Table 2.

Mapping matrix of potential intervention functions, policy categories and Behavior Change Techniques (BCI) to previously identified determinants of inappropriate statin prescription and healthy lifestyle promotion categorized by Theoretical Domains Framework (TDF) dimensions identified from the qualitative study.

TDF	What needs to change (statin prescription/healthy lifestyle promotion)	Intervention function policy category	Potential BCTs
Knowledge	Be aware of the problem of inappropriate statin prescription	Education	Feedback on behavior
		Training	Feedback on outcome of the behavior
	Be knowledgeable of the CVD prevention clinical guidelines, especially regarding adequate or recommended care depending on actual CVD risk	Persuasion Enablement	Information about social and health consequences Credible source
	Have updated and unified clinical practice criteria based on independent scientific evidence		Information about others' approval
		Regulation (principles of practice)	Social comparison
	Be aware of the beneficial impact of healthy lifestyles for the prevention of CVD (professionals and patients)	Guidelines (mandating changes to adequate service provision) Service provision (training)	Instruction on how to perform a behavior Demonstration of the behavior
	Be knowledgeable of the evidence-based healthy lifestyle promotion intervention in primary care (physical activity and healthy diet)	Communication/marketing	Behavioral practice/ rehearsal
			Habit formation
			Behavioral substitution
			Goal setting (behavior)
			Action planning
			Self-monitoring of behavior
			Review behavior goal(s)
			Problem solving
Cognitive and interpersonal skills	Increase skills to estimate and to address/communicate on CVD risk with a focus that goes beyond the numbers and risk factors	Education	Instruction on how to perform a behavior
	Increase skills for appropriate statin prescription	Training	Demonstration of the behavior
		Persuasion	Behavioral practice/rehearsal
	Have skills in prescribing physical activity and other healthy lifestyles (healthy diet, giving up smoking)	Enablement	Feedback on behavior
		Environmental restructuring	Review behavior goal(s)
	Have a standardized protocol that facilitates clinical actions to promote habits		Self-monitoring of behavior
		Service provision (continued training/tools)	Adding object to the environment
		Guidelines (mandating changes related to service provision)	Prompts /Cues
		Communication/marketing	Goal setting (behavior)
		Regulation	Action planning
			Self-monitoring of behavior
Memory, attention, and decision processes	Remember to provide the recommended clinical practice in CVD primary prevention	Training	Prompts/cues
		Environmental restructuring	Framing/reframing
	Remove visual cues that induce an inappropriate approach to high cholesterol in low-risk patients	Enablement	Adding objects to the environment
		Environmental planning	Restructuring the physical environment
			Avoidance/reducing exposure to cues for the behavior (inappropriate statin prescription)
Behavioral regulation	Reflect on the performance/practice of inappropriate prescription of statins in primary prevention of CVD	Education Training	Goal setting (behavior) Feedback on behavior
	Have clear and specific objectives, at a personal and organizational level, in reduction of inappropriate statin prescription in primary prevention of CVD	Modeling Enablement	Self-monitoring of behavior
	Have access to data on inappropriate statin prescribing in primary prevention of CVD.	Service provision (auditing)
	Have access to healthy lifestyles promotion practice data
Environmental context and resources	Have a simple tool that favors correct estimation of CVR, according to evidence, that considers additional characteristics of the people (e.g., antecedents)	Environmental restructuring Enablement	Adding/Removing object to the environment Prompts /Cues
	Have support systems in the electronic records that remind about and promote practice in primary prevention of CVD according to the CPGs (avoiding statins and recommending promotion of lifestyles)	Restriction Training	Avoidance/reducing exposure to cues for the behavior Restructuring the physical environment
	Restrict or impede the inappropriate prescription of statins because of simplicity and speed of clinical prescribing conduct		Framing/reframing
		Guidelines	Behavior substitution
	Having tools for a feasible (fast) and effective intervention in healthy lifestyles	Service provision (IT support tools in EHR and training)	Habit formation Associative learning
	Having access to resources within/outside the health care setting to favor the provision of recommended primary prevention of CVD practice (i.e., healthy lifestyle resources in the community)		Action planning
			Goal-setting (behavior) (organization level)
	Nursing participation in the primary prevention of CVD: provision of the recommended intervention to avoid inappropriate prescription		Demonstration of the behavior Review behavior goals Review outcome goals
Social influences	Patients should be aware of the problem of inappropriate statin prescribing: Risks vs. Benefits	Persuasion Education	Information about social and health consequences Feedback on behavioral outcomes
	Patients must have knowledge of the criteria and practice guidelines: cholesterol, CVD, CVR (patients)	Environmental restructuring Restriction	Credible source Prompts/cues
	The general population must be aware of the problem of excessive medication	Enablement	Framing/reframing Exposure
	The organization must continuously become aware of the problem of inappropriate prescription of statins in healthcare practice (Adaptation; Priority health policies)	Communication/marketing Regulation (organizational priority & standards)	Review behavior goals Review outcome goals
	The organization must have up-to-date clinical criteria, established in the guidelines based on independent scientific evidence	Environmental/social planning Guidelines	Discrepancy between current behavior and goal Instructions on how to perform the behavior
	The organization must have a focus beyond the figures and risk factors, both in CPGs and in risk-screening tools and/or interventions	Legislation	Action planning Habit reversal
	Advertising or promoting the use of statins in primary prevention of CVD should be restricted		Commitment Removing objects to the environment Avoidance/reducing exposure to cues for the behavior
Professional/social role and identity	Believe that adequate CVD prevention is considered important at their peer and organizational level	Education Persuasion	Information about social and health consequences Feedback on outcomes of the behavior
