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Table 