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PURPOSE: To explore influences on the capability, opportunity and motivation of physiotherapists integrating new evidence into routine care. MATERIALS AND METHODS: Mixed-methods study utilising the Theoretical Domains Framework and Capability-Opportunity-Motivation-Behaviour model. Metropolitan inpatient rehabilitation physiotherapists participated by integrating the Balance Intensity Scale into routine care for 6 weeks. Evidence integration was supported by a tailored theory-informed approach. Participants completed pre- and post-evidence integration surveys and a post-evidence integration focus group. RESULTS: Pre- and post-surveys were completed by 24 and 12 participants, respectively. One focus group (n = 7) was conducted. Framework analysis identified themes in Capability (n = 4), Opportunity (n = 4) and Motivation (n = 5) domains influencing behaviour when implementing new evidence. The evidence integration process enhanced participants' Knowledge (p = 0.04), Skills (p = 0.003) and Belief in capabilities (p = 0.03) when prescribing and measuring balance exercises. CONCLUSIONS: This study identified perceived barriers and enablers to evidence integration of a new outcome measure into routine care. It highlights strategies that may support physiotherapy teams in incorporating new evidence into routine care. These strategies include education on the evidence being implemented, physical resources, change champions to facilitate social support, management endorsement, and recognition of the time and effort required for evidence integration in the short term.

When integrating new evidence into routine physiotherapy care in rehabilitation settings, the theoretical domains framework can provide a suitable framework to identify potential barriers and enablers of evidence integration at a local level, to guide the tailoring of support strategies.Rehabilitation physiotherapists can integrate the Balance Intensity Scale into balance exercise prescription as part of routine care.Targeted education provides support to change practice and implement evidence-informed care.Clinical change champions and sharing the effort to change as a team are pivotal in fostering the adoption of new evidence, such as the Balance Intensity Scale, into practice.

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Endovascular aortic repair (EVAR) is now first line therapy for most patients with abdominal aortic aneurysms (AAA) as it reduces perioperative morbidity and mortality compared to open surgery. However, up to 40 % of patients do not undergo recommended follow-up, increasing risk of subsequent rupture. Risk factors for loss to follow-up have been studied retrospectively, however, qualitative studies assessing perceived barriers and facilitators to follow-up have not been performed and there are few qualitative protocols within the vascular surgery literature. This article presents a qualitative descriptive study protocol aimed at understanding and improving post-operative follow-up adherence after EVAR developed through an iterative process based on the Theoretical Domains Framework of behavior change. Steps include:•Selection of target behavior and study design•Development of study materials, sampling/recruitment strategy, and data collection•Qualitative data analysis and reporting findingsWe demonstrate the feasibility of this study by pilot testing of the semi-structured interview guides on a small group of patients, healthcare providers, and key personnel. This protocol aims to describe key stakeholder experiences within the healthcare system that will ultimately serve as the basis for future multi-institutional research piloting intervention strategies to improve EVAR follow-up.