	Be clear about the criteria for action and responsibilities at the inter-institutional and inter-sectorial level (external: e.g., business medicine) in CVD prevention, based on indication (primary, secondary prevention, etc.)	Modeling Enablement	Credible source Social comparison
	Understand that the role of the doctor goes beyond prescribing drugs		Information about others' approval
		Communication/marketing	Identity associated with changed behavior
	Family Medicine and Community Health professionals establishment should be the protagonists (leadership, responsibility) in primary prevention of CVD	Regulation (organizational priority & standards)	Valued identity
		Guidelines (mandating changes to practice and service provision)	Review behavior goals
	Get other professionals (nurses) involved in the optimization of primary prevention of CVD	Service provision	Review outcome goals
			Discrepancy between current behavior and goal
			Instructions on how to perform the behavior
			Action planning
			Habit reversal
			Commitment
Beliefs about consequences	Perceive that not prescribing statins in primary prevention of CVD is not “not treating”	Education Persuasion	Demonstration of the behavior Feedback on outcome(s) of behavior
	Perceive that statins are not more effective than the promotion of habits to avoid CV events in primary prevention of CVD	Modeling	Information about health consequences
		Incentivization	Information about social and environmental consequences
	Perceive that the statin, in primary prevention of CVD, may have adverse effects and is not entirely safe		Credible source
		Communication/marketing	Identity associated with changed behavior
	Have an expectation of the benefits of healthy lifestyle promotion actions (short, medium and long term)	Guidelines (evidence diffusion)	Valued identity
		Service provision (continued training)	Information about others' approval
			Social support
			Incompatible beliefs
			Incentive
Beliefs about capabilities	Perceive that one is able and has the necessary skills to provide the healthy lifestyle promotion	Education	Feedback on behavior
		Training	Focus on past success
	Perceive that statin prescribing is not such a simple (low skill) or safe practice	Persuasion	Verbal persuasion about
		Modeling	capability
	Perceive that one is competent and confident enough to carry out the CV risk screening process	Enablement	Vicarious consequences Information about social an environmental consequences
			Information about health consequences
	Perceive that one is competent and confident enough to respond to the sporadic arrival of patients in the target population for CVD primary prevention (they come infrequently), through the promotion of good habits	Guidelines	Demonstration of the behavior
		Service provision (auditing and provision) (continued training)	Instruction on how to perform a behavior
	Perceive that statin treatment is not so easy for the patient (dosage)		Behavioral practice/ rehearsal
			Credible source
	Have a sense of self-confidence in prescription of physical activity and other healthy lifestyles		Problem solving
			Action planning
	Not have a perception of difficulty in modifying lifestyles (compared to taking a pill)		Social support (practical)
			Problem solving
Intentions	Should have a strong intention not to prescribe statins inappropriately in primary prevention of CVD	Education	Information about health consequences
		Persuasion	Information about social and environmental consequences
	Should have a strong intention to provide interventions to promote healthy habits for the primary prevention of CVD	Incentivization	Credible source
		Modeling	Identity associated with changed behavior
			Discrepancy between current behavior and goal
		Communication/marketing (evidence diffusion)	Instructions on how to perform the behavior
		Regulation (organizational priority & standards)	Action planning
		Guidelines (mandating changes to service provision)	Habit reversal
			Commitment
			Feedback on outcome(s) of behavior
			Incompatible beliefs
			Incentive
			Verbal persuasion about capability
Goals	Have organizational objectives related to the reduction of inappropriate prescription of statins in primary prevention of CVD	Education	Review behavior goals
		Persuasion	Review outcome goals
	Should consider the practice of primary prevention of CVD a priority in accordance with the recommendations.	Incentivization	Discrepancy between current behavior and goal
		Modeling	Instructions on how to perform the behavior
	Should be committed to carrying out a practice of primary prevention of CVD according to the recommendations	Enablement	Goal-setting (behavior)
			Action planning
	Have the motivation (priority and commitment) to promote lifestyles in primary prevention of CVD	Regulation (organizational priority & standards)	Commitment
		Guidelines (mandating changes to adequate service provision) Service provision (training)	Self-monitoring of behavior Monitoring of behavior by others Feedback on behavior Feedback on outcomes of the behavior
Reinforcement	Receive positive or negative reinforcement related to adequate ECV prevention performance	Training Incentivization	Feedback on behavior Material incentive
	Should avoid prescribing out of habit, routine or inertia (to treat cholesterol)	Coercion	(behavior)
		Environmental restructuring	Material reward
			Social reward
		Service provision (auditing)	Reward alternative
		Regulation (principles of practice)	behavior
			Avoidance/reducing exposure to cues for the behavior (inappropriate statin prescription)
Emotion	Not feel threatened (fear) for not prescribing a drug	Education Persuasion	Feedback on behavior
	Feel confident about not prescribing a statin for CVD primary prevention	Incentivization Coercion	Information about health consequences Credible source
	Experience positive feelings/emotions associated with not doing defensive medicine	Guidelines	Discrepancy between current behavior and goal Anticipated regret
	Experience negative emotions when making an inappropriate prescription	Communication and marketing Regulation	Remove aversive stimulus Information about others' approval
	Feel safe and confident with the action guidelines		Social support

Target behavior: Reduce the prescription of statins in the context of the primary prevention of CVD in low-risk patients and favor the promotion of healthy habits (regular physical activity, healthy diet and giving up smoking) at any opportunistic or programmed office visit for screening or addressing CVD risk factor and/or prevention.