Table 3.

Overview of barriers, facilitators and unclear factors that influence the implementation of LIs as perceived by HCPs for all domains, which were largely based on the Tailored Implementation for Chronic Diseases checklist*

Category	Subcategory—barriers	Subcategory—facilitators	Subcategory—unclear factors
Domain 1: Intervention factors (factors related to LIs)
Effectiveness	LIs have little or no effect on OA29 32 33 44 46 47 49 53 59 61 Potential effects of LIs are difficult to accomplish.47 48 53 61	LIs have positive effects on affected joint(s).35 38 40–42 47 49 52 53 58 61 LIs have positive effects on general health.33 40 47 49 56 57 LIs have positive mental effects.30 35 37 38 40 49 52 57 LIs have positive effects (not further specified).34 37 44 49 52 54 57
Safety	LIs are unsafe or have negative effects.39 47 52 61	LIs are safe.53 57 Research environment or protocols provide a safety net.31 35 38 39
Design	Non-optimal content or structure of LIs.34 36 52 53 62 Challenges for patients during participation in LIs.39 40 45 Challenges for HCPs during delivery of LIs.28 30 39 60 62	Positive experiences with or suggestions to improve the content or structure of LIs.28 30 34 37 40 45 52 60 62 Ease for patients during participation in LIs.39 40 52 Ease for HCPs during delivery of LIs.30 31 34 39 45 60 62
Personalised treatment	Insufficient ability to provide personalised treatment within LIs.32 45 62	Ability and importance of providing personalised treatment within LIs.37 39 42 45 47 51 53 60–62
Accessibility	LIs are unavailable or inaccessible.28 33 41 43 44 53 56 59 61 Costs of LIs to patients.32 33 41 44 51 52 LIs are not feasible or sustainable.32 60 Inconvenience to patients when accessing LIs.51–53	LIs are available or accessible, or suggestions for improvement.32 37 41 46 57 59 LIs are feasible or sustainable.32 36 37 42 60 Convenience for patients when accessing LIs.52
Telehealth	Disadvantages of telehealth in terms of effectiveness32 58 62 Telehealth is not safe for patients or patient/data privacy.32 58 Challenges for HCPs regarding lack of physical/visual contact.35 38 58 62 Other challenges for HCPs regarding feasibility of telehealth.28 32 35 38 58 62 Patient-related challenges regarding feasibility of telehealth.28 32 62 Negative aspects regarding communication and relationship using telehealth.34 35 38 40	Benefits of telehealth in terms of effectiveness.28 35 38 58 62 Telehealth is safe for patients or patient/data privacy.35 58 62 Lack of physical/visual contact not a major issue for HCPs.35 38 58 Positive attitude or needs of HCPs regarding feasibility of telehealth.35 38 40 58 62 Patient-related benefits regarding feasibility of telehealth.28 32 35 38 58 Positive aspects regarding communication and relationship using telehealth.38 40
Domain 2: Individual HCP factors (factors related to individual primary and secondary HCPs)
Expertise	Lack of knowledge or skills around LIs or promoting behavioural change.27 29 33 41 42 45 47 49–51 56 60 61 Lack of knowledge or skills around OA care in general.43 44 46 48 Lack of knowledge or skills around specific resources.33 50 60	Having or improving knowledge or skills around LIs or promoting behavioural change.33 34 41 42 45 46 50 Having or improving knowledge or skills around OA care in general.33 44 46 48 Available resources might improve knowledge and decision-making.31 50 60	Clinical experience42
Attitude	Negative attitude towards LIs.29 53 61 Negative attitude towards guidelines or protocols.46	Positive attitude towards LIs.33 41 42 45–47 50 51 53 55–57 59 Positive attitude towards guidelines or protocols.27 57 60	Autonomy37
Role	Perception of own role potentially impeding prescription or follow-up of LIs.29 33 42 44 47–51 53 55 61 Negative consequences for own role when referring patients to LIs.32	Perception of own role potentially stimulating prescription or follow-up of LIs.33 41 42 47 48 51 53 55 56 61 Positive consequences for own role when referring patients to LIs.32
