Table 2.
Common barriers coded using the CFIR with exemplar quotes and matching interventions.
| CFIR Code | Barrier | Quote from Text | Matched Intervention from the Interview Transcripts | Quote from Text |
|---|---|---|---|---|
| Inner setting: Available resources | Long waiting time for clinic | Patients have reported back saying there is a 3–6 month wait for an opinion. CN2 | Funding for testing and clinic | Funding support for the test and consultation is also very important. CN1 |
| Lack of resources | I would say that we are fairly dysfunctional in the genetics component, largely perhaps due to a combination of personnel, infrastructure and funding being the reasons. HD1 | Funding for genomics service | Funding support—that is going to become critical. HD6 | |
| Lack of genetics expertise | Even if there is funding, it is very hard to recruit people to work in XX and I don’t think any clinical geneticist is ever going to set foot in XX to work. CN8 | Easier access to local genetics expertise | Easy access locally. It would be really good even if we had a genetics counsellor locally, so once we get some results back to talk through what they mean with the patients, and also help us interpret what the test is might be really useful. CN5 | |
| Intervention characteristics: Adaptability | Long turn-around time for results | …the tests take a long time to come back, so that’s one common feedback from the patients as well. CN2 | Funding for testing and clinic | Funding support for the test and consultation is also very important. CN1 |
| Outer setting: Patient Needs and resources | Poor communication about timing of results | It is not a quick turnaround test and the communication around that probably has need for improvement. HD6 | Involve patients/consumers and family members 1 | |
| Intervention characteristics: Cost | Lack of funding overall | They probably do need more funding and resources to implement some of their models of care. CN10 | Funding for testing and clinic | Funding support for the test and consultation is also very important. CN1 |
| Lack of funding for testing | There is a very small amount of money that the department will allocate to genetic tests. CN8 | Funding for testing | Funding support to get the test done to be able to pay for the cost of the genomic test which probably needs to happen at the central level. Medicare reimbursement type process but that doesn’t seem to exist. HD5 | |
| Lack of funding for clinic | It is not a funded clinic and is not incorporated in usual hospital outpatients and is such a small component. HD1 | Funding for testing | Funding support to get the test done to be able to pay for the cost of the genomic test which probably needs to happen at the central level. Medicare reimbursement type process but that doesn’t seem to exist. HD5 | |
| Lack of funding for staff | There are potential people who are extremely suited for the job but we don’t have enough money to create another position. HD4 | Funding for clinic | Funding support for the test and consultation is also very important. CN1 | |
| Characteristics of individual: Knowledge and beliefs about the intervention | Perceived impact of results | Genetics is always going to be hard to give a patient a definite answer on, but presumably that will improve as we collect more data. CN1 | Genomics Champion | The most important ones really are a Genomics Champion, which we have but we really need that pushed along. HD2 |
| Process: Champions | Lack of interest | Whereas with the genetics clinic, I feel like there is probably going to be a lot of barriers to setting one up, particularly if there is not a lot of interest from the nephrology department. AT4 | Genomics Champion | The most important ones really are a Genomics Champion, which we have but we really need that pushed along. HD2 |
| Inner setting: Access to knowledge and information | Lack of time for learning | People are already time-poor, the average age of a nephrology trainee is getting older and you have competing priorities on time, so how are you going to put in a completely new area, superimposed on what is already a very grounded curriculum. HD9 | Genetics training for nephrology trainees as a rotation | It does need to incorporated into our basic training—absolutely. Six-month rotation could be an option. HD9 |
| Lack of theoretical knowledge | I think that needs a lot more discussion and a lot more presence at national meetings and ANZSN. HD2 | Educational meetings | Some incorporation of more education. Update course and kidney school. CN3 | |
| Lack of knowledge about process | I think executive summary, very early on we all think it is going to be important in the not too distant future but currently most people are unsure what tests are out there, who we should be referring to, and exactly how we should doing it—in terms of the logistics of including [the] right paperwork or the right person. CN6 | Develop educational materials | Have a clear form, what you need to do, what we can offer, cost, approximate waiting time and [if] the result will be discussed by Geneticists and Counsellor or both. CN6 | |
| Inner setting: Tension for change | Perception of need for service | I don’t think there is enough business and scope to have a whole single nephrology genetics clinic, certainly on a weekly basis or perhaps even a monthly basis. HD1 | Conduct local needs assessment/facilitate relay of clinical data to providers 1 |
1 CFIR-ERIC theory informed.