Table 4 Mapped barriers to TDF domains, intervention strategies and channels of delivery
Barriers | TDF domains | BCTs (Online tool)* | Effective BCTs in Cochrane Review (Patients) | Effective BCTs in Cochrane Review (HCP**) | BCTs + Effective strategies (Cochrane) | BCTs to be Operationalized | Target: Patient vs HCP** | Operationalized Solutions (Components of the intervention) | Mode and Settings of Delivery1,2 |
|---|---|---|---|---|---|---|---|---|---|
Language Barrier | Skills + Social Influences | 4.1., 3.2., 7.1., 7.5., 8.1., 8.7., 12.1., 12.2., 12.3., 12.5., 1.2., 6.1., 8.1., 8.7., 15.1., 15.3., 15.4 | 4.1., 3.2., 7.1., 12.2 | 4.1., 3.2., 7.1., 12.2., 12.5 | 4.1., 1.2 | 3.2. Social support (practical) 4.1. Instructions on how to perform behaviour | Patient | 1. Language support services: Leveraging Language support services to deliver the intervention via phone, virtual (zoom), and physical interpretation as needed 2. Flyers with translated terms: Provide flyers with translated key medical terms | 1. Human interactional mode of delivery 2. Printed publication mode of delivery |
Not knowing what retinopathy screening is/ Lack of knowledge | Knowledge | 2.6., 4.1., 4.2., 5.1., 5.3 | 4.1., 5.1 | 4.1 | 4.1., 5.1 | 4.1 Instruction on how to perform the behavior 5.1. Information about health consequences | Patient | 1. Group workshops: Programming is provided at the Community Health Centre (CHC) in Mandarin and French focused on diabetes and its complications. Provide information about the intervention, diabetic retinopathy, consequences, screening, and how to attend screening (i.e., 1–2 presentation slides) at the programs 2. Posters: create a “poster” with short and simple messaging on diabetic retinopathy, consequences, and screening that can be displayed at doctors’ offices, pharmacies, other CHCs, Diabetes Education Programs, walk-in clinics, and clinics accepting newcomers 3. Flyers, information sheets, and videos: - Communicate information about how to book screening, the screening process, the difference between screening and routine check, and risks | 1. Group-based mode of delivery at Community Healthcare facility 2. Public notice mode of delivery at healthcare facilities 3. Printed publication mode of delivery, Visual informational mode of delivery, and Website mode of delivery at Community and retail, facilities, and social settings |
Lack of communication with the family doctor about screening + Doctor hasn’t told him/her about it + Doctor doesn’t help to make appointment | Social Influences | 3.1., 3.2., 6.2., 6.3., 10.4 | 3.1., 3.2 | 3.2 | 3.1., 3.2 | 3.1. Social support (unspecified) 3.2. Social support (practical) | HCP | 1. Send Reminders: - Appointment reminders are generated and sent to patients 24 h before scheduled visits - Pre-book yearly visits, i.e., book appointments one-year in advance via the Electronic Medical Record (EMR) and reminders will be sent one week before the appointment 2. Social Support: Arranging for support from friends/family/ community. i.e., provide support via Community Champions and create a diabetes patient WeChat group 3. Disseminate resources at various locations: - Information about diabetic retinopathy screening and the intervention sent to HCPs | 1. Messaging mode of delivery, or Email mode of delivery 2. Human interactional mode of delivery and electronic mode of delivery (Diabetes support WeChat group) |
Insufficient publicity about the screening | Knowledge + Environmental Context and Resources | 2.6., 4.1., 4.2., 5.1., 5.3., 3.2., 7.1., 7.5., 12.1., 12.2., 12.3., 12.5 | 4.1., 5.1., 7.1 | 4.1., 7.1., 12.5 | 4.1., 5.1., 7.1., 12.5 | 4.1 Instruction on how to perform the behavior 5.1. Information about health consequences 7.1. Prompts/cues 12.5. Adding objects to the environment | Patient and HCP | 1. WeChat for communicating about the intervention: Patient partners communicate via their networks and groups on WeChat about the intervention using the developed resources 2. Host videos and other resources on CHC Website: -Video resources for the intervention hosted on the CHC website 3. Disseminate resources at various locations: - Information about the intervention posted via the CHC’s communication channels, sent to health practitioners at other CHCs, and community organizations 4. Using TV Screens for promotion: - Where CHCs have a TV screen in client waiting areas, leverage this to display a poster with intervention information | 1. Electronic mode of delivery (WeChat) 2. Visual informational mode of delivery, and Website mode of delivery 3. Printed publication mode of delivery at health, religious, retail facilities, and social settings 4. Electronic billboard mode of delivery at Community healthcare facility |
Hard to fit eye screening around work and other activities | Environmental Context and Resources | 3.2., 7.1., 7.5., 12.1., 12.2., 12.3., 12.5 | 3.2., 7.1., 12.2 | 3.2., 7.1., 12.2., 12.5 | 3.2., 7.1., 12.2., 12.5 | 3.2. Social support (practical) 7.1. Prompts/cues 12.2. Restructuring the social environment | HCP | 1. Send Reminders to patients 2. Conduct screening with other diabetes care: - Coordinate eye screening with diabetes education visits and diabetes care activities such as foot care - Retinopathy screening integrated with the ongoing diabetes workshops such as the Chinese group workshops, where clients can connect with peers to have support whilst getting their eyes screened | 1. Messaging mode of delivery, or Email mode of delivery, or Letter mode of delivery 2. Community healthcare facility |