COM-B construct TDF domain Specific belief (linked to implementation factor) | Quote no Sample quote | Count of relevant quotes (count reflecting ‘expected’ barriers) | Count of participants with relevant quotes (count reflecting ‘expected’ barriers) |
TASK 1: applying clinical judgement | |||
COM-B construct: psychological capability | |||
TDF domain: knowledge | |||
Specific belief: therapeutics | |||
Specific belief: patient preferences/ circumstances | 1.‘… your therapeutics has got to be up to scratch’. (Pharmacist 09) | 15 (0) | 3 (0) |
TDF domain: skill | 2.‘If I don’t know the patient I would speak to the GP because I might be making suggestions that he’s tried before. He’ll say, oh there’s no point in trying to stop that because, I’ve tried that a million times before’. (Pharmacist 10) | 4 (1) | 4 (1) |
Specific belief: clinical | |||
COM-B construct: reflective motivation | 3.‘you might decide oh I want to look at those indicators but maybe I don’t [feel] confident enough to make the changes myself, or I would be then having to refer back to other practitioners, so you might want to up-skill your clinical skills in that…’ (Pharmacist 06) | 13 (4) | 8 (4) |
TDF domain: memory, attention and decision making | |||
Specific belief: decision making | |||
Specific belief: attention | 4.‘I was hoping that the P-DQIP tool would help identify the patients that need to come in, to help to review them, because at the moment you’re sitting with 6000 patients on repeat meds and where do you start’. (Pharmacist 08) | 10 (0) | 5 (0) |
TDF domain: beliefs about capabilities | 5.‘That [the informatics tool] would really help, ‘cause you may not have thought about this interaction or something, you may just be prescribing, you might not have thought about the fact you can't put these two drugs together or perhaps the patient’s age or whatever’. (Pharmacist 14) | 5 (0) | 4 (0) |
Specific belief: professional confidence | |||
6.‘I’ve been a practice pharmacist for a long time, so, I’ve seen a lot of cases and worked with a lot of patients with a lot of different conditions and sometimes that confidence, it just comes with experience doesn’t it?’ (Pharmacist 09) | 17 (4) | 11 (3) | |
COM-B construct: | 7.‘I wouldn’t be confident in going and stopping some of the anti-psychotics and schizophrenic patients and things like that if they were under mental health’. (Pharmacist 08) | ||
TDF domain: emotion | Reflective motivation | ||
Specific belief: anxiety | |||
8.‘I feel a greater weight of responsibility when I am actually prescribing for somebody, it takes me quite a lot to put the pen to paper to actually do the prescription’. (Pharmacist 13) | 2 (0) | 2 (0) | |
TASK 2: collaboration with GPs | |||
COM-B construct: psychological capability | |||
TDF domain: knowledge | |||
Specific belief: task environment | 9.‘You’ve got(…)to understand how a practice works and how it interacts with other care environments …’ (Pharmacist 09) | 15 (0) | 9 (0) |
TDF domain: skill | |||
Specific belief: interpersonal | 10.‘You're going to have to get to know the people that you're working with, and I think for the first little while you might say right I'll speak to the GPs about the changes first of all, just to demonstrate that you're capable, you're not going to do something dangerous and you're not going to just spend all your time(…)telling the patients that the GPs are rubbish…’ (Pharmacist 11) | 15 (0) | 8 (0) |
COM-B construct: reflective motivation | |||
TDF domain: beliefs about capabilities | |||
Specific belief: personal self-confidence | 11.‘I'd be quite happy to say, yeah, I would lead on that in the practice; I'd quite happily take that… I'd take it to the GPs and say right, this is what we're going to do’. (Pharmacist 11) | 4 (0) | 4 (0) |
TDF domain: professional/social role and identity | |||
Specific belief: professional boundaries | 12.‘I will make my recommendations, they’ll be discussed round the table by various professionals and then there’ll be a decision made as to whether they’re appropriate actions or not and how they’re going to be implemented’. (Pharmacist 09) | 7 (0) | 4 (0) |
COM-B construct: social opportunity | |||
TDF domain: social influences | |||
Specific belief: interpersonal trust | 13.‘My GPs are like that with me because I’ve been with them for a long time and they know what I can do and what I don’t. They know that if I’m in doubt about anything I would go and ask them. If you see what I mean? They’d be supportive of me, whereas I’m not so sure if I went someplace else how that would be without those GPs knowing that Pharmacist there’. (Pharmacist 08) | 21 (2) | 13 (1) |
Specific belief: practices’ staff interest in collaboration | 14.‘We have weekly meetings, multidisciplinary meetings and we discuss vulnerable patients who are maybe tinkering on the edge of needing admission to hospital and maybe just need a little bit more support at home’. (Pharmacist 10) | 27 (4) | 8 (3) |
Specific belief: practices’ perception of pharmacist role | 15.‘I’m concerned now that they look at me and say, oh she’s just here to, help cut costs, because I think they can… because it’s such a big thing and I don’t think it’s me that’s doing it I think it’s the management that are doing it and it’s filtering through to them … I don’t feel comfortable with that because I think we’re there as a quality thing. Obviously cost does come into it, but, that does concern me to a certain extent’. (Pharmacist 02) | 8 (3) | 5 (3) |
