Table 2.
TDF domains and subthemes identified as barriers and/or enablers in each included study
| Qualitative analysis themes | Studies conducted in the NH setting | Studies conducted in ambulatory setting | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Anthierens, 2009 [36] | Bourgeois, 2014 – study a [37] | Bourgeois, 2014 – study b [38] | de Souto Barreto, 2015 [13] | Evrard, 2020 [39] | Lambson, 2003 [40] | Maclagen, 2020 [41] | Mestres Gonzalvo, 2018 [42] | Allary, 2020 [43] | Barter, 1996 [44] | Bell, 2011 [45] | Chen, 2010 [46] | |
| Beliefs about capabilities: Perceived capability of stakeholders to perform BZRA deprescribing and the problems they face | ||||||||||||
| Patients’ self-efficacy | E | |||||||||||
| Deprescribing is challenging | B | B | ||||||||||
| Perceived efficacy or lack of efficacy | B | B | B | B;E | ||||||||
| Beliefs about consequences:What stakeholders think could happen from performing BZRA deprescribing | ||||||||||||
| No perceived benefit | B | B | B | B | B | |||||||
| Return of primary condition | B | B | B | |||||||||
| Withdrawal symptoms | B | B | B | |||||||||
| Increase in care burden | B | |||||||||||
| Avoiding adverse effects of long-term BZRA | E | E | E | E | ||||||||
| Environmental context and resources:Influence of the environment on stakeholders’ behaviour | ||||||||||||
| Tool implementation | E | E | ||||||||||
| Favourable/unfavourable moment | B | B | B | |||||||||
| Lack of resources | ||||||||||||
| Difficulty of alternatives | B | |||||||||||
| Heavy workload | B | |||||||||||
| Inheritance of prescribing culture | ||||||||||||
| BZRA deprescribing not prioritised by the healthcare system | B | |||||||||||
| NH specific requirements | B | B | B | |||||||||
| NH characteristics | B;E | B;E | ||||||||||
| BZRA cost | E | |||||||||||
| Intention: How inclined stakeholders are to perform BZRA deprescribing | ||||||||||||
| Level of willingness | B | B | B | B | B | E | ||||||
| No intention to use non-pharmacological approaches | B | |||||||||||
| Goals:How important is BZRA deprescribing for stakeholders | ||||||||||||
| Competing goals | B | |||||||||||
| Patients’ attachment to these medicines | B | B | B | |||||||||
| Perceived need of sleep | B | E | ||||||||||
| Having a more natural sleep | E | E | ||||||||||
| Social influences: How others influence stakeholders’ behaviour | ||||||||||||
| Expected patient resistance | B | B | B | B | ||||||||
| Pressure for continuous prescribing | B | |||||||||||
| Belief that GP’s prescription equals safety and approval for continuous use | B | B | ||||||||||
| Patient’s trust in GP | B | |||||||||||
| Memory, attention and decision process: Habits factors and decision process regarding BZRA deprescribing | ||||||||||||
| BZRA as an easy solution | B | |||||||||||
| Routine approach | B | B | B | B | ||||||||
| Preference for status quo | ||||||||||||
| Knowledge: What stakeholders know on BZRA deprescribing | ||||||||||||
| Nurses‘ lack of knowledge | B | B | ||||||||||
| Patients’ lack of knowledge | B | |||||||||||
| Skills:What stakeholders know about how they should perform BZRA deprescribing | ||||||||||||
| GPs’ lack of systematic strategy | ||||||||||||
| Nurses’ lack of skills regarding non-pharmacological approaches | B | |||||||||||
| Social, professional role and identity: Perception of who stakeholders are (as healthcare professionals) | ||||||||||||
| Nurses perceived ideal role | B;E | |||||||||||
| Scarce and difficult multidisciplinary work | B | B | B | |||||||||
| Perceived expectation of prescribing | ||||||||||||
| Reinforcement: Influence of stakeholders’ past experiences with BZRA deprescribing | ||||||||||||
| Previous attempts and failure | B | B | B | B | B | |||||||
| Emotion:How stakeholders feel about BZRA deprescribing | ||||||||||||
| Various patient emotions | E | |||||||||||
| GP frustration | ||||||||||||
| Patient characteristics | ||||||||||||
| Older age | B | E | E | |||||||||
| Woman | B | B | ||||||||||
| Depression | E | |||||||||||
| Anxiety | ||||||||||||
| Psychiatric history | B | |||||||||||
| Dementia | E | |||||||||||
| Aggressive behaviour | E | |||||||||||
| Low orientation score | ||||||||||||
| Parkinson or extrapyramidal symptoms | E | |||||||||||
| Comorbidities | B | |||||||||||
| Hospitalisation in past 3 months | E | |||||||||||
| Higher number of medications | B | |||||||||||
| Antidepressant use | E | |||||||||||
| Medical cause of sleeplessness | B | |||||||||||
| Poorer quality of sleep | E | |||||||||||
| Low income | B | |||||||||||
| Widowed men | E | |||||||||||
| BZRA prescribing patterns | ||||||||||||
| Lower dose | E | |||||||||||
| Lower frequency of intake | ||||||||||||
| Shorter duration of treatment | E | |||||||||||
| Indication other than sleeping issues | B | |||||||||||
