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Understanding physician behaviour in the 6–8 weeks hip check in primary care: a qualitative study using the COM-B
  1. Angel Chater1,
  2. Sarah Milton2,
  3. Judith Green2,
  4. Gill Gilworth2,
  5. Andreas Roposch3,4
  1. 1Department of Sport Science and Physical, University of Bedfordshire, Luton, UK
  2. 2Department of Population Health Sciences, King's College London, London, UK
  3. 3Institute of Child Health, University College London, London, UK
  4. 4Department of Orthopaedic Surgery, Great Ormond Street Hospital for Children, London, UK
  1. Correspondence to Professor Andreas Roposch; a.roposch{at}


Objectives A compulsory hip check is performed on an infant at 6–8 weeks in primary care for the detection of developmental dysplasia of the hip (DDH). Missed diagnoses and infants incorrectly labelled with DDH remain an important problem. The nature of physician behaviour as a likely source of this problem has not been explored. The aims of this study were to make a behavioural diagnosis of general practitioners (GPs) who perform these hip checks, and identify potential behavioural change techniques that could make the hip checks more effective.

Design Qualitative study with in-depth semistructured interviews of 6–8 weeks checks. We used the Capability, Opportunity, Motivation and Behaviour model in making a behavioural diagnosis and elicited factors that can be linked to improving the assessment.

Setting Primary care.

Participants 17 GPs (15 female) who had between 5 and 34 years of work experience were interviewed.

Results Capability related to knowledge of evidence-based criteria and skill to identify DDH were important behavioural factors. Both physical (clinic time and space) and social (practice norms), opportunity were essential for optimal behaviour. Furthermore, motivation related to the importance of the 6–8 weeks check and confidence to perform the check and refer appropriately were identified in the behavioural diagnosis.

Conclusion Aspects of capability, opportunity and motivation affect GPs’ diagnosis and referral behaviours in relation to DDH. The findings from this work extend current knowledge and will inform the development of an intervention aimed at improving the diagnosis of DDH.

  • paediatric orthopaedics
  • paediatrics
  • primary care

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  • Contributors AC, JG, SM, AR substantially contributed to the conception and design of the work. AC, SM and GG contributed equally to acquisition and analysis of the data. All authors contributed to the interpretation of data. AC, SM and AR wrote the first draft; all authors revised the draft and approved the final manuscript. AR, JG and AC secured the funding for the work (AR is chief investigator). All authors approved the final version to be published and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grant for Applied Research funding stream (RP-PG-0616–20006).

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval King’s College London University Ethics Board (MRA-17/18–6433) and Health Research Authority (18/SW/0168) approved this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. All data have been handled in accordance with the UK Data Protection Act 2018. Data have been transcribed and coded using computer software NVivo. All raw data are confidential and resides with Kings College London.