Results of TDF belief statements by referral frequency
| TDF domain | TDF questions (n=54) | Frequent referral n=109 (%) (weekly/monthly) | Infrequent referral n=113 (%) (>monthly or no referral) | Total n=222(%) |
| 1. Knowledge | I am aware of the content of PR programmes* | 97/109 (89.0) | 72/113 (63.7) | 169/222 (76.1) |
| I am aware of PR programme objectives.* | 99/109 (90.8) | 75/113 (66.4) | 174/222 (78.4) | |
| I am unsure of the evidence base for PR | 18/109 (16.5) | 30/113 (26.5) | 49/222 (21.6) | |
| I know where geographically my local PR programme is delivered* | 92/109 (84.4) | 70/113 (61.9) | 162/222 (73.0) | |
| I know when it is appropriate to refer a patient with COPD to PR* | 106/109 (97.3) | 74/113 (65.5) | 180/222 (81.1) | |
| I can answer questions patients have about PR* | 88/109 (80.7) | 60/113 (53.1) | 148/222 (66.7) | |
| I know how to contact my local PR provider* | 91/109 (83.2) | 68/113 (60.2) | 159/222 (71.6) | |
| 2. Skill | It is easy to refer a patient to PR* | 87/109 (80.0) | 48/113 (42.5) | 135/222 (60.8) |
| 3. Social and professional role | Referral to PR is the practice nurse role | 63/109 (57.8) | 45/113 (39.8) | 108/222 (48.6) |
| Other general practice staff in my practice (excluding practice nurse) refer patients to PR | 52/109 (47.7) | 63/113 (55.8) | 115/222 (51.8) | |
| I believe in encouraging patients to attend PR | 109/109 (100) | 104/112 (92.9) | 213/221 (96.4) | |
| 4. Environment | Resources about PR (ie, written information) are readily available | 39/109 (35.7) | 25/112 (22.3) | 64/221 (29.0) |
| There is not enough time in practice to refer | 12/109 (11.0) | 22/113 (19.5) | 34/222 (15.3) | |
| 5. Social influences | My local PR providers regularly engage with me | 31/109 (28.4) | 17/113 (15.0) | 48/222 (22.6) |
| PR is something that patients ask for | 3/109 (2.8) | 8/112 (7.1) | 11/221 (5.0) | |
| There are good relationships in practice with PR providers | 44/109 (40.4) | 28/112 (25.0) | 72/221 (32.6) | |
| PR providers are good at communicating outcomes of referrals I have made | 39/109 (35.8) | 25/112 (22.3) | 64/221 (29.0) | |
| 6. Optimism (including pessimism) | I am confident my local PR provider offers a good service for my patients* | 81/109 (74.3) | 52/113 (46.0) | 135/222 (60.8) |
| I don’t believe patients will attend PR after I have referred | 16/109 (14.7) | 16/113 (14.2) | 32/222 (14.4) | |
| Patients who smoke are not motivated to take part in PR | 7/109 (6.4) | 7/113 (6.2) | 14/222 (6.3) | |
| Patients who live alone won’t like to take part in group PR | 5/109 (4.6) | 2/113 (1.8) | 7/222 (3.2) | |
| Patients are motivated to attend PR | 23/109 (21.6) | 30/111 (27.0) | 53/219 (24.2) | |
| 7. Belief about capabilities (self) | I am confident in my ability to encourage patients to attend PR, even when they are not motivated | 91/109 (83.5) | 73/113 (67.6) | 164/222 (73.9) |
| I do not find it easy to discuss PR with patients | 8/109 (7.3) | 25/113 (22.1) | 36/222 (16.2) | |
| Belief about capabilities (patients) | Patients without their own transport won’t be able to get to PR | 40/109 (36.7) | 26/113 (23.0) | 66/222 (29.7) |
| Patients in work are not able to attend PR* | 62/109 (56.9) | 35/113 (31.0) | 97/222 (43.7) | |
| Patients who use home oxygen are unable to take part in PR | 4/109 (3.7) | 6/113 (5.3) | 10/222 (4.5) | |
