title: Barriers and enablers to delivery of the Healthy Kids Check: an analysis informed by the Theoretical Domains Framework and COM-B model.
abstract: BACKGROUND
  More than a fifth of Australian children arrive at school developmentally vulnerable. To counteract this, the Healthy Kids Check (HKC), a one-off health assessment aimed at preschool children, was introduced in 2008 into Australian general practice. Delivery of services has, however, remained low. The Theoretical Domains Framework, which provides a method to understand behaviours theoretically, can be condensed into three core components: capability, opportunity and motivation, and the COM-B model. Utilising this system, this study aimed to determine the barriers and enablers to delivery of the HKC, to inform the design of an intervention to promote provision of HKC services in Australian general practice.
  
  
  METHODS
  Data from 6 focus group discussions with 40 practitioners from general practices in socio-culturally diverse areas of Melbourne, Victoria, were analysed using thematic analysis.
  
  
  RESULTS
  Many practitioners expressed uncertainty regarding their capabilities and the practicalities of delivering HKCs, but in some cases HKCs had acted as a catalyst for professional development. Key connections between immunisation services and delivery of HKCs prompted practices to have systems of recall and reminder in place. Standardisation of methods for developmental assessment and streamlined referral pathways affected practitioners' confidence and motivation to perform HKCs.
  
  
  CONCLUSIONS
  Application of a systematic framework effectively demonstrated how a number of behaviours could be targeted to increase delivery of HKCs. Interventions need to target practice systems, the support of office staff and referral options, as well as practitioners' training. Many behavioural changes could be applied through a single intervention programme delivered by the primary healthcare organisations charged with local healthcare needs (Medicare Locals) providing vital links between general practice, community and the health of young children.
authors.affiliation: Department of General Practice, School of Primary Health Care, Monash University, Building 3, 270 Ferntree Gully Road, Notting Hill, Melbourne, Victoria 3168, Australia. karyn.alexander@monash.edu.
authors.forename: Karyn E
authors.initials: KE
authors.lastname: Alexander
authors.forename: Bianca
authors.initials: B
authors.lastname: Brijnath
authors.forename: Danielle
authors.initials: D
authors.lastname: Mazza
mesh_terms: D017144:Focus Groups; D058005:General Practitioners; D015438:Health Behavior; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration*; D006304:Health Status; D006801:Humans; D008962:Models, Theoretical; D012959:Socioeconomic Factors; D014739:Victoria