Table 3 Provider-oriented barriers and facilitators to patient-to-provider messaging implementation
TDF Domaina | COM-B Domain | Theme—Barriers | Theme—Facilitators |
|---|---|---|---|
Skills | Physical Capability | • Lack of provider trainingb | • None identified |
Knowledge | Psychological Capability | • Lack of provider trainingb • Lack of direction in policy guidelines • Lack of institutional and professional guidelines | • Providers can better share detailed information regarding patient care • Providers can use graphical data for interpreting data and identifying trends |
Memory, Attention, and Decision Processes | Psychological Capability | • Simple errors when writing a message may result in ambiguity and inaccurate content | • Having a written record aids recall |
Social or professional role and identity | Reflective Motivation | • Patient-to-provider messaging is not currently seen as part of the provider's professional role, making it a challenge for providers to adopt into their professional practice • “Tech support” is not within the scope of healthcare providers practice • Blurring of the boundaries in the relationship | • None identified |
Beliefs about capabilities | Reflective Motivation | • Asynchronous nature makes building a trusting relationship difficultc | • Providers are better able to manage their time (answer patient requests at their own convenience vs interrupting their activities at unpredictable times for phone conversations) |
Beliefs about consequences | Reflective Motivation | • Burden on provider (i.e., increased workload, responsibility) • Privacy and confidentiality issues (concerns about who is reading/answering messages intended for a patient) • Virtual messaging not appropriate to share urgent issues • Unable to communicate using visual cues making it difficult to recognize misunderstandings • Unable to provide instant feedback | • Flexibility of access (i.e., messages can be sent at a suitable time where convenient) • Increased convenience • Virtual messaging can allow for more detailed informational exchanges • Decreased provider burden (i.e., improves efficiency and productivity; self-documenting nature of messages decreases charting time) • Reduced clinic costs |
Environmental context and resources | Physical Opportunity | • Lack of clinician trainingb • Lack of time • Lack of resources (i.e., infrastructure, equipment, access to internet or mobile phones) • Affordability of technology • Technical issues with devices | • Increased accessibility of niche education/training for rural healthcare providers • Providers have more time to contemplate their answers |
Social influences | Social Opportunity | • Asynchronous nature makes building a trusting relationship difficultc • Blurring of boundaries in the relationshipc | • Increased access to healthcare provider improves patient-provider relationship • Providers have increased time to consult with colleagues and provide more considered responses • Informal nature of messaging can strengthen patient-provider relationship • Can help in establishing and maintaining rapport with the patient |