at the end of it what they need to be referred to.”

[H1, AHP, 5 Years of experience]

 Reinforcement

Content of primary care long-term conditions template is influenced by performance-based incentives (Quality and Outcomes Framework) (B)

“Cause one of the things we have at present in our clinical systems is templates… I think they tend to be very much QOF kind of based. So, it’ll probably be addressing things like cholesterol, blood pressure, their sugar etc. etc. Medication, making sure they are on the appropriate medications… I don’t think it actually addresses the kind of psychological aspects.”

[H10, GP, 31 Years of experience]

Screening tool mandated by local Clinical Commissioning Group (B)

“…the Barthel Index is obviously the Clinician Commissioning Group level, so I don’t think that will change…”

[H2, AHP, 3 Years of experience]

 Memory, attention and decision processes

Checklist/ screening tool used to inform decision making (E)

“…then we’ll use it [screening tool] to set the goals and then we’re doing it to give them to focus. What we want to do is improve their score and also so that we can monitor that what we’re doing is effective as well.”

[H5, AHP, 16 Years of experience]

 Skill

Skilled/ not skilled in use and interpretation of screening tools (M)

“…we’ve trained the physios to do MOCAs, so, we provide weekend service on the wards. Unfortunately not in ESD at the moment, so, if a physio is working at the weekend, they can do a MOCHA over the weekend, so, there isn’t that delay.”

[H14, AHP, 17 Years of experience]

 Social influences

Cultural/ language barriers (B)

“The obvious one is language and non-English speaking patients where you may not know that until they come to clinic and you’re really then stuck…”

[H3, AHP, 23 Years of experience]

Patients not wanting to “bother” doctor or raise non-medical issues (B)

“…especially elderly people they don’t pester their GP for things, my mum says that, I don’t want to trouble the GP.”

[H4, nurse, 37 Years of experience]

Family members as facilitators/ barriers to identification of patient needs (M)

“The other one is just normally again partners coming in and it tends to be men who come in and they don’t say a great deal and then the partner or wife mentions they’re worried that the patient’s been like this for a long time and then they tell me everything.”

[H12, GP, 7 Years of experience]

“…people can be quite proud and not want to sort of, they want to put a good front on it for other family members and things and not admit it.”

[H6, AHP]