Table 1.
Thematic content analysis based on the Theoretical Domains Framework (TDF)
| TDF domainsa | Number of questions | Utterances | Reduceb(%) | Increasec(%) | No influence (%) | Specific beliefs | Themes |
|---|---|---|---|---|---|---|---|
|
Nature of the behaviors |
2 |
88 |
45 (51.1) |
35 (39.8) |
8 (9.1) |
7 |
Lumbar x-ray utilization |
|
Skills |
3 |
1 |
0 (0) |
0 (0) |
1 (100) |
1 |
None identified |
|
Beliefs about capabilities |
3 |
106 |
70 (66) |
31 (29.2) |
5 (4.7) |
5 |
Capabilities; ease of ordering test |
|
Motivation & goals |
5 |
50 |
28 (56) |
17 (34) |
5 (10) |
4 |
Intrinsic motivations |
|
Beliefs about consequences |
4 |
334 |
93 (27.8) |
211 (63.2) |
30 (18.9) |
15 |
Consequence of ordering lumbar x-rays; attitudes |
|
Environmental context and resources |
2 |
41 |
16 (39) |
25 (61) |
0 |
3 |
Environmental resource; Signs within the clinic |
|
Social influences |
2 |
128 |
37 (29) |
62 (48) |
19 (13.3) |
6 |
Influence of others’ opinions (colleagues, patients); influence of organization and new literature |
|
Emotion |
2 |
4 |
1 (25) |
1 (25) |
2 (50) |
2 |
Own emotions |
|
Knowledge |
7 |
86 |
39 (45.3) |
33 (38.4) |
14 (16.3) |
6 |
Awareness of the guidelines; knowledge of evidence |
|
Memory, attention, and decision process |
4 |
77 |
67 (87) |
10 (13) |
0 (0) |
8 |
Factors that influence decision; ease of decision |
|
Social/professional role &identity |
4 |
133 |
39 (29) |
67 (50.4) |
27 (20.3) |
12 |
Professional role; professional norms; professional agreement |
|
Behavioral regulation |
5 |
91 |
91 (100) |
0 (0) |
0 (0) |
12 |
Ways to reduce testing; barriers; organizational changes; post intentional behavior |
| Total | 43 | 1,139 | 526 (46.2) | 492 (43.2) | 109 (9.6) | 88 | 23 |
aTDF domains are presented in the order in which questions were asked in the focus groups. bUtterances perceived to reduce x-ray utilization (facilitators). cUtterances perceived to increase x-ray utilization (barriers).