Table 5 Top barriers and example policy and clinical solutions identified using the behaviour change wheel

Physical Opportunity, and Reflective Motivation

Environmental Context and Resources, Beliefs about Consequences

Privacy and confidentiality

Development of guidelines or procedures to ensure patient data is secure and protected when using digital messaging platforms (IF^b = enablement)

Ensure that patients are fully informed of the privacy risks and benefits of messaging before they opt-in to these services (IF = education)

Psychological Capability, and Physical Opportunity

Knowledge, Environmental Context and Resources

Technical problems

Implement user-friendly messaging platforms that are easy to navigate and have a low learning curve for both patients and clinicians (IF = environmental restructuring)

Provide training and technical support to patients and providers to troubleshoot common technical problems (IF = education, training)

Physical Opportunity

Environmental Context and Resources

Disparities in internet access and affordability of technology

Development of policies or initiatives to provide technology to underserved populations, subsidies for technology purchases, and improvement to internet infrastructure (IF = environmental restructuring). Policies that provide financial incentives for healthcare providers and practices to invest in tech infrastructure (IF = incentivization)

Healthcare providers can ensure that any patient-to-provider messaging systems implemented in their clinical practice are accessible to all their patients (i.e., using text messaging that is not reliant on internet capabilities) (IF = environmental restructuring)

Reflective Motivation

Beliefs about Consequences

Perceived increase in clinician workload

Create and implement policies which integrate patient-provider messaging into clinical workflows (IF = environmental restructuring). Policies to incentivize providers to use messaging platforms in their workflows (IF = incentivization)

Create campaigns which emphasize how virtual messaging services can improve efficiencies and decrease provider burden while positively benefitting patients (IF = persuasion and education). Provide administrative support to providers to help manage their workload (IF = enablement)

Physical Opportunity

Environmental Context and Resources, Skills, Knowledge

Lack of clinician training

Policies to ensure that healthcare providers are trained to use patient-provider messaging effectively, efficiently, and safely (IF = training)

Training programs integrating evidence-based BCTs (e.g., instruction on how to perform the behaviour, demonstration of the behaviour, behavioural practice/rehearsal) to teach healthcare providers how to effectively and efficiently integrate technology into their clinical practice (IF = training)