Specific belief: practices’ perception of pharmacist skills | 16.‘If every decision that they're making is questioned and the pharmacist then feels that they're unwilling to make any changes because it's just going to come back and hit them in the face kind of thing’. (Pharmacist 13) | 12 (2) | 9 (2) |
TASK 3: fitting P-DQIP into work routines | |||
COM-B construct: Psychological capability | |||
TDF domain: behavioural regulation | |||
Specific belief: action/work planning | 17.‘f we get that sort of system set up, that would be fine, you know, it’s not that kind of thing I’m worried about. It’s actually having the protected time to do it’. (Pharmacist 08) | 17 (1) | 10 (1) |
COM-B construct: reflective motivation | |||
TDF domain: professional/social role and identity | |||
Specific belief: professional identity | 18.‘The core of our job is patient safety and these drugs are obviously very, very risky to patients, so I think they [other pharmacists] should be engaged’. (Pharmacist 12) | 11 (0) | 6 (0) |
TDF domain: beliefs about consequences | |||
Specific belief: review process | 19.‘The positive would be for me, it would make polypharmacy reviews a lot easier and give you areas to focus on which is good’. (Pharmacist 12) | 24 (0) | 12 (0) |
Specific belief: patient benefit | 20.‘Helping to reduce the high risk prescribing basically and help some of the patients out there that shouldn’t be on drugs that they are currently on and harming them. Well, you’re going to stop them falling, ending up in hospital. Some of the dreadful side effects that some of the drugs have. A lot of them don’t realise they’ve got a dry mouth because of their drugs…’ (Pharmacist 08) | 6 (0) | 6 (0) |
TDF domain: optimism | |||
Specific belief: positive attitudes | 21.‘Yes, it is something else to do but, if we do this it will hopefully help pre-empt problems in the long run’. (Pharmacist 9) | 8 (0) | 7 (0) |
TDF domain: goals | |||
Specific belief: professional recognition | 22.‘When I did the Polypharmacy pilot I was working late every night because I was doing this really in addition to my other work.… I wanted it to be done properly so I invested a lot of my energy and time to doing that … maybe I wouldn’t do it in so much depth now but, at that point, I did want to know… because we were at the beginning. The first time I’d work with the Consultant and the GP together so I wanted to pre-empt any questions I would be asked’. (Pharmacist 03) | 13 (0) | 9 (0) |
Specific belief: professional satisfaction | 23.[in a previous multidisciplinary project on polypharmacy] the consultant from Medicine for the Elderly was, very much taking the lead,… so there was a certain amount of professional satisfaction but not, not the same as you would, if you were actually doing the review on your own’. (Pharmacist 13) | 1 (0) | 1 (0) |
TDF domain: reinforcement | |||
Specific belief: prompts/cues | 24.‘As you're doing it that would be a way to prompt you, and as I said if you see one you might go and search for patients on say, I mean… there's some computer systems where they flag up interactions and from that you may think oh well, OK, this seems to be coming up a lot, I can go and search and see if there's any more patients and then you would then set up and probably go, and go and have a look’. (Pharmacist 14) | 8 (0) | 5 (0) |
Specific belief: goal/target setting | 25.‘…I don't know, setting people targets … I wouldn’t, I would steer away from that in like, you know, in the practice …, 'cause I know they've tried it … and it, it's not fabulously helpful. You’d pick the easy ones wouldn’t you’. (Pharmacist 01) | 3 (0) | 3 (0) |
Specific belief: peer comparison | 26.‘There's always a list and nobody wants to be at the bottom, so it's nice to see yourself… we've improved and got better, you sort of, you can rank yourself against the others and see how well you're doing…’ (Pharmacist 03) | 7 (0) | 5 (0) |
COM-B construct: physical opportunity | |||
TDF domain: environmental context and resources | |||
Specific belief: competing demands on time—health board | 27.‘We have to do cost-savings but sometimes, …we may get asked just to drop some of the work we do, safety work we do, and cost savings are always a, a priority’. (Pharmacist 01) | 9 (6) | 8 (5) |
28.‘It’s actually having the protected time to do it and not just asking us to do something else at the end of a really, really long day’. (Pharmacist 08). | |||
Specific belief: competing demands on time—practices | 29.‘And then I went away on three weeks’ holiday and I’ve come back and they said oh we’re so pleased to see you [laughter]. The GP even stopped me in the car park and he says oh, fantastic, he says, I can send my discharges your way now again, because they need some help’. (Pharmacist 08) | 1 (1) | 1 (1) |
Specific belief: Staff resources—pharmacy | 30.‘So this particular practice has a Prescribing Support Technician on a Thursday every week doing work, because it's a high-cost practice, but like the practice that I came from before that, didn’t have technician cover for months and so the cost-minimisation work has just been done by me’. (Pharmacist 13) | 5 (0) | 3 (0) |
Specific belief: Staff resources—practice | 31.‘At the moment, because of the lack of GPs in the practice, there’s not the appetite to move forward with it because we could identify lots of patients and there’s just not the staff to agree the changes that need to be made’. (Pharmacist 09) | 5 (1) | 4 (1) |
COM-B, Capability-Opportunity-Motivation-Behaviour; GP, general practitioner; P-DQIP, Pharmacist and Data-Driven Quality Improvement in Primary Care; TDF, Theoretical Domains Framework.