150 Chapter 7 anticipate that the implementation of the OQUA will be an ongoing process, which requires continuous evaluations and modifications. In general, we expect that the findings of this study will be informative for healthcare providers and for applying the IS approach to improve PROM implementation. Because of the large overlap between the identified barriers and enablers in our study and those in the literature, we suggest that incorporating these factors into (pre-)implementation processes may contribute to the successful uptake of PROMs in clinical practice. Conclusion This study has demonstrated that barriers to the use of the OQUA are related to the capability, opportunity and motivation of ENT professionals and patients. The identified enablers have shown that both groups are motivated to incorporate the OQUA into their daily practices. These findings highlight that interventions are needed to improve implementation of the OQUA. We suggest that the implementation strategy should focus on education and training about the objective, outcomes and relevance of the OQUA, environmental restructuring regarding the optimal use of the OQUA, and incentivisation with feedback on the valuable outcomes of the OQUA for the patient, professional and healthcare. Supplementary Information The online version contains additional online files, available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11324631/ Acknowledgments We gratefully acknowledge Erik M. Kraak, with his 30 years of experience in the field of qualitative market research, he was the leader and expert in the focus groups. He was closely involved in analysing the data from the focus groups leading to some of the conclusions that were made. We thank all the ENT surgeons and patients who participated in the focus groups and interviews. KV and JK analysed the data. All authors participated in the interpretation of the data. JK had the leading role in the writing process. All authors revised the manuscript critically for important intellectual content and approved the current version to be submitted.
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