133 Barriers to and enablers of the use of the Otology Questionnaire Amsterdam in clinical practice 7 considering their relevance to the definitions of the COM-B components and TDF domains. Second, the COM-B model was applied to subdivide the meaning units into the categories of capability, opportunity, and motivation. Third, these meaning units were further assigned based on the 14 theoretical domains of behaviour by using the TDF. Fourth, overarching themes were created to analyses and summarize the meaning units within the domains. An Illustration of this coding process is provided as additional online supplement S5. Three factors were considered to determine the key domains, which were previously applied in other published studies15,20. First, the frequency of a theme was calculated by counting how often the theme was mentioned by one specific ENT professional or patient. Second, all themes were analysed independently for the presence of contrasting statements. Third, the perceived strength of a theme was calculated, which was based on how often the theme was mentioned as the biggest or most important barrier or enabler by one specific ENT professional or patient. A theme was considered relevant if it (1) was frequently mentioned as barrier or enabler, (2) did not contain conflicting statements and (3) was mentioned as an influential barrier of enabler of the performance of specific behaviour. Finally, the key domains were matched to their corresponding intervention functions and policy categories of the BCW (Additional online file S3). The Behaviour Change Techniques (BCT)16 were used to provide suggestions for an implementation strategy. Results A total of 15 ENT professionals and 25 patients participated in the study. Characteristics of the ENT professionals and patients are provided respectively in table 2 and 3. Table 2. Characteristics of the ENT professionals (N=15) Total Amsterdam UMC NWZ Deventer Hospital Number of participants 15 5 5 5 • ENT surgeons 14 5 5 4 • ENT residents 1 0 0 1 Gender male/female 10/5 5/0 2/3 3/2 Years of work experience mean (range) 13.2 15.8 (7-26) 13.4 (8-20) 10.3 (1-19)
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