Abstract：
The inappropriate use of lumbar spine imaging remains common in primary care despite recommendations from evidence-based clinical practice guidelines to avoid imaging in the absence of red flags. This study aimed to explore factors influencing ordering behaviours and adherence to radiographic guidelines for low back pain (LBP) in chiropractors in Newfoundland and Labrador (NL), Canada.
We conducted two focus groups in December 2018 with chiropractors in different regions of NL (eastern, n = 8; western, n = 4). An interview guide based on the Theoretical Domains Framework (TDF) served to identify perceived barriers to, and enablers of, target behaviours of guideline adherence and managing LBP without X-rays. We conducted thematic analysis of chiropractors\' statements into relevant theoretical domains, followed by grouping of similar statements into specific beliefs. Domains key to changing radiographic guideline adherence, LBP imaging behaviours, and/or informing intervention design were identified by noting conflicting beliefs and their reported influence on the target behaviours.
Six of the 14 TDF domains were perceived to be important for adherence to radiographic guidelines and managing non-specific LBP without imaging. Participating chiropractors reported varying levels of knowledge and awareness of guidelines for LBP imaging (Knowledge). Many chiropractors based their decision for imaging on clinical presentation, but some relied on \"gut feeling\" (Memory, attention, and decision processes). While chiropractors thought it was their role to manage LBP without imaging, others believed ordering imaging was the responsibility of other healthcare providers (Social/professional role and identity). Contrasting views were found regarding the negative consequences of imaging or not imaging LBP patients (Beliefs about consequences). Communication was identified as a skill required to manage LBP without imaging (Skills) and a strategy to enable appropriate imaging ordering behaviours (Behavioural regulation). Chiropractors suggested that access to patients\' previous imaging and a system that facilitated better interprofessional communication would likely improve their LBP imaging behaviours (Behavioural regulation).
We identified potential influences, in six theoretical domains, on participating chiropractors\' LBP imaging behaviours and adherence to radiographic guidelines. These beliefs may be targets for theory-informed behaviour change interventions aimed at improving these target behaviours for chiropractors in NL.
We conducted two focus groups in December 2018 with chiropractors in different regions of NL (eastern, n = 8; western, n = 4). An interview guide based on the Theoretical Domains Framework (TDF) served to identify perceived barriers to, and enablers of, target behaviours of guideline adherence and managing LBP without X-rays. We conducted thematic analysis of chiropractors\' statements into relevant theoretical domains, followed by grouping of similar statements into specific beliefs. Domains key to changing radiographic guideline adherence, LBP imaging behaviours, and/or informing intervention design were identified by noting conflicting beliefs and their reported influence on the target behaviours.
Six of the 14 TDF domains were perceived to be important for adherence to radiographic guidelines and managing non-specific LBP without imaging. Participating chiropractors reported varying levels of knowledge and awareness of guidelines for LBP imaging (Knowledge). Many chiropractors based their decision for imaging on clinical presentation, but some relied on \"gut feeling\" (Memory, attention, and decision processes). While chiropractors thought it was their role to manage LBP without imaging, others believed ordering imaging was the responsibility of other healthcare providers (Social/professional role and identity). Contrasting views were found regarding the negative consequences of imaging or not imaging LBP patients (Beliefs about consequences). Communication was identified as a skill required to manage LBP without imaging (Skills) and a strategy to enable appropriate imaging ordering behaviours (Behavioural regulation). Chiropractors suggested that access to patients\' previous imaging and a system that facilitated better interprofessional communication would likely improve their LBP imaging behaviours (Behavioural regulation).
We identified potential influences, in six theoretical domains, on participating chiropractors\' LBP imaging behaviours and adherence to radiographic guidelines. These beliefs may be targets for theory-informed behaviour change interventions aimed at improving these target behaviours for chiropractors in NL.
摘要：
尽管循证临床实践指南建议在没有危险信号的情况下避免成像，但腰椎成像的不当使用在初级保健中仍然很常见。这项研究旨在探讨影响纽芬兰和拉布拉多（NL）脊医订购行为和对下腰痛（LBP）影像学指南的依从性的因素，加拿大。
我们在2018年12月与NL不同地区的脊医进行了两个焦点小组（东部，n=8；西方，n=4)。基于理论域框架(TDF)的访谈指南用于识别感知到的障碍，和推动者，指南依从性和无X线管理LBP的目标行为。我们对脊医的陈述进行了相关理论领域的主题分析，然后将类似的陈述分组为特定的信念。领域是改变射线照相指南依从性的关键，LBP成像行为，和/或告知干预设计是通过注意到相互冲突的信念及其报告对目标行为的影响来确定的。
14个TDF域中的6个被认为对于遵守放射学指南和无成像管理非特异性LBP很重要。参与的脊医报告了不同水平的知识和对LBP成像指南（知识）的认识。许多脊医根据临床表现决定成像，但有些人依赖“直觉”(记忆，注意,和决策过程)。虽然脊医认为他们的角色是在没有成像的情况下管理LBP，其他人认为订购成像是其他医疗保健提供者的责任(社会/专业角色和身份).关于成像或不成像LBP患者的负面后果，发现了相反的观点（对后果的信念）。沟通被确定为在没有成像的情况下管理LBP所需的技能（技能）和实现适当的成像订购行为（行为调节）的策略。脊医建议，获得患者先前的成像和促进更好的职业间交流的系统可能会改善他们的LBP成像行为（行为调节）。
我们确定了潜在的影响，在六个理论领域，参与脊医的LBP成像行为和对影像学指南的依从性。这些信念可能是旨在改善NL脊医的这些目标行为的理论知情行为改变干预措施的目标。
我们在2018年12月与NL不同地区的脊医进行了两个焦点小组（东部，n=8；西方，n=4)。基于理论域框架(TDF)的访谈指南用于识别感知到的障碍，和推动者，指南依从性和无X线管理LBP的目标行为。我们对脊医的陈述进行了相关理论领域的主题分析，然后将类似的陈述分组为特定的信念。领域是改变射线照相指南依从性的关键，LBP成像行为，和/或告知干预设计是通过注意到相互冲突的信念及其报告对目标行为的影响来确定的。
14个TDF域中的6个被认为对于遵守放射学指南和无成像管理非特异性LBP很重要。参与的脊医报告了不同水平的知识和对LBP成像指南（知识）的认识。许多脊医根据临床表现决定成像，但有些人依赖“直觉”(记忆，注意,和决策过程)。虽然脊医认为他们的角色是在没有成像的情况下管理LBP，其他人认为订购成像是其他医疗保健提供者的责任(社会/专业角色和身份).关于成像或不成像LBP患者的负面后果，发现了相反的观点（对后果的信念）。沟通被确定为在没有成像的情况下管理LBP所需的技能（技能）和实现适当的成像订购行为（行为调节）的策略。脊医建议，获得患者先前的成像和促进更好的职业间交流的系统可能会改善他们的LBP成像行为（行为调节）。
我们确定了潜在的影响，在六个理论领域，参与脊医的LBP成像行为和对影像学指南的依从性。这些信念可能是旨在改善NL脊医的这些目标行为的理论知情行为改变干预措施的目标。
