Table 2.
Summary of theoretical domains identified from two focus groups (n = 12) as key to adherence to LBP radiography guidelines and LBP imaging ordering behaviours (including overarching themes and belief statements)
| Domain | Overarching theme | Example belief statements |
|---|---|---|
| Knowledge | Knowledge and awareness of LBP radiography guidelines and indications for imaging. (Enabler) | I know the limitations of X-rays and when it would be appropriate to choose X-ray as an imaging modality |
| I am aware of guidelines and/or indications for LBP and imaging | ||
| I agree with the content of the guidelines for imaging and LBP | ||
| I think the guidelines are evidence-based | ||
| My knowledge of indications for imaging comes from school | ||
| Lack of awareness and/or knowledge of LBP radiography guidelines. (Barrier) | I do not follow a guideline | |
| I have limited knowledge/awareness of guidelines for imaging | ||
| Skills | Adequate training is required to manage LBP without imaging. (Enabler) | A lot of expertise and training is needed in order to manage someone with LBP (and determine if they need an X-ray) |
| Having good communication skills is important for managing LBP without imaging. (Enabler) | Good communication skills are required for managing LBP without X-rays | |
| Social/professional role and identity | Chiropractors’ responsibility to manage LBP without imaging. (Enabler) | It is my responsibility as a clinician to manage someone’s LBP without taking an X-ray |
| Chiropractors should not be routinely taking X-rays | ||
| Other healthcare providers’ responsibility to manage LBP without imaging. (Barrier) | It is the medical doctor’s role to order imaging | |
| Beliefs about consequences | Negative consequences to imaging for LBP. (Enabler) | Radiation is a negative consequence of taking X-rays |
| Cost to the healthcare system is a negative consequence of taking X-rays | ||
| Delayed treatment (waiting for results) is a negative consequence of taking X-rays | ||
| Exposure to infectious diseases is a negative consequence of sending a patient for an X-ray | ||
| Patient worry is a negative consequence of taking an X-ray | ||
| Negative consequences to not using imaging for LBP. (Barrier) | Missing a diagnosis is a potential negative consequence of NOT taking an X-ray | |
| Neutral consequences to not using imaging for LBP. (Enabler) | The plan of management does not change with taking an X-ray | |
| Memory, attention, and decision processes | Decision for LBP imaging is based on a patient’s clinical presentation. (Enabler) | I decide whether a patient needs an X-ray based on their clinical presentation |
| Decision for LBP imaging is based on gut feeling. (Barrier) | I would decide to order an X-ray (instead of following the guidelines) if I have a gut feeling that there is something else going on | |
| Able to remember indications for LBP imaging. (Enabler) | I can remember indications for when a patient needs imaging/needs a referral | |
| Behavioural regulation | Communication is a strategy that can be used to reduce imaging for LBP. (Enabler) | I manage LBP without X-rays by explaining to my patients why they do not need X-rays |
| Continuing education requirements is a strategy that can be used to reduce imaging for LBP. (Enabler) | Continuing education in radiology helps me manage LBP [with or without X-rays] | |
| Having access to a patient’s previous imaging is a strategy that can be used to reduce imaging for LBP. (Enabler) | Being able to access previous X-rays/reports helps me manage LBP without taking an X-ray | |
| A better health system organisation that facilitates better communication amongst health care professionals would help with reducing imaging for LBP. (Enabler) | Having a system to easily communicate with physicians and access previous imaging would help me better manage LBP [without X-rays] |
LBP low back pain