A qualitative study exploring perceived barriers and enablers to fidelity of training and delivery for an intervention to reduce non-indicated imaging for low back pain

Background Non-specifc low back pain (LBP) commonly presents to primary care, where inappropriate use of imaging  remains common despite guideline recommendations against its routine use. Little is known about strategies to  enhance intervention fdelity (i.e., whether interventions were implemented as intended) for interventions developed  to reduce non-indicated imaging for LBP. Objectives We aim to inform the development of an intervention to reduce non-indicated imaging among general practitioners (GPs) and chiropractors in Newfoundland and Labrador (NL), Canada. The study objectives are: [1] To explore perceived barriers and enablers to enhancing fdelity of training of GPs and chiropractors to deliver a proposed intervention to reduce non-indicated imaging for LBP and [2] to explore perceived barriers and enablers to enhancing fdelity of delivery of the proposed intervention.Methods An exploratory,  qualitative study was conducted with GPs and chiropractors in NL. The interview guide was  informed by the National  Institutes of Health Behavior Change Consortium fdelity checklist; data analysis was guided  by the Theoretical Domains Framework (TDF). Participant quotes were coded into TDF domains, belief statements  were generated at each domain, and domains reevant to enhancing fdelity of provider training or intervention delivery  were identifed. Results The study included fve GPs and five chiropractors from urban and rural settings. Barriers and  enablers to enhancing fdelity to provider training related to seven TDF domains: [1] Beliefs about capabilities, [2] Optimism, [3]  Reinforcement, [4] Memory, attention, and decision processes, [5] Environmental context and resources, [6] Emotion,  and [7] Behavioural regulation. Barriers and enablers to enhancing fdelity to intervention delivery related to seven  TDF domains: [1] Beliefs about capabilities, [2] Optimism, [3] Goals, [4] Memory, attention, and decision processes, [5]  Environmental context and resources, [6] Social infuences, and [7] Behavioural regulation. Conclusion The largest perceived barrier to attending training was time; perceived enablers were incentives and  fexible training. Patient pressure, time, and established habits were perceived barriers to delivering the intervention  as intended. Participants suggested enhancement strategies to improve their ability to deliver the intervention as  intended, including reminders and check-ins with researchers. Most participants perceived intervention fdelity as  important. These results may aid in the development of a more feasible and pragmatic intervention to reduce non-indicated imaging for GPs and chiropractors in NL