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Understanding physician behaviour in the 6-8 weeks hip check in primary care: A qualitative study using the COM-B

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Angel Chater, Sarah Milton, Judith Green, Gill Gilworth, Andreas Roposch

Original languageEnglish
Article numbere044114
JournalBMJ Open
Volume11
Issue number3
DOIs
Published19 Mar 2021

Bibliographical note

Funding Information: Funding This paper presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grant for Applied Research funding stream (RP-PG-0616–20006). Disclaimer The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: © Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

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Abstract

Objectives A compulsory hip check is performed on an infant at 6-8 weeks in primary care for the detection of developmental dysplasia of the hip (DDH). Missed diagnoses and infants incorrectly labelled with DDH remain an important problem. The nature of physician behaviour as a likely source of this problem has not been explored. The aims of this study were to make a behavioural diagnosis of general practitioners (GPs) who perform these hip checks, and identify potential behavioural change techniques that could make the hip checks more effective. Design Qualitative study with in-depth semistructured interviews of 6-8 weeks checks. We used the Capability, Opportunity, Motivation and Behaviour model in making a behavioural diagnosis and elicited factors that can be linked to improving the assessment. Setting Primary care. Participants 17 GPs (15 female) who had between 5 and 34 years of work experience were interviewed. Results Capability related to knowledge of evidence-based criteria and skill to identify DDH were important behavioural factors. Both physical (clinic time and space) and social (practice norms), opportunity were essential for optimal behaviour. Furthermore, motivation related to the importance of the 6-8 weeks check and confidence to perform the check and refer appropriately were identified in the behavioural diagnosis. Conclusion Aspects of capability, opportunity and motivation affect GPs' diagnosis and referral behaviours in relation to DDH. The findings from this work extend current knowledge and will inform the development of an intervention aimed at improving the diagnosis of DDH.

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