Table 4 Barriers to conducting the study described using the CFIR
CFIR domain | Element | Barrier | Quote |
|---|---|---|---|
Intervention characteristics | Design quality and packaging | Possibility of being allocated to attention control | “Patients did not cite AC as a reason for not participating in the study but personally feel it was an issue” |
Patients viewed intervention as burdensome | “One of the main reasons for people declining was essentially people were saying they have got enough on their plate” | ||
Baseline assessments were considered lengthy | “I do not sometimes feel like I can do a session after the baseline, sometimes they are tired” | ||
Characteristics of individuals | Self-efficacy | Patients declining to participate reduced confidence to recruit | “This trial got the most negative responses…it sort of knocked my confidence a bit” |
MI therapists lacked confidence in their ability to deliver MI | “Do not feel a hundred per cent confident in my skills in MI, it’s difficult to know whether I am doing it right” | ||
MI skills weakened due to irregular recruitment | “There were periods with no patients so not doing MI, so felt I was losing skills a little bit” | ||
Other personal attributes | High turnover among therapy assistants | “Therapy assistants are looking for other jobs and there is high turnover among them” | |
Inner setting | Networks and communication | Lack of co-ordination for the trial on-site | “Would be better to have someone identified as the co-ordinator within the hospital, it was difficult knowing who was doing what” |
Structural characteristics | Backfill for therapy assistants was not always appropriate | “Backfill does not really cover my time… because of the way our team is made up… therapy assistants are not generic, we are specialised, so backfill was not appropriate” | |
Available resources | Therapy assistants left their role | “Going from three therapists in each arm to one has been difficult” | |
Leadership engagement | Supervisors lacked knowledge of the study | “Supervisors in [new department] did not know anything about the study so it has been a bit tricky to do the study role” | |
Relative priority | Therapy assistant role prioritised over study role | “It’s difficult to say, ‘Oh no I cannot do that because I have got the motivational interviewing’….In some ways you feel like that should take priority over the MI” | |
Process | Executing | Not enough training and feedback | “Training was quite intensive to start with but then fizzled out when recruitment started… we did not get a lot of feedback… Would be useful to be able to refresh skills” |