title: Fast tracking the design of theory-based KT interventions through a consensus process.
abstract: BACKGROUND
  Despite available evidence for optimal management of spinal pain, poor adherence to guidelines and wide variations in healthcare services persist. One of the objectives of the Canadian Chiropractic Guideline Initiative is to develop and evaluate targeted theory- and evidence-informed interventions to improve the management of non-specific neck pain by chiropractors. In order to systematically develop a knowledge translation (KT) intervention underpinned by the Theoretical Domains Framework (TDF), we explored the factors perceived to influence the use of multimodal care to manage non-specific neck pain, and mapped behaviour change techniques to key theoretical domains.
  
  
  METHODS
  Individual telephone interviews exploring beliefs about managing neck pain were conducted with a purposive sample of 13 chiropractors. The interview guide was based upon the TDF. Interviews were digitally recorded, transcribed verbatim and analysed by two independent assessors using thematic content analysis. A 15-member expert panel formally met to design a KT intervention.
  
  
  RESULTS
  Nine TDF domains were identified as likely relevant. Key beliefs (and relevant domains of the TDF) included the following: influence of formal training, colleagues and patients on clinicians (Social Influences); availability of educational material (Environmental Context and Resources); and better clinical outcomes reinforcing the use of multimodal care (Reinforcement). Facilitating factors considered important included better communication (Skills); audits of patients' treatment-related outcomes (Behavioural Regulation); awareness and agreement with guidelines (Knowledge); and tailoring of multimodal care (Memory, Attention and Decision Processes). Clinicians conveyed conflicting beliefs about perceived threats to professional autonomy (Social/Professional Role and Identity) and speed of recovery from either applying or ignoring the practice recommendations (Beliefs about Consequences). The expert panel mapped behaviour change techniques to key theoretical domains and identified relevant KT strategies and modes of delivery to increase the use of multimodal care among chiropractors.
  
  
  CONCLUSIONS
  A multifaceted KT educational intervention targeting chiropractors' management of neck pain was developed. The KT intervention consisted of an online education webinar series, clinical vignettes and a video underpinned by the Brief Action Planning model. The intervention was designed to reflect key theoretical domains, behaviour change techniques and intervention components. The effectiveness of the proposed intervention remains to be tested.
authors.affiliation: School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, H3G 1Y5, Montreal, QC, Canada. andre.bussieres@mcgill.ca.|Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada. andre.bussieres@mcgill.ca.|Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, QC, Canada. andre.bussieres@mcgill.ca.
authors.forename: André E
authors.initials: AE
authors.lastname: Bussières
authors.affiliation: School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, H3G 1Y5, Montreal, QC, Canada. fadi.alzoubi@mail.mcgill.ca.
authors.forename: Fadi
authors.initials: F
authors.lastname: Al Zoubi
authors.affiliation: School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. jeffrey.quon@ubc.ca.|International Collaboration on Repair Discoveries (ICORD), Vancouver Coastal Health Research Institute, Vancouver, BC, Canada. jeffrey.quon@ubc.ca.|Spine Program, Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada. jeffrey.quon@ubc.ca.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Quon
authors.affiliation: School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, H3G 1Y5, Montreal, QC, Canada. sara.ahmed@mcgill.ca.|Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, QC, Canada. sara.ahmed@mcgill.ca.|Clinical Epidemiology, McGill University Health Center, Montréal, QC, Canada. sara.ahmed@mcgill.ca.
authors.forename: Sara
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, 3630 Promenade Sir-William-Osler, H3G 1Y5, Montreal, QC, Canada. aliki.thomas@mcgill.ca.|Centre de recherche interdisciplinaire en réadaptation (CRIR), Montréal, QC, Canada. aliki.thomas@mcgill.ca.|Center for Medical Education, Faculty of Medicine, McGill University, Montréal, QC, Canada. aliki.thomas@mcgill.ca.
authors.forename: Aliki
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Division of Graduate Education and Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada. kjstuber@gmail.com.
authors.forename: Kent
authors.initials: K
authors.lastname: Stuber
authors.affiliation: Private practice, Toronto, ON, Canada. sandysajko@gmail.com.
authors.forename: Sandy
authors.initials: S
authors.lastname: Sajko
authors.affiliation: School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, ON, Canada. simon.french@queensu.ca.
authors.forename: Simon
authors.initials: S
authors.lastname: French
mesh_terms: D002170:Canada; D032921:Consensus; D055317:Evidence-Based Practice / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D026882:Manipulation, Chiropractic / Q000379:methods / Q000592:standards; D008875:Middle Aged; D019547:Neck Pain / Q000628:therapy; D012107:Research Design; D057170:Translational Research, Biomedical / Q000379:methods* / Q000458:organization & administration