| 8. Belief about consequences | If I keep pushing patients to attend PR this will disadvantage my relationship with them. | 10/109 (9.2) | 10/112 (8.9) | 20/221 (9.0) |
| I believe patients may be harmed by taking part In PR | 1/109 (0.9) | 1/113 (0.9) | 2/222 (0.9) | |
| I believe most patients will attend and complete PR following my referral | 55/109 (50.4) | 47/112 (42.0) | 102/221 (46.2) | |
| PR is not beneficial to patients who are breathless | 3/109 (2.8) | 3/113 (2.7) | 6/222 (2.7) | |
| PR is best suited to those patients with worsening breathlessness | 29/109 (26.6) | 29/112 (25.9) | 58/221 (26.2) | |
| PR is best suited to those who have frequent exacerbations | 27/109 (24.8) | 28/112 (25.0) | 55/221 (24.9) | |
| PR reduces hospital admissions | 101/109 (92.7) | 97/112 (86.6) | 198/221 (89.6) | |
| PR reduces risk of mortality | 85/109 (78.0) | 82/112 (73.2) | 167/221 (75.6) | |
| If patients attend PR this will reduce their general practice visits | 73/109 (67.0) | 78/112 (69.6) | 151/221 (68.3) | |
| PR reduces exacerbations | 88/109 (80.7) | 84/112 (75.0) | 172/221 (77.8) | |
| PR improves breathlessness | 103/109 (94.5) | 100/112 (89.3) | 203/221 (91.9) | |
| PR reduces a patient’s anxiety and/or depression. | 97/108 (89.8) | 96/112 (85.7) | 193/220 (87.7) | |
| 9.Goals | Referring patients to PR is something I have been advised to do* | 95/107 (88.8) | 57/112 (50.9) | 152/219 (69.4) |
| My practice regularly reviews COPD registers to ensure eligible patients with COPD are offered PR | 51/109 (46.8) | 40/113 (35.4) | 91/222 (41.0) | |
| There are set targets within the practice to improve PR referral rates | 23/109 (21.1) | 21/113 (18.6) | 44/222 (19.8) | |
| 10. Memory (Inc. decision-making) | I often forget to refer patients with COPD to PR | 3/109 (2.8) | 23/113 (20.4) | 26/222 (11.7) |
| Prompts to refer patients to PR within annual review templates are important reminders for me | 72/109 (66.1) | 69/112 (61.6) | 141/221 (63.8) | |
| I only refer patients if they have quit smoking | 1/109 (0.9) | 3/113 (2.7) | 4/222 (1.8) | |
| I only refer patients if they are optimised on their respiratory medication | 17/109 (15.6) | 12/113 (10.6) | 29/222 (13.1) | |
| PR is most suited to patients with COPD who have frequent exacerbations | 20/109 (18.3) | 20/113 (17.7) | 40/221 (18.1) | |
| The best time to discuss PR referral with patients is when they are stable | 32/109 (29.4) | 25/112 (22.3) | 57/221 (25.8) | |
| 11. Reinforcement | More healthcare practitioners will discuss PR with patients because of the QoF incentive | 75/109 (68.8) | 73/112 (65.2) | 148/221 (67.0) |
| My practice receives financial incentives for referral to PR (before April 2019) | 6/108 (5.6) | 5/113 (4.4) | 11/221 (5.0) | |
| I believe patient attendance to PR will increase because of the QoF incentive | 41/109 (37.6) | 58/112 (51.8) | 99/221 (44.8) | |
| I believe the QoF incentive will not increase patients PR attendance | 29/109 (26.6) | 25/112 (2.3) | 54/221 (24.4) | |
| There will be greater awareness of PR within practices because of the new QoF incentives | 84/109 (77.1) | 71/112 (63.4) | 155/221 (70.1) | |
| 12. Intentions | I will refer more patients to PR now there are practice QoF incentives (from April 2019) | 30/109 (27.5) | 42/112 (37.5) | 72/221 (32.6) |
*Differences in results of >20% between frequent and infrequent referrer.
COPD, chronic obstructive pulmonary disease; PR, pulmonary rehabilitation; TDF, Theoretical Domains Framework.