Domain 3: Patient factors (factors related to patients with hip and/or knee OA)
Health status	Severity of disease and symptoms.32 44 47 50 52 61 Negative impact of comorbidities.29 39 44 47 48 51 52 Other patient characteristics.47 52 59	Severity of disease and symptoms.39 47 53 59 61 Other patient characteristics.41 51 59	Severity of disease and symptoms.42 46 53 61 Other patient characteristics.41
Treatment expectations and preferences	Negative attitude towards LIs29 33 34 36 39 41–48 51–53 60 61 Positive attitude towards TJA37 43 48	Make use of patients’ preference for TJA within LIs37	Patients’ preferences46
Active participation	Low patient adherence or engagement33 37 41 42 46 47 51 54 61	High patient adherence or engagement34 39 40 54 Importance of high patient adherence or engagement for effectiveness of LIs30 41 42 47 53 61
Capabilities	Low health literacy33 37 39–41 43 44 47 49 51 52 60 61 Limited financial resources41 44 Other responsibilities41 52	High health literacy or importance of education39 42 43 49 51 60 Social support40 48	Health literacy46 Other responsibilities41
Domain 4: Professional interactions (factors related to interactions between primary and secondary HCPs)
Collaboration	Non-optimal interdisciplinary collaboration or healthcare provision27 32 34 41 43 46 47 49 53 60 No access to other HCPs41	Good interdisciplinary collaboration or healthcare provision, or suggestions for improvement27 32 34 37 41 43 44 46–49 52 53 55–57 59 60 62 Access to other HCPs32 41–43 46
Communication and referral	Lack of communication between HCPs46 48 60 Challenges of communication and referral procedures34 36 44 46 60	Improving communication between HCPs32 34 46 48 52 57 Needs regarding communication and referral procedures32 41 46 49 52
Domain 5: Incentives and resources (factors related to the availability of incentives and resources for primary and secondary HCPs)
Time	Lack of time within patient consultations33 41 43–45 49 53 61 Lack of time due to other demands (or not further specified)32 37 41 48 62	Adequate duration of patient consultations33 41 Adequate duration of specific interventions or protocols32 45 60 62
Financial resources	Limited financial resources within organisation45 48	Financial reward for implementing LIs32 48 60
Information resources	Lack of information resources27 37 44 48 Challenges in accessing information resources41 44 53	Availability of information resources27 44 52 57 Access to information resources33 41 42 52
Facilities	Negative attitude towards information technology33	Potential use of information technology33 44 Benefits of working in health centres49
Domain 6: Capacity for organisational change (factors related to the organisation where primary and secondary HCPs work)
Professional paradigm		Adequate professional paradigm or suggestions for expansion27 41 45
Monitoring		Audit57
Support within the organisation	Management not supportive60
Domain 7: Social, political, and legal factors (factors related to the social, political and legal context)
Healthcare system	Restrictions due to health insurance41 48 60	Benefits of good health insurance44 46 60 Government subsidies33
Domain 8: Patient and HCP interactions (factors related to interactions between patients with hip and/or knee OA and primary and secondary HCPs)
Therapeutic alliance	Potential negative influence of implementing LIs to relationship37	Importance of communication and relationship39 42 48 49
Lifestyle as conversation topic	Challenges of discussing weight27 33 42 49 50	Factors that could ease the way to discussing weight27 42 44 47 49
Domain 9: Disease factors (factors related to OA)
Image	OA seen as low priority29 32 43 46–48 OA seen as untreatable and local condition (wear-and-tear)33 44 46 47 51 52 61	Optimistic views towards OA33 47

HCP, healthcare professional; LI, lifestyle intervention; OA, osteoarthritis; TJA, total joint arthroplasty.