Summary of intervention components and the theoretical framework underpinning them
| Intervention component and brief description | Theoretical domains framework factor(s) addressed | Supporting theories of behavioural change |
| Local consensus processes: Local clinical pathways on common musculoskeletal conditions (low back pain, shoulder pain and osteoarthritis) designed with input from multidisciplinary teams (using the Delphi technique) summarising guideline recommendations and availability of local services. These pathways were disseminated to all 36 practices, were presented at local educational events and were published on the local website for general practitioners (GPs) to access. | Knowledge, beliefs about consequences, memory and decision processes. | Theory of planned behaviour Bandura’s social cognitive theory Diffusion of innovation. Rational system theory. |
| Clinical audit: Audit and reflection on current practice using standardised proformas, opportunity for team discussion of findings, identification of learning needs and agreeing ways to improve practice. The audits took place at practice level and the results were discussed both within practices and also at network events. | Knowledge, motivation and goals, social influences, behavioural regulation. | Theory of planned behaviour Bandura’s social cognitive theory. Diffusion of innovation. Social influence theory. Complexity theory. Rational system theory. |
| Feedback: Monthly reports to provide ongoing feedback to clinicians on referral activity (comparative data at GP, practice, network and borough levels). These reports were disseminated both at practice and network levels. | Motivation and goals, social influences, behavioural regulation. | Theory of planned behaviour. Bandura’s social cognitive theory. Diffusion of innovation. Social influence theory. Rational system theory. Statistical process control theory. |
| Monthly educational meetings and outreach visits facilitated via local opinion leaders: Opportunity to discuss the clinical pathways and clinical practice with peers (case-based discussions). Local opinion leaders (referral champions) in each network of practices facilitated discussions on referral decision-making, best clinical practice and identification of learning needs. The meetings were attended by GPs and practice managers from each practice. | Knowledge and skills, motivation and goals, social/professional role and identity, social influences, behavioural regulation. | Theory of planned behaviour Bandura’s social cognitive theory. Diffusion of innovation. Social influence theory. Natural system theory. |