Table 2.
Target behaviour area 1 (ensuring appropriate patients receive testing) grouped barriers coded by the Theoretical Domains Framework and Capability, Opportunity and Motivation (COM) Behaviour framework. Detailed information about the barriers and enablers reported for each grouped barrier can be found in the Supplementary Files (Supplementary Table S4).
| COM | Barriers | Example Quote (Related to the Bolded Barrier) | Enablers |
|---|---|---|---|
| C | Gain belief about genomics e.g., understanding the value of doing the test (TDF domain: belief about consequences) | ||
| There is a lack of natural referral patterns, and time requirements, which make it more challenging to appreciate the value of testing as clinicians are time poor | We have busy clinics here. This, you know, one of the things that (this genomics project is) supposed to be done in the context of a routine clinic. No chance. No chance at all. NGMS11 | Seeing results NGMS 1, 2, 6 | |
| Gain confidence in (i) themselves (ii) trust in others e.g., to gain/grow i.e., genetic knowledge and skills (TDF domain: i) belief about capabilities and ii) social influences) | |||
| O | Challenging to gain/grow genetic knowledge and skills because they are unable to join meetings to grow confidence, not trained to counsel, lack of experience, lack of GC at offering stage to build confidence | I learnt a huge amount from our genetic counsellors on how they consent. I don’t think, to start off with, I would have appreciated that that was important and I think, because my experience would be fairly reflective of most (physicians), nobody told me that I needed to worry so much about incidental findings ‘cause nobody—no other (physicians) appreciated that so I didn’t know that so I didn’t do that or I wouldn’t have done it. NGMS4 | Having knowledgeable person to aske informal questions NGMS2 CGs and GCs to support NGMS3 Lab experience NGMS5 Gaining experience NGMS9 Informal discussions with colleagues NGMS15 Research programme experience NGMS1 Easy to explain to patients in research setting NGMS13 Access to other physicians with genetic knowledge NGMS12 |
| Set the tone for environment (culture) e.g., running meetings (TDF domain: social influences) | |||
| How meetings are run | No barriers noted—enabler coded | Congenial relationships NGMS16 Personal contact with physicians NGMS3 Small local meetings best for info sharing NGMS4 |
|
| M | A Gain genetic knowledge e.g., Who to refer? What conditions might have a genetic basis? (TDF domain: knowledge) | ||
| Need to know who to refer and what conditions might have a genetic basis. There is a gap in understanding of who to select, lack of awareness of how many conditions may be genetic and a need for people to understand the whole process not just the test | The issue is that people (nongenetic medical specialists) really need to change thinking because people (nongenetic medical specialists) don’t think about this being genetic. NGMS7 | Dynamic and fluid checklists for selecting patients NGMS13 Interim gatekeeping as knowledge grows NGMS13 Training NGSM12 |
|
| B Find out about the process of “doing” genomics e.g., information about consent processes, how to access services (TDF domain: skills) | |||
| Lack of information about consent processes with no (formal) consent training and how to access services with no centralised/established path | I think historically we haven’t been particularly well trained as adult physicians (about consent). NGMS12 | Clear referral criteria Having an informal checklist (clinical reasoning) NGMS10-links to confidence |
|
| C Develop genomic (clinical) skills e.g., getting hands-on (TDF domain: skills) | |||
| Getting hands-on with the process of clinical genomics | I think the evolution of clinical expertise and practice over years (helps gain clinical skills). Did I go to any training course to talk about it or anything like that? No. It’s just something that you, another bit of information and a skill that you acquire. NGMS10 | Seeking feedback, reflecting NGMS4 Gained during the research process NGMS7 Scientists “dumbing down” information NGMS8—ties to gain confidence |
|
| C | Managing the evolution of motivation barriers A,B,C e.g., knowledge shifting, processes changing (TDF domain: professional identity and belief about capabilities) | ||
| Knowledge is shifting and the evidence base is dynamic and fluid, so processes are changing. The lack of guidance leads to relying on own clinical experience, and hindered by a lack of genomic literacy | Even if we were to limit our interest to (one clinical area) genetics, it’s still a very dynamic and fluid field. Even the most enthusiastic have a hard time to keep up with the research discoveries—which happen, almost on a monthly basis, you have a new gene associated with a condition. NGMS1 | “Generational shift” younger practitioners will come in with knowledge NGMS5 Summaries of latest evidence NGMS3 |
|
Green—opportunity; Red—capability; Yellow—motivation; A Develop genomic (clinical) skills; B The process of “doing” genomics; C Gain genetic knowledge.