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Understanding delays in chronic limb‐threatening ischaemia care: Application of the theoretical domains framework to identify factors affecting primary care clinicians' referral behaviours

Atkins, Eleanor; Birmpili, Panagiota; Kellar, Ian; Johal, Amundeep S.; Li, Qiuju; Waton, Sam; Boyle, Jonathan R.; Pherwani, Arun D.; Chetter, Ian; Cromwell, David A.

Authors

Eleanor Atkins

Panagiota Birmpili

Ian Kellar

Amundeep S. Johal

Qiuju Li

Sam Waton

Jonathan R. Boyle

Arun D. Pherwani

Ian Chetter

David A. Cromwell



Abstract

Introduction: Patients in the community with suspected Chronic limb‐threatening ischaemia (CLTI) should be urgently referred to vascular services for investigation and management. The Theoretical Domains Framework (TDF) allows identification of influences on health professional behaviour in order to inform future interventions. Here, the TDF is used to explore primary care clinicians' behaviours with regards to recognition and referral of CLTI. Methods: Semi‐structured interviews were conducted with 20 podiatrists, nurses and general practitioners in primary care. Directed content analysis was performed according to the framework method. Utterances were coded to TDF domains, and belief statements were defined by grouping similar utterances. Relevance of domains was confirmed according to belief frequency, presence of conflicting beliefs and the content of the beliefs indicating relevance. Results: Nine TDF domains were identified as relevant to primary care clinicians: Knowledge, Environmental context and resources, Memory, Decision and attention processes, Beliefs about capabilities, Skills, Emotions, Reinforcement and Behavioural regulation. Relationships across domains were identified, including how primary care clinician confidence and working in a highly pressurized environment can affect behaviour. Conclusion: We have identified key barriers and enablers to timely recognition and referral behaviour. These beliefs identify targets for theory‐driven behaviour change interventions to reduce delays in CLTI pathways.

Citation

Atkins, E., Birmpili, P., Kellar, I., Johal, A. S., Li, Q., Waton, S., …Cromwell, D. A. (2024). Understanding delays in chronic limb‐threatening ischaemia care: Application of the theoretical domains framework to identify factors affecting primary care clinicians' referral behaviours. Journal of Foot and Ankle Research, 17(2), Article e12015. https://doi.org/10.1002/jfa2.12015

Journal Article Type Article
Acceptance Date Apr 15, 2024
Online Publication Date May 4, 2024
Publication Date Jun 1, 2024
Deposit Date May 13, 2024
Publicly Available Date May 13, 2024
Journal Journal of Foot and Ankle Research
Print ISSN 1757-1146
Publisher BioMed Central
Peer Reviewed Peer Reviewed
Volume 17
Issue 2
Article Number e12015
DOI https://doi.org/10.1002/jfa2.12015
Keywords pathways, referral, vascular surgery, primary care, chronic limb‐threatening ischaemia
Public URL https://keele-repository.worktribe.com/output/826260
Publisher URL https://onlinelibrary.wiley.com/doi/10.1002/jfa2.12015

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Understanding delays in chronic limb‐threatening ischaemia care: Application of the theoretical domains framework to identify factors affecting primary care clinicians' referral behaviours (198 Kb)
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Licence
https://creativecommons.org/licenses/by/4.0/

Publisher Licence URL
https://creativecommons.org/licenses/by/4.0/

Copyright Statement
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.




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