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BACKGROUND: Back pain is very common and a leading cause of disability worldwide. Due to health care system inequalities, Indigenous communities have a disproportionately higher prevalence of injury and acute and chronic diseases compared to the general Canadian population. Indigenous communities, particularly in northern Canada, have limited access to evidence-based spine care. Strategies established in collaboration with Indigenous peoples are needed to address unmet healthcare needs, including spine care (chiropractic and movement program) services. This study aimed to understand the views and perspectives of Cross Lake community leaders and clinicians working at Cross Lake Nursing Station (CLNS) in northern Manitoba regarding the implementation of the Global Spine Care Initiative (GSCI) model of spine care (MoC) and related implementation strategies. METHOD: A qualitative exploratory design using an interpretivist paradigm was used. Twenty community partners were invited to participate in semi-structured interviews underpinned by the Theoretical Domains Framework (TDF) adapted to capture pertinent information. Data were analyzed deductively and inductively, and the interpretation of findings were explored in consultation with community members and partners. RESULTS: Community leaders (n = 9) and physicians, nurses, and allied health workers (n = 11) emphasized: 1) the importance of contextualizing the MoC (triaging and care pathway) and proposed new services through in-person community engagement; 2) the need and desire for local non-pharmacological spine care approaches; and 3) streamlining patient triage and CLNS workflow. Recommendations for the streamlining included reducing managerial/administrative duties, educating new incoming clinicians, incorporating follow-up appointments for spine pain patients, and establishing an electronic medical record system along with a patient portal. Suggestions regarding how to sustain the new spine care services included providing transportation, protecting allocated clinic space, resolving insurance coverage discrepancies, addressing misconceptions about chiropractic care, instilling the value of physical activity for self-care and pain relief, and a short-term (30-day) incentivised movement program which considers a variety of movement options and offers a social component after each session. CONCLUSION: Community partners were favorable to the inclusion of a refined GSCI MoC. Adapting the TDF to unique Indigenous needs may help understand how best to implement the MoC in communities with similar needs.

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Background: Social disconnection is a public health concern among rural Australian older adults. While research suggests technology can enhance social wellbeing and protect against social disconnection, many older adults are not digitally literate, and little is known as to why and how technology adoption could be promoted in rural contexts. This study aimed to (1) explore the barriers and facilitators of technology adoption among rural older adults and (2) determine the potential utility of technology to promote social connectedness in the aged population. The Theoretical Domains Framework and the Behaviour Change Wheel (BCW) were employed to gain a comprehensive understanding of the digital and social behaviours of rural Australian older adults. Methods: Semi-structured interviews were conducted with a convenience sample of 33 rural older adults aged between 65 and 87 years. Interviews were conducted over the phone, audio-recorded, and transcribed. Interview transcripts were coded and analysed using thematic analysis and the BCW. Results: Numerous barriers and facilitators of technology adoption were identified, with the most prominent being knowledge, perceived value, perceived self-efficacy, and social support. Findings suggest that older adults' technology adoption is not simply a technical matter, but influenced by various individual, social, and environmental contexts. Consideration of these factors during development, marketing, training and implementation may facilitate technology adoption among older adults. With regard to social connectedness, several rural barriers emerged, including low population density, geographic isolation, limited community opportunities and poor public transport infrastructure. Conclusion: Technology was consistently identified as a facilitator of the social experience, indicating that technology is a promising tool to enhance social connectedness among older adults, particularly those living in rural areas. Future research should focus on enhancing the capability, opportunity and motivation of older adults in technology adoption, with reference to the rural contexts.

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BACKGROUND: While osteoarthritis is a significant issue within the hemodialysis population and contributes to reduced quality of life, pain related to osteoarthritis is poorly managed by healthcare professionals (HCPs) in hemodialysis settings due to the absence of clinical guidance applicable to this population. The purpose of this study was to explore the perceptions of HCPs on the barriers and facilitators to using a clinical decision support tool for osteoarthritis pain management in the hemodialysis setting. METHODS: A qualitative descriptive study was conducted. Purposeful and snowball sampling techniques were used to recruit hemodialysis clinicians from academic and community settings across multiple Canadian provinces. One-to-one interviews were conducted with clinicians using a semi-structured, open ended interview guide informed by the Theoretical Domains Framework, a behavior change framework. A general inductive approach was applied to identify the main themes of barriers and facilitators. RESULTS: A total of 11 interviews were completed with 3 nephrologists, 2 nurse practitioners and 6 pharmacists. Findings revealed 6 main barriers and facilitators related to the use of the clinical decision support tool. Alignment of the tool with practice roles emerged as a key barrier and facilitator. Other barriers included challenges related to the dialysis environment, varying levels of clinician comfort with pain medications, and limited applicability of the tool due to patient factors. An important facilitator was the intrinsic motivation among clinicians to use the tool. CONCLUSIONS: Most participants across the included hemodialysis settings expressed satisfaction with the clinical decision support tool and acknowledged its overall potential for improving osteoarthritis pain management among patients on hemodialysis. Future implementation of the tool may be limited by existing roles and practices at different institutions. Increased collaboration among hemodialysis and primary care teams may promote uptake of the tool.