| Qualitative analysis themes | Studies conducted in ambulatory setting | Studies conducted in hospital setting | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Chen, 2014 [47] | Cook, 2007 – study a [48] | Cook, 2007 – study b [49] | Cook, 2007 – study c [50] | Iliffe, 2004 [51] | Joester, 2010 [52] | Kuntz, 2018 [53] | Lasserre, 2010 [54] | Martin, 2017 [55] | Williams, 2016 [56] | Yokoi, 2014 [57] | |
| Beliefs about capabilities: Perceived capability of stakeholders to perform BZRA deprescribing and the problems they face | |||||||||||
| Patients’ self-efficacy | E | ||||||||||
| Deprescribing is challenging | B | B | B | B | B | ||||||
| Perceived efficacy or lack of efficacy | B | B | B;E | B | B | ||||||
| Beliefs about consequences:What stakeholders think could happen from performing BZRA deprescribing | |||||||||||
| No perceived benefit | B | B | B | B | B | B | |||||
| Return of primary condition | B | B | B | B | B | ||||||
| Withdrawal symptoms | B | B | B | ||||||||
| Increase in care burden | B | B | |||||||||
| Avoiding adverse effects of long-term BZRA | E | E | E | E | |||||||
| Environmental context and resources:Influence of the environment on stakeholders’ behaviour | |||||||||||
| Tool implementation | B | B | E | ||||||||
| Favourable/unfavourable moment | B;E | B;E | |||||||||
| Lack of resources | B | B | |||||||||
| Difficulty of alternatives | B | B | B | ||||||||
| Heavy workload | B | B | |||||||||
| Inheritance of prescribing culture | B | ||||||||||
| BZRA deprescribing not prioritised by the healthcare system | B | ||||||||||
| NH specific requirements | |||||||||||
| NH characteristics | B | ||||||||||
| BZRA cost | |||||||||||
| Intention: How inclined stakeholders are to perform BZRA deprescribing | |||||||||||
| Level of willingness | B | B | B | E | B | E | |||||
| No intention to use non-pharmacological approaches | B | B | |||||||||
| Goals:How important is BZRA deprescribing for stakeholders | |||||||||||
| Competing goals | B | B | B | B | |||||||
| Patients’ attachment to these medicines | B | B | B | B | B | B | |||||
| Perceived need of sleep | E | B | |||||||||
| Having a more natural sleep | |||||||||||
| Social influences: How others influence stakeholders’ behaviour | |||||||||||
| Expected patient resistance | B | B | B | B | |||||||
| Pressure for continuous prescribing | B | ||||||||||
| Belief that GP’s prescription equals safety and approval for continuous use | B | B | B | ||||||||
| Patient’s trust in GP | B;E | E | |||||||||
| Memory, attention and decision process: Habits factors and decision process regarding BZRA deprescribing | |||||||||||
| BZRA as an easy solution | B | ||||||||||
| Routine approach | B | B | B | ||||||||
| Preference for status quo | B | ||||||||||
| Knowledge: What stakeholders know on BZRA deprescribing | |||||||||||
| Nurses‘ lack of knowledge | |||||||||||
| Patients’ lack of knowledge | B | B | B | B | B | ||||||
| Skills:What stakeholders know about how they should perform BZRA deprescribing | |||||||||||
| GPs’ lack of systematic strategy | B | ||||||||||
| Nurses’ lack of skills regarding non-pharmacological approaches | |||||||||||
| Social, professional role and identity: Perception of who stakeholders are (as healthcare professionals) | |||||||||||
| Nurses perceived ideal role | |||||||||||
| Scarce and difficult multidisciplinary work | |||||||||||
| Perceived expectation of prescribing | B | B | |||||||||
| Reinforcement: Influence of stakeholders’ past experiences with BZRA deprescribing | |||||||||||
| Previous attempts and failure | B | B | B | B | |||||||
| Emotion:How stakeholders feel about BZRA deprescribing | |||||||||||
| Various patient emotions | B | ||||||||||
| GP frustration | B | B | |||||||||
| Patient characteristics | |||||||||||
| Older age | B | ||||||||||
| Woman | E | ||||||||||
| Depression | |||||||||||
| Anxiety | B | ||||||||||
| Psychiatric history | |||||||||||
| Dementia | |||||||||||
| Aggressive behaviour | |||||||||||
| Low orientation score | E | ||||||||||
| Parkinson or extrapyramidal symptoms | |||||||||||
| Comorbidities | B | ||||||||||
| Hospitalisation in past 3 months | |||||||||||
| Higher number of medications | |||||||||||
| Antidepressant use | E | ||||||||||
| Medical cause of sleeplessness | |||||||||||
| Poorer quality of sleep | |||||||||||
| Low income | |||||||||||
| Widowed men | |||||||||||
| BZRA prescribing patterns | |||||||||||
| Lower dose | E | ||||||||||
| Lower frequency of intake | E | E | |||||||||
| Shorter duration of treatment | |||||||||||
| Indication other than sleeping issues | |||||||||||
BZRA benzodiazepines receptor agonists, GP general practitioner, NH nursing home, TDF theoretical domains framework [B] stands for an identified barrier and [E] for an identified enabler