Skip to main content

Table 1 Barriers to the risk stratification and referral processes

From: Implementing stratified care for acute low back pain in primary care using the STarT Back instrument: a process evaluation within the context of a large pragmatic cluster randomized trial

Barrier CFIR Domain - Construct Illustrative Quote or Example
Identification of Patients with Low Back Pain Characteristics of Individuals - Knowledge & Beliefs about the Intervention “The challenge was knowing the patient was here for back pain.”
Outer Setting - Patient Needs & Resources “Some patients are reluctant to talk about their issues. They want to wait until they’re talking to the physician.”
Technology Outer Setting - Patient Needs & Resources “Some patients get through the tablet and some just don’t, because of age or not tech-savvy.”
Process - Executing “I do have to go up to the front desk to get the tablet and the front desk has to change the visit type [in the EHR].”
Inner Setting - Networks & Communications Example: Some clinics had figured out solutions or work arounds to issues with study activities in the EHR while other clinics within their practice were not aware of these solutions/work arounds.
Physician Engagement Process - Engaging “Some [physicians] don’t even want the questionnaires done because they are busy, and they need to get in to see the patient.”
Competing Priorities Inner Setting - Relative Priority “We have a lot of #1 priorities and back pain is not one of them.”
  1. Abbreviations: CFIR Consolidated Framework for Implementation Research