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BACKGROUND: The burden of hypertension among people with HIV is high, particularly in low-and middle-income countries, yet gaps in hypertension screening and care in these settings persist. This study aimed to identify facilitators of and barriers to hypertension screening, treatment, and management among people with HIV in primary care clinics in Johannesburg, South Africa. Additionally, different stakeholder groups were included to identify discordant perceptions. METHODS: Using a cross-sectional study design, data were collected via interviews (n = 53) with people with HIV and hypertension and clinic managers and focus group discussions (n = 9) with clinic staff. A qualitative framework analysis approach guided by COM-B and the Theoretical Domains Framework were used to identify and compare determinants of hypertension care across stakeholder groups. RESULTS: Data from clinic staff and managers generated three themes characterizing facilitators of and barriers to the adoption and implementation of hypertension screening and treatment: 1) clinics have limited structural and operational capacity to support the implementation of integrated care models, 2) education and training on chronic care guidelines is inconsistent and often lacking across clinics, and 3) clinicians have the goal of enhancing chronic care within their clinics but first need to advocate for health system characteristics that will sustainably support integrated care. Patient data generated three themes characterizing existing facilitators of and barriers to clinic attendance and chronic disease self-management: 1) the threat of hypertension-related morbidity and mortality as a motivator for lifestyle change, 2) the emotional toll of clinic's logistical, staff, and resource challenges, and 3) hypertension self-management as a patchwork of informational and support sources. The main barriers to hypertension screening, treatment, and management were related to environmental resources and context (i.e., lack of enabling resources and siloed flow of clinic operations) and patients' knowledge and emotions (i.e., lack of awareness about hypertension risk, fear, and frustration). Clinical actors and patients differed in perceived need to prioritize HIV versus hypertension care. CONCLUSIONS: The convergence of multi-stakeholder data highlight key areas for improvement, where tailored implementation strategies targeting motivations of clinic staff and capacity of patients may address challenges to hypertension screening, treatment, and management recognized across groups.

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Introduction: Antimicrobial resistance (AMR) poses a significant global threat to public, animal, and environmental health, consequently producing downstream economic impacts. While top-down approaches to addressing AMR (e.g., laws regulating antimicrobial use) are common in high-income countries, limited enforcement capacities in low- and middle-income countries highlight the need for more bottom-up approaches. Within agriculture, efforts to apply bottom-up approaches to AMR have often focused on the promotion of biosecurity, which should reduce the need for antimicrobials by mitigating disease risk and limiting AMR transmission. Traditionally, efforts to encourage biosecurity adoption have emphasized training and awareness-raising initiatives. However, a growing body of research suggests a disconnect between knowledge and behavior, highlighting the existence of a knowledge-action gap. Method: To understand the barriers and enablers patterning the knowledge-action gap in on-farm biosecurity uptake, we draw upon models from behavioral science. We analyzed in-depth interviews and two focus group discussions with smallholder poultry producers in Ghana to understand factors underlying the intention-action gap in adopting biosecurity. As an analytical framework, we draw upon the Theoretical Domains Framework in combination with the Capability-Opportunity-Motivation Behavioral Model. Results and discussion: While smallholder poultry farmers in Ghana were aware of the importance of biosecurity practices, they struggled with consistent implementation. Financial constraints, challenges in adapting practices to the local context, and limited resources hindered adoption. Additionally, cognitive biases like prioritizing short-term gains and underestimating disease risks played a role. However, some farmers found motivation in professional identity and social influences. These findings highlight the need for designing biosecurity interventions that consider human behavioral factors and the context in which behavior occurs. This underscores the importance of collaboration across disciplines, including veterinary science and the social and behavioral sciences. Implications and recommendations for researchers and practitioners are discussed.

