Table 1.
CFIR domain | Key element | Barrier | Facilitator |
---|---|---|---|
Intervention characteristic | Complexity | Amount of material was perceived as overwhelming and time consuming | Strong evidence for intervention (previous RCT) Patients liked comprehensiveness (multifactorial approach as opposed to specific disease or organ) |
Cost | Perception of intervention being too costly | Perception of intervention being cost effective (investing in prevention offsets acute care costs) | |
Outer setting | Perception of fit | Lack of remuneration Lack of resources (particularly staff) Physicians’ perception that PP’s prevention visit is a duplication of services |
Perception by other stakeholders (including managers) that CDPS is a “hot topic” Patients’ perception of visits as valuable, necessary and motivating |
Characteristics of individuals | The PPs | Barrier did not emerge from data | Interest in prevention Ability to support and motivate patients |
Inner setting | Local champion | Lack of local champion or losing a local champion (e.g., physician left community) | Facilitator did not emerge from data |
Working in a team versus working as a team | Not working as a team (e.g., team tensions, lack of relationship, competition, unclear roles) | Working as a team (e.g., trust; physicians appreciating PPs structuring CDPS) | |
Process | Planning and engaging | Not including collaborators enough in planning process | Starting collaborative conversations early |
Collaboration and teamwork | Lack of awareness/misconception of BETTER approach | Availability of team members, frequent and open conversations |