Table 2.
Barriers to assessing vulnerability in pregnant women among 760 general practitioners (2022).
| TDF domain | Construct | Item | Fully agree/agree | Neither agree nor disagree | Disagree/fully disagree |
|---|---|---|---|---|---|
| N (%) | N (%) | N (%) | |||
| A) Knowledge | Knowledge of condition | Lacking knowledge of indicators of vulnerability in pregnancy | 61 (8.0%) | 169 (22.2%) | 528 (69.5%) |
| B) Skills (reversed) | Competence | Perceived competence in vulnerability assessment | 610 (80.3%) | 120 (15.8%) | 21 (2.8%) |
| C) Memory attention and decision making | Shared attention | GPs and staff lacking shared attention on vulnerability assessment | 134 (17.6%) | 219 (28.8%) | 376 (49.5%) |
| D) Behavioural regulation | Action planning/routines | Lacking routines in how to address vulnerability | 135 (17.8%) | 181 (23.8%) | 439 (57.8%) |
| E.1) Environmental context and resources | Time limits | Time limits the possibility of assessing vulnerability | 48 (6.3%) | 121 (15.9%) | 585 (77.0%) |
| E.2) Environmental context and resources (reversed) | Socio-political context—remuneration | Perceived sufficiency of ANC remuneration for vulnerability assessment | 210 (27.6%) | 206 (27.1%) | 326 (42.9%) |
| F) Social influences | Organizational culture—medical record-keeping | Insufficient medical record-keeping on indicators of vulnerability | 282 (37.1%) | 204 (26.8%) | 240 (31.6%) |
| G) Social/Professional role and identity (reversed) | Obligation and role | Perceived obligation and role regarding vulnerability assessment in pregnancy | 715 (94.1%) | 42 (5.5%) | 2 (0.3%) |
| H.1) Believes about capabilities | Control of behaviour, and social environment | Lacking overview whether assessing all pregnant women who are vulnerable | 197 (25.9%) | 236 (31.1%) | 314 (41.3%) |
| H.2) Believes about capabilities | Control of environment—delegating to Staff* | Lacking overview of vulnerability assessment due to delegating ANC to staff* | 23 (15.1%) | 34 (22.4%) | 95 (62.5%) |
| H.3) Believes about capabilities | Control of environment—delegating to GP trainees** | Lacking overview of vulnerability assessment due to delegating ANC to GP trainees** | 106( 17.0%) | 148 (23.8%) | 339 (54.5%) |
| H.4) Believes about capabilities | Self-efficacy | Perceived low self-efficacy in vulnerability assessment | 28 (3.7%) | 127 (16.7%) | 596 (78.4%) |
| I) Believes about consequences | Outcome expectancies | Perceived adverse outcome expectancies regarding patient relation | 38 (5.0%) | 102 (13.4%) | 614 (80.8%) |
| J) Goal | Priority | Perceived inferior priority of vulnerability assessment | 53 (7.0%) | 256 (33.7%) | 441 (58.0%) |
| K) Intention (reversed) | Commitment | Commitment in relation to vulnerability assessment | 720 (94.7%) | 34 (4.5%) | 5 (0.7%) |
| L) Emotion | Cognitive overload | Cognitive overload in relation to vulnerability assessment | 15 (2.0%) | 134 (17.6%) | 603 (79.3%) |
| M) Reinforcement | Incentives | Increased motivation to spend extra time on vulnerability assessment in case of extra remuneration | 303 (39.9%) | 250 (32.9%) | 183 (24.1%) |
| N) Optimism (reversed) | Usefulness | Perceived usefulness of assessing vulnerability | 716 (94.2%) | 33 (4.3%) | 9 (1.2%) |
TDF: Theoretical Domains Framework; ANC: Antenatal care.
*N = 152, as only GPs who delegated ANC fully to practice staff received this question.
**N = 622, as only GPs having GP trainees in their clinic received this question. To comply with general data protection requirements for cells with small numbers (<5), categories for fully agree/agree and fully disagree/disagree are combined, while the category don’t know/not relevant is omitted from the table. Therefore the sum of responses does not equal 760.