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Background: Internet hospitals have become an important way to improve the accessibility of medical services and promote medical equity in China. However, there is still lack of research on the behavior of medical personnel during the process of using Internet medical services, and the elements of behavior that motivate doctors to actively use or resist the use of Internet hospitals are still not fully analyzed. The study applied the Theoretical Domains Framework to examine the factors affecting the engagement of medical personnel in Internet hospitals, with the aim of guiding the design of intervention to enhance Internet hospital participation. Methods: This study utilized qualitative analysis. Semi-structured questionnaires based on the Theoretical Domains Framework (TDF) and Capability-Opportunity-Motivation-Behavior (COM-B) model was developed and administered to 40 doctors and nurses at a Grade A tertiary hospital in Guangdong Province. Data was coded and analyzed using qualitative methods including Nvivo software. Results: The research displayed 19 barriers and 7 enablers for the implementation of Internet hospitals, all 14 TDF domains impacted participation with motivation cited most frequently. Despite challenges, medical personnel exhibited a generally optimistic stance towards utilization of the Internet hospital. Major barriers include the higher requirement of diagnostic ability, objective difficulties brought by online consultation to the decision-making process, limitation of time and other resources, not ideal technological and institutional environment, lack of self-efficacy and negative expectation of results in online consultation. Key enablers include patient needs and the positive impact of online care on the medical process and patient experience. Discussion: This qualitative study identified a range of barriers and enablers to Internet hospital participation according to medical personnel, providing an conceptual framework to guide further research evaluating implementation strategies. Expanded research and targeted interventions design can help optimize participation in this evolving healthcare delivery model.

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BACKGROUND: Physical activity engagement following a cancer diagnosis is positively associated with survival, reduced risk of disease recurrence, and reduced cancer-specific and all-cause mortality. However, rates of physical activity engagement are low among individuals diagnosed with and being treated for breast cancer or prostate cancer. OBJECTIVE: The purpose of this study was to describe the systematic process of developing an e-cycling intervention aimed at increasing physical activity among individuals living with prostate cancer or breast cancer and outline the key components to be implemented. METHODS: The Medical Research Council guidance for developing complex interventions and the Behaviour Change Wheel were used to guide intervention development. Information was gathered from the literature and through discussions with end users to understand factors influencing e-cycling. These factors were mapped onto the Theoretical Domains Framework to identify potential mechanisms of action. Behavior change techniques were selected from theory and evidence to develop intervention content. Interested parties, including cycling instructors, end users, and behavior change experts, reviewed and refined the intervention. RESULTS: Anticipated barriers and facilitators to e-cycling engagement were mapped onto 11 of the 14 domains of the Theoretical Domains Framework. A total of 23 behavior change techniques were selected to target these domains over 4 one-to-one e-cycling sessions delivered by trained cycling instructors in the community. Cycling instructors were provided a 3-hour classroom training session on delivering the intervention and a 3-hour practical session with feedback. The outcome of this work is a theory and evidence-informed intervention aimed at promoting e-cycling behavior among individuals being treated for breast cancer or prostate cancer, which is currently being implemented and evaluated. CONCLUSIONS: Transparent intervention development and reporting of content is important for comprehensively examining intervention implementation. The implementation of this intervention package is currently being evaluated in a pilot randomized controlled trial. If the intervention is found to be effective and the content and delivery are acceptable, this intervention will form a basis for the development of e-cycling interventions in other survivors of cancer. TRIAL REGISTRATION: ISRCTN Registry ISRCTN39112034 https://www.isrctn.com/ISRCTN39112034; and IRSCTN Registry ISRCTN42852156; https://www.isrctn.com/ISRCTN42852156.

