Table 4 Barriers and enablers to implementation of PROMs in pediatric outpatient asthma clinics
Domain | Barrier | Enabler |
|---|---|---|
Knowledge | Limited awareness | |
Skills | Data interpretation skills | Communication skills |
Social/professional role and identity | Lack of guidelines from professional organizations | Willingness to Provide patient and family-centered care |
Beliefs about capabilities | Resistance to change culture | As a standardization tool Ease of integrating PROMs Confidence in self-ability |
Optimism | Optimism about positive impact of PROMs | |
Beliefs about consequences | Lack of clear processes and strategies Potential negative consequences | To deliver comprehensive healthcare To optimize healthcare delivery Benefits of using PROMs outweighs harms |
Reinforcement | Perceptions with time (increases appointment time) Specific motivations for clinicians Specific motivations for patients and families | Perceptions with time (decreases appointment time) Incentives |
Intentions | High importance | |
Goals | Compatibility | |
Memory, attention and decision processes | Language barriers Technological barriers Complex family background | |
Environmental context and resources | Challenges of working within larger system Acuity of the patient Disruption to clinical workflow | |
Social influences | Patient and families’ emotions | Influence of leaders and team members |
Emotion | Excitement among healthcare providers | |
Behavioural regulation | Electronic PROMs Engagement with stakeholders at the asthma clinic |