Theory-Informed Development of a Multicomponent Intervention to Implement Clinical Practice Guideline Recommendations in the Management of Shoulder Pain

Objective: Suboptimal primary health care management of shoulder pain has been reported in previous studies. Implementing clinical practice guidelines (CPGs) recommendations using a theoretical approach is recommended to improve shoulder pain management. This study aims to identify determinants for implementing recommendations from shoulder CPGs to help develop an intervention based on the identified determinants.

Methods: Family physicians and physical therapists managing patients with shoulder pain in primary care were invited to participate in a qualitative study to identify determinants to implementing recommendations from shoulder CPGs. The Theoretical Domains Framework (TDF) was used to inform the creation of the semi-structured interview guide and for deductive coding of transcriptions. The determinants were mapped to intervention functions, behavior change techniques (BCT) using the Behavior Change Wheel (BCW) method and strategies for implementing CPGs recommendations were identified.

Results: Interviews were conducted with 16 family physicians and 19 physical therapists. We identified 12 barriers and 6 facilitators within 7 TDF domains: knowledge, skills, beliefs about capabilities, beliefs about consequences, intentions, environmental context and resources, and social influence. We identified 6 intervention functions and 12 BCT addressing the relevant determinants. The 11 implementation strategies identified include the development and distribution of educational material, interactive educational outreach visits, and audit and feedback. Other components to consider are the identification and preparation of champions in primary care clinical settings, revision of professional roles, and creation of interdisciplinary clinical teams.

Conclusions: The identification of barriers and facilitators to implementing recommendations from shoulder CPGs allowed us to select implementation strategies at individual and organizational levels.

Impact: The implementation strategies will be adapted to specific primary care contexts in consultation with stakeholders and operationalized into a multi-component implementation intervention. Implementing the intervention has the potential to improve shoulder pain management in primary care and facilitate the use of evidence-based recommendations from CPGs.