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INTRODUCTION: Medication errors have a significant impact on patient safety and professional practice. The widespread under-reporting of errors by clinicians indicates the critical need for behavioral change. This systematic review aimed to identify and synthesize qualitative evidence on factors influencing clinicians' reporting of medication errors. AREAS COVERED: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, PubMed, and Embase were searched until March 2023 for studies on factors influencing clinicians' reporting of medication errors. Two independent reviewers conducted the screening, data extraction, and quality appraisal. Using framework synthesis approach, the identified themes were mapped to Theoretical Domains Framework (TDF). EXPERT OPINION: The review analyzed fourteen high-quality studies across various regions. Facilitators of reporting were identified in the TDF domains of beliefs about consequences knowledge and social/professional role and identity. More themes emerged as barriers, mapped to the domains of beliefs about consequences, emotions, environmental context and resources and knowledge. The review suggests aligning these barriers with key behavior change techniques, such as emphasizing the risks of non-reporting, promoting emotional well-being, improving accessibility of reporting systems and advancing knowledge through educational programs. Future work should focus on developing these behavior change techniques into practical interventions.

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Background: The Theoretical Domains Framework (TDF) is among the most extensively utilised foundational frameworks in implementation science. It was developed from 33 psychological theories, with the latest version identifying 14 domains encompassing 84 theoretical constructs. These domains and constructs capture the complexity of factors that affect behaviours, making the framework a valuable tool for designing and implementing interventions within health and social care settings. Objective: To summarise the development, hot topics, and future trends in TDF-related research and provide implementation practitioners with more information on the application of TDF. Methods: We used TDF as the topic and searched the ISI Web of Science Core Collection, identifying 1382 relevant publications. We used analytical tools such as Excel, Tableau, VOSviewer, and Citespace to conduct a bibliometric analysis of the relevant publication. Results: We identified the United Kingdom as the primary contributor, with University College London as the key institution. Susan Michie ranked highest in total citations. The analysis highlighted cancer and stroke as primary clinic medicine-related topics using TDF. Emerging themes encompass abuse, violence, maternal health, antenatal care, patient involvement, and trauma-informed care et al. "Nurse" and "qualitative research" emerged as recent and enduring hotspots, possibly indicating future research trends. Conclusion: This article represents the first attempt to summarise the TDF using bibliometric analysis. We suggest this method can be used to analyse other theoretical frameworks in scientific implementation of its objectivity and quantifiability. Overall, the application scope of TDF is shifting from public health towards more specialised clinical directions, although its application in the field of public health is continuously expanding. In the future, the number of users of TDF is also expected to expand from implementation scientists to professional technical personnel.

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Consumer interest in plant-based milk alternatives is growing, despite extra charges in coffeehouses. While much research exists on non-dairy alternatives, plant-based milks in coffee drinks remain understudied. This study examines consumer preferences and behaviors regarding milk alternatives in coffee, using the Theoretical Domains Framework (TDF) and the Behavior Change Wheel (BCW). A survey of 200 participants from 19 countries explored demographics, coffee habits, attitudes towards non-dairy milk charges, and marketing awareness. Market insights showed taste as the main reason for coffee choice, with a preference for cow's milk and local cafes for quality. Many opposed the extra charges for non-dairy options, citing lactose intolerance or allergies, especially among Gen Z and Millennials. Regional variations included stronger opposition in the UK and Germany compared to the UAE and USA. The marketing for non-dairy milk was less memorable than general coffee advertisements. Regression analysis confirmed that viewing non-dairy milk as a dietary staple increased consumption, aligning with the TDF's "Beliefs about Consequences" domain. Finally, within the BCW framework, the intervention strategies centered on training and coercion were discussed. Implementing these approaches could encourage the wider adoption of non-dairy milk options in coffee shops, fostering inclusivity, health awareness, and supporting environmental sustainability efforts.

