135 Barriers to and enablers of the use of the Otology Questionnaire Amsterdam in clinical practice 7 Table 4. Identified barriers to the use of the OQUA as perceived by ENT professionals. COM-B TDF domain Setting* Theme* FRQ CS PS Psychological Capability Knowledge 1,2,3 Lack of knowledge regarding the use of the OQUA in clinical practice 11/15 Yes 0/15 Physical Capability Skills 1,2 Lack of skills to access the OQUA in the electronic patient record 8/15 Yes 0/15 Physical Capability Skills 1,2,3 Lack of skills to interpret scores of the OQUA 7/15 Yes 0/15 Reflective motivation Beliefs about consequences 1,2,3 Perceived lack of clarity of the clinical significance of the OQUA 8/15 No 3/15 Physical Opportunity Environmental context and resources 1,2,3 Lack of IT support to (automate) use of the OQUA 12/15 No 4/15 Physical Opportunity Environmental context and resources 1,2,3 Perceived (additional) time investment and administrative tasks to use the OQUA 8/15 Yes 5/15 Reflective motivation Beliefs about consequences 1 Perceived obligation to review the results of the OQUA with the patient 3/15 No 0/15 Psychological capability Behavioural regulation 1,2 Perceived resistance to change daily habits and routines 6/15 Yes 1/15 Reflective motivation Optimism (pessimism) 2,3 Uncertainty whether the OQUA scores accurately reflect the severity of problems 4/15 Yes 0/15 Reflective motivation Beliefs about consequences 2,3 Perceived fear to be judged by patient-defined quality 3/15 Yes 0/15 Automatic Motivation Emotion 2,3 Perceived competition among hospitals 4/15 Yes 0/15 Automatic Motivation Reinforcement 1,2,3 Lack of feedback regarding new insights based on the OQUA 9/15 No 2/15 Social opportunity Social influences 1,2 Lack of triggers that encourage use of the OQUA 7/15 No 0/15 Physical opportunity Environmental context and resources * Setting: 1 = Amsterdam UMC, location VUmc, 2 = Noordwest Ziekenhuisgroep, location Alkmaar, 3 = Deventer Hospital * Theme: represent a brief statement about the perceived barrier or enabler * COM-B: Capability, Opportunity, Motivation – Behaviour; TDF: Theoretical Domains Framework * FRQ: frequency of which a theme was mentioned among ENT professionals ; CS: presence of Contrasting Statements yes/no ; PS: Perceived Strength represents how often the theme was mentioned as the biggest or most important barrier.
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