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Table 5 List of the three most substantive gaps, challenges and barriers identified, with results of their secondary analysis using TDF domains

From: Contextualized analysis of a needs assessment using the Theoretical Domains Framework: a case example in endocrinology

# Challenge TDF Domain Underlying determinant of the Challenge
1 Challenges in overcoming patient barriers and resistance "1 – Knowledge" Lack of knowledge of tools to facilitate patient – provider communication
   "2 – Skills" Lack of communication skills
   "4 - Beliefs about Capabilities" Lack of confidence
   "5 – Optimism" Underestimation of impacts of miscommunications
   "6 - Beliefs about Consequences"  
2 Challenges with the treatment decision-tree "1 – Knowledge" Extent to which short-term adverse side-effects compare to long term benefits of treatment in patients with AGHD
   "2 – Skills" Challenge in balancing long term benefits of treatment with short-term adverse effects
   "4 - Beliefs about Capabilities" Confidence issues
   "9 – Goals" Prioritization between proximal goal of avoiding side effects and distal goal of avoiding long-term consequences of disorder
   "10 - Memory, Attention, and Decision Processes" Specific challenges in the clinical reasoning process
3 Challenges associated with the transition from childhood to teen years, to adulthood "1 – Knowledge" Consequences of inappropriate cessation of GH therapy
   "2 – Skills" Lack of skills in addressing compliance during teenage years
   "3 - Social/Professional Role and Identity" Lack of clarity on which tests should be done at primary care levels and which ones should be done by specialists
   "4 - Beliefs about Capabilities" General pediatricians preferring to refer because of lack of confidence
   "6 - Beliefs about Consequences" Underestimation of impact of growth hormone treatment cessation
   "11 - Environmental Context and Resources" Lack of adult-treating endocrinologists forcing pediatric endocrinologists to keep patients under their management longer