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BACKGROUND: Data analysis approaches such as qualitative content analysis are notoriously time and labor intensive because of the time to detect, assess, and code a large amount of data. Tools such as ChatGPT may have tremendous potential in automating at least some of the analysis. OBJECTIVE: The aim of this study was to explore the utility of ChatGPT in conducting qualitative content analysis through the analysis of forum posts from people sharing their experiences on reducing their sugar consumption. METHODS: Inductive and deductive content analysis were performed on 537 forum posts to detect mechanisms of behavior change. Thorough prompt engineering provided appropriate instructions for ChatGPT to execute data analysis tasks. Data identification involved extracting change mechanisms from a subset of forum posts. The precision of the extracted data was assessed through comparison with human coding. On the basis of the identified change mechanisms, coding schemes were developed with ChatGPT using data-driven (inductive) and theory-driven (deductive) content analysis approaches. The deductive approach was informed by the Theoretical Domains Framework using both an unconstrained coding scheme and a structured coding matrix. In total, 10 coding schemes were created from a subset of data and then applied to the full data set in 10 new conversations, resulting in 100 conversations each for inductive and unconstrained deductive analysis. A total of 10 further conversations coded the full data set into the structured coding matrix. Intercoder agreement was evaluated across and within coding schemes. ChatGPT output was also evaluated by the researchers to assess whether it reflected prompt instructions. RESULTS: The precision of detecting change mechanisms in the data subset ranged from 66% to 88%. Overall κ scores for intercoder agreement ranged from 0.72 to 0.82 across inductive coding schemes and from 0.58 to 0.73 across unconstrained coding schemes and structured coding matrix. Coding into the best-performing coding scheme resulted in category-specific κ scores ranging from 0.67 to 0.95 for the inductive approach and from 0.13 to 0.87 for the deductive approaches. ChatGPT largely followed prompt instructions in producing a description of each coding scheme, although the wording for the inductively developed coding schemes was lengthier than specified. CONCLUSIONS: ChatGPT appears fairly reliable in assisting with qualitative analysis. ChatGPT performed better in developing an inductive coding scheme that emerged from the data than adapting an existing framework into an unconstrained coding scheme or coding directly into a structured matrix. The potential for ChatGPT to act as a second coder also appears promising, with almost perfect agreement in at least 1 coding scheme. The findings suggest that ChatGPT could prove useful as a tool to assist in each phase of qualitative content analysis, but multiple iterations are required to determine the reliability of each stage of analysis.

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PURPOSE: Patient-report outcome measures (PROMs) have gained widespread support as a mechanism to improve healthcare quality. We aimed to map out key enablers and barriers influencing PROMs implementation strategies in routine clinical practice. METHODS: An umbrella review was conducted to identify reviews exploring enablers and barriers related to the integration of PROMs in routine clinical practice from January 2000 to June 2023. Information on key enablers and barriers was extracted and summarised thematically according to the Theoretical Domains Framework. RESULTS: 34 reviews met our criteria for inclusion. Identified reviews highlighted barriers such as limited PROMs awareness among clinicians and patients, perceived low value by clinicians and patients, PROMs that were too complex or difficult for patients to complete, poor usability of PROMs systems, delayed feedback of PROMs data, clinician concerns related to use of PROMs as a performance management tool, patient concerns regarding privacy and security, and resource constraints. Enablers encompassed phased implementation, professional training, stakeholder engagement prior to implementation, clear strategies and goals, 'change champions' to support PROMs implementation, systems to respond to issues raised by PROMs, and integration into patient pathways. No consensus favoured paper or electronic PROMs, yet offering both options to mitigate digital literacy bias and integrating PROMs into electronic health records emerged as important facilitators. CONCLUSIONS: The sustainable implementation of PROMs is a complex process that requires multicomponent organisational strategies covering training and guidance, necessary time and resources, roles and responsibilities, and consultation with patients and clinicians.

