Table 2.

Example intervention strategies and their mechanistic links.

TDF domain (MoA)	Barrier description	Behavior change technique	Example intervention strategy	Reference
Environmental context & resources	Competing clinical demands make it difficult to ensure referrals are enacted for patients at increased hereditary cancer risk	3.2 Social support (practical)	Patient navigator role developed (cancer nurses) to assist with coordination of genetic referrals. Navigators kept lists of the tumor screen-positive patients as reported by pathologists, and helped to coordinate their referrals for genetic counseling.	Miesfeldt, 2018 [49]
	Limited integration of genetic testing into the cancer treatment workflow; long wait times for genetic testing, workforce shortages of genetic counselors (GC), and a lack of easily available genetic counseling in clinic locations	3.2 Social support (practical)	A dedicated genetic counselor was co-located in the medical and gynecologic oncology clinic provider workroom. The genetic counselor met with providers daily and was available to see patients in real time, as needed. The genetic counselor’s contact details were supplied to all providers and they were encouraged to reach out if there was any uncertainty about genetic testing.	Rana, 2020 [56]
	Lack of geographical access to genetic counseling, with no on-site genetics team	12.5 Adding objects to the environment	Patients at a remote site could complete a family history survey via computer tablet during their oncology treatment. Information is remotely accessible by an offsite genetics team to identify and triage eligible patients.	Cohen, 2013 [42]
Knowledge	Provider lack of understanding about the potential clinical utility of genetic testing (in the context of hereditary cancer)	5.1 Information about health consequences	Lecture series delivered to health-care providers on the topics of hereditary cancer risk assessment, genetic testing, hereditary breast–ovarian cancer, and hereditary colon cancer.	Scheuner, 2013 [36]
	Provider lack of knowledge about genetics and/or referral criteria	4.1 Instruction on how to perform the behavior	A “traffic light” classification system was developed for the most common cancer types seen in the unit, providing instruction on the indicators for genetic referral.	Moss, 2019 [58]
Memory, attention, & decision processes	Performing the recommended pathology genetic screening tests [e.g., microsatellite instability for colorectal cancer (CRC) cases can easily be forgotten	7.1 Prompts & cues	Pathologists were provided with monthly electronic reminders on patients meeting inclusion criteria for genetic screening.	Overbeek, 2020 [62]
	Numerous (sometimes conflicting) guidelines make it difficult for clinicians to decide which patients are eligible for genetic referral	11.3 Conserving mental resources	Patients entered relevant personal health and family history information into an electronic form, through which a report is generated summarizing the patients genetic risk and guiding clinicians about whether or not a genetic referral is indicated	Edelman, 2014 [40]
Beliefs about capabilities	Discomfort by nongenetics health-care providers in providing genetic services (lack of knowledge & confidence)	6.1 Demonstration of the behavior	A registered nurse shadowed a genetic counselor and attended genetic counseling sessions for observational purposes prior to offering nurse-led genetic risk assessment and testing	Cohen, 2013 [42]