title: Application of the Theoretical Domains Framework and the Behaviour Change Wheel to Understand Physicians' Behaviors and Behavior Change in Using Temporary Work Modifications for Return to Work: A Qualitative Study.
abstract: Purpose Applying the theoretical domains framework (TDF) and the Behaviour Change Wheel (BCW) to understand physicians' behaviors and behavior change in using temporary work modifications (TWMs) for return to work (RTW). Methods Interviews and focus group discussions were conducted with 15 occupational physicians (OPs). Responses were coded using the TDF and the BCW. Results Key behaviors related to applying TWMs were initiating the process with the employee, making recommendations to the workplace, and following up the process. OP behaviors were influenced by several factors related to personal capability and motivation, and opportunities provided by the physical and social environment. Capability comprised relevant knowledge and skills related to applying TWMs, remembering to initiate TWMS and monitor the process, and being accustomed to reflective practice. Opportunity comprised physical resources (e.g., time, predefined procedures, and availability of modified work at companies), and social pressure from stakeholders. Motivation comprised conceptions of a proper OP role, confidence to carry out TWMs, personal RTW-related goals, beliefs about the outcomes of one's actions, feedback received from earlier cases, and feelings related to applying TWMs. OPs' perceived means to target these identified factors were linked to the following BCW intervention functions: education, training, persuasion, environmental restructuring, and enablement. The results suggest that at least these functions should be considered when designing future interventions. Conclusions Our study illustrates how theoretical frameworks TDF and BCW can be utilized in a RTW context to understand which determinants of physicians' behavior need to be targeted, and how, to promote desired behaviors.
authors.affiliation: Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland. ritva.horppu@ttl.fi.
authors.forename: Ritva
authors.identifier: 0000-0002-4146-4376
authors.initials: R
authors.lastname: Horppu
authors.affiliation: Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland.
authors.forename: K P
authors.initials: KP
authors.lastname: Martimo
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.|Centre for Research on Work Disability Policy, Institute for Work & Health, Toronto, Canada.
authors.forename: E
authors.initials: E
authors.lastname: MacEachen
authors.affiliation: Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Lallukka
authors.affiliation: Work Disability Prevention, Finnish Institute of Occupational Health, P.O. Box 40, 00251, Helsinki, Finland.
authors.forename: E
authors.initials: E
authors.lastname: Viikari-Juntura
mesh_terms: D001291:Attitude of Health Personnel; D003657:Decision Making; D003863:Depression / Q000534:rehabilitation; D017144:Focus Groups; D006801:Humans; D059352:Musculoskeletal Pain / Q000534:rehabilitation; D009786:Occupational Health Services / Q000379:methods*; D010819:Physician's Role; D036301:Qualitative Research; D062707:Return to Work; D017132:Workplace / Q000458:organization & administration*
keywords: Behavior change; Occupational health services; Physicians; Return to work