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Japan faces significant challenges associated with its super-aged society. Exercise and physical activity are recommended strategies to promote healthy aging and quality of life in older age. However, what determines exercise behavior among Japanese older adults is relatively unknown. The principle aim of this study was to explore exercise determinants and their relation to exercise behavior among Japanese older adults. Completed self-report questionnaires were received from 1,000 Japanese older adults aged between 65 and 74 years who resided in the Kansai area. A cross-sectional maximum likelihood path analysis was used to test the relationships between variables, where it was hypothesized that affective experiences in childhood had an indirect association with the exercise behavior of Japanese older adults through the seven psychological determinants of exercise. Demographic factors were also included in the model as potential influences of all factors. Knowledge held the largest significant direct association with exercise behavior (ß = .539, p = <.001), particularly more intense forms of exercise such as resistance exercise (ß = .725, p = <.001) and moderate to strenuous exercise (ß = .420, p = <.001), whilst affective exercise experience in childhood (B = 3.749, p = <.001) and gender (B = 5.183, p = .003) held significant indirect associations. This paper emphasizes the importance of exercise-related knowledge among Japanese older adults and future research is warranted to further explore the role of positive affective exercise experiences in childhood and their influence on exercise behavior, especially amongst girls.

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In the UK people living in disadvantaged communities are less likely than those with higher socio-economic status to have a healthy diet. To address this inequality, it is crucial scientists, practitioners and policy makers understand the factors that hinder and assist healthy food choice in these individuals. In this scoping review, we aimed to identify barriers and facilitators to healthy eating among disadvantaged individuals living in the UK. Additionally, we used the Theoretical Domains Framework (TDF) to synthesise results and provide a guide for the development of theory-informed behaviour change interventions. Five databases were searched, (CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science) for articles assessing healthy dietary intake of disadvantaged adults living in the UK. A total of 50 papers (34 quantitative; 16 qualitative) were included in this review. Across all studies we identified 78 barriers and 49 facilitators found to either impede and/or encourage healthy eating. Both barriers and facilitators were more commonly classified under the Environmental, Context and Resources TDF domain, with 74% of studies assessing at least one factor pertaining to this domain. Results thus indicate that context related factors such as high cost and accessibility of healthy food, rather than personal factors, such as lack of efficiency in healthy lifestyle drive unhealthy eating in disadvantaged individuals in the UK. We discuss how such factors are largely overlooked in current interventions and propose that more effort should be directed towards implementing interventions that specifically target infrastructures rather than individuals.

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BACKGROUND: Discharging older adult patients from the hospital poses risks due to their vulnerable conditions, complex instructions and limited health literacy. Insufficient information about medication side effects adds to patient concerns. To address this, a post-discharge information summary system was developed. While it has shown positive impacts, concerns exist regarding implementation fidelity. OBJECTIVE: This study employed a theory-driven approach to understand health providers' perspectives on effective implementation. METHOD: Individual semi-structured interviews were conducted via telephone with nurses, doctors and pharmacists from local public hospitals. All interviews were audio-recorded and transcribed verbatim. Theoretical Domains Framework (TDF) was applied for direct content analysis. Belief statements were generated by thematic synthesis under each of the TDF domains. RESULTS: A total of 98 participants were interviewed. Out of the 49 belief statements covering eight TDF domains, 19 were determined to be highly relevant to the implementation of the post-discharge information summary system. These TDF domains include knowledge, skills, social/professional role and identity, beliefs about consequences, intentions, memory, attention and decision processes, environmental context and resources and social influences. CONCLUSION: Our study contributes to the understanding of determinants in implementing discharge interventions for older adult patients' self-care. Our findings can inform tailored strategies for frontline staff, including aligning programme rationale with stakeholders, promoting staff engagement through co-creation, reinforcing positive programme outcomes and creating default settings. Future research should employ rigorous quantitative designs to examine the actual impact and relationships among these determinants.

