130 Chapter 7 From December 2020 till December 2022, response rate on the OQUA was low. In a total of 288 patients who received the questionnaire, 15.5% completed the OQUA both pre- and post-operatively. The descriptive data analysis of this retro-perspective patient cohort is shown in Table 1. The aim of this study was to identify the barriers to and enablers of using the OQUA as perceived by ENT surgeons and patients. Based on the identified barriers and enablers, the study will provide recommendations for the development of effective interventions as part of an implementation strategy. Previous research has demonstrated that enablers are dependent on the context and availability of local resources. Barriers in general include uncertainty about the relevance and negative consequences of PROMs, competing requirements in daily practice, and technological restrictions 3 We hypothesize that the identified barriers in this study will be coherent with the existing literature3,6,12,13 and that the development of an implementation strategy is needed to overcome these barriers and enhance the enablers. Methods & Materials A prospective, multicentre, qualitative study was performed at the ENT department of the Amsterdam UMC, NWZ and Deventer hospital Netherlands from November 2022 to April 2023. Focus groups and interviews were conducted with ENT professionals and patients to identify the barriers to and enablers of the use of the OQUA in clinical practice. The study was designed according to the Standards for Reporting Qualitative Research.14 The use of a theoretical framework for structured identification and categorization of barriers to and enablers of implementation is highly recommended.7,15 In this study, the Behaviour Change Wheel (BCW) was used.4 Supplementary to the COM-B model, the Theoretical Domains Framework (TDF) was used to separate the capability, opportunity, and motivation categories into 14 theoretical domains of behaviour. Sampling strategy ENT surgeons and ENT residents involved in providing care to patients with ear- or hearing-related complaints, received an email invitation from the research team to partake in the study. To ensure a representative sample of clinical hearing health care in the Netherlands, ENT surgeons and ENT residents from a secondary setting (NWZ and Deventer Hospital) and a tertiary setting (Amsterdam UMC) were included.
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