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Table 1 Potential barriers to prescribing and setting individualized dialysate temperatures (IDTs) (n = 18)

From: Barriers and facilitators to healthcare professional behaviour change in clinical trials using the Theoretical Domains Framework: a case study of a trial of individualized temperature-reduced haemodialysis

Themes

Sub-theme

Belief statement

Frequency (out of 18)

Theoretical Domains Framework, domain(s)

Theme 1: awareness of clinical guidelines and how IDT fits with local policies

Awareness of guidelines

- We don't use guidelines for individualized cooler dialysate temperatures

14

Knowledge

- There are no guidelines for dialysate temperature

5

Potential for conflict of IDT with local policies

- Individualized cooler dialysate temperatures will/may conflict with local policies

3

Knowledge/Goals

Theme 2: benefits and motivation to use IDT

Not a priority

- It’s a little priority at this point

10

Goals

No rewards in place

- I can’t think of any rewards

8

Reinforcement

Motivation limited to subset of patients

- I am more motivated to set or prescribe cooler dialyste temperatures when my patients have hypotension on dialysis

6

Intention

- I am not inclined to use individualized cooler dialysate temperatures for patients doing well on current dialysate temperatures

5

- You have to weigh the benefits of preventing hypotension with patient complaints of feeling cold

3

Theme 3: IDT alignment with usual prescribing and setting practices and roles

Currently not individualizing dialysate temperatures at each treatment

- We don't individualize dialysate temperatures

10

Nature of the Behaviour

- When setting or prescribing cooler dialysate temperatures it is usually 0.5 degrees below standard

8

Sometimes individualize the dialysate temperature

- I occasionally or rarely prescribe or set cooler dialysate temperatures

11

Social Professional Role and Identity/Nature of the Behaviour/ Beliefs about Capabilities

Nurses require physicians' order for permanent change in dialysate temperature

- We need a global order/ policy change/ medical directive so nurses can set individualized cooler dialysate temperatures

7

Social Professional Role and Identity/Social Influences

- We would need a doctor's order to set individualized cooler dialysate temperatures

5

- I need an order from the doctor for a permanent change in dialysate temperature beyond one treatment session

3

Theme 4: thermometer availability/ accuracy and dialysis machine characteristics

Outdoor temperature and drinks can influence temperature reading

- Climate in winter or summer can impact accuracy of core body temperature readings

3

Environmental Context and Resources

- Consumption of warm beverages or ice can impact accuracy of core body temperature readings

3

Thermometer availability

- Potential limited thermometer availability

2

Environmental Context and Resources

Dialysis machine can be adjusted in 0.5 or 0.1 increments up to 35 degrees Celsius

- Can adjust dialysate temperatures by 0.5 increments

2

Environmental Context and Resources

Theme 5: impact on workload

Negative impact on workload

- Physicians say nurses’ workload will increase

6

Beliefs about Capabilities/ Beliefs about Consequences

- My workload will increase

4

Theme 6: patient comfort

Negative clinical management consequences

- Patients may feel too cold on cooler dialysate temperatures

11

Beliefs about Consequences

- It is common for patients to feel cold on dialysis

7

Coping plans that lead to increased dialysate temperature

- If patients are really complaining of being cold we may increase dialysate temperature by 0.5

9

Behavioural Regulation

- I may increase the dialysate temperature for someone with hypertension to see if that decreases their blood pressure

2

- If patients are feeling cold and have no issues with blood pressure or fever and request an increase in dialysate temperature I would not have evidence to deny their request

2

Emotions related to patient comfort

- I may feel worried or concerned if patients are feeling cold

6

Emotion

Theme 7: forgetting to prescribe or set IDT

Potential to forget

- I may forget to prescribe or set an IDT if I am busy

9

Memory, Attention and Decision Making /Emotion

- We would need reminders for IDTs

6

- It may be easy to forget in emotional or tense situations

2