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BACKGROUND: Eighty one percent of adolescents do not meet the recommended physical activity (PA) guidelines with levels of physical activity declining steadily with age and more pronounced in girls of low socioeconomic position (SEP). Furthermore, early adolescence is a time when the rate of decline in PA is most severe amongst girls, placing them at an increased likelihood of developing negative health outcomes associated with physical inactivity. In response, the aim of this study was to explore low-SEP pre-teen girls' experiences of being physically active and to understand their perceptions of the individual, social and environmental factors that influence these experiences. METHODS: Focus groups were conducted with 107 girls aged 10-12 years from four urban and three rural primary schools. Reflexive thematic analysis was used to analyse the data, with themes mapped to the relevant domains of the Theoretical Domains Framework (TDF). RESULTS: Themes highlighted how skills and confidence underpin girls' self-identity for PA. Girls described how their social network (i.e., peers, family, coaches and teachers) shaped their experiences of being active. Girls recognised how being active was impacted by the challenges and opportunities in their local community (e.g., lack of facilities and anti-social behaviour). CONCLUSION: This study provides insight into low-SEP pre-teen girls' experiences of being physically active in both rural and urban locations, while highlighting the complex interplay of individual, social and environmental factors. Additionally, the use of the TDF presents an in-depth behavioural diagnosis which can be used to inform future theory-based interventions to promote low-SEP pre-teen girls PA.

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Primary care providers (PCPs) have been given the responsibility of managing the follow-up care of low-risk cancer survivors after they are discharged from the oncology center. Survivorship Care Plans (SCPs) were developed to facilitate this transition, but research indicates inconsistencies in how they are implemented. A detailed examination of enablers and barriers that influence their use by PCPs is needed to understand how to improve SCPs and ultimately facilitate cancer survivors' transition to primary care. An interview guide was developed based on the second version of the Theoretical Domains Framework (TDF-2). PCPs participated in semi-structured interviews. Qualitative content analysis was used to develop a codebook to code text into each of the 14 TDF-2 domains. Thematic analysis was also used to generate themes and subthemes. Thirteen PCPs completed the interview and identified the following barriers to SCP use: unfamiliarity with the side effects of cancer treatment (Knowledge), lack of clarity on the roles of different healthcare professionals (Social Professional Role and Identity), follow-up tasks being outside of scope of practice (Social Professional Role and Identity), increased workload, lack of options for psychosocial support for survivors, managing different electronic medical records systems, logistical issues with liaising with oncology (Environmental Context and Resources), and patient factors (Social Influences). PCPs value the information provided in SCPs and found the follow-up guidance provided to be most helpful. However, SCP use could be improved through streamlining methods of communication and collaboration between oncology centres and community-based primary care settings.

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OBJECTIVE: Hearing aid use is lowest in 0-3-year-olds with hearing loss, placing spoken language development at risk. Existing interventions lack effectiveness and are typically not based on a theoretically driven, comprehensive understanding of the factors influencing infant hearing aid use. The present study is the first to address this gap in understanding. DESIGN AND STUDY SAMPLE: A 55-item online survey based on the Theoretical Domains Framework (TDF) was completed by 56 parents of 0-3-year-old hearing aid users. RESULTS: Participants reported a wide range of barriers across TDF domains, which were associated with parent-reported hearing aid use and more pronounced in parents of lower hearing aid users. The most strongly reported domains across participants were "emotion" (e.g. feelings of worry when using hearing aids), "beliefs about capabilities" (e.g. belief in ability to use hearing aids consistently), and "environmental context and resources" (e.g. child removing hearing aids). CONCLUSIONS: Parents report a wider range of barriers to infant hearing aid use than existing investigations suggest and current interventions address. Interventions would benefit from: (i) targeting a wider range of TDF domains in their design; and (ii) implementing the present TDF survey to identify and target family-specific barriers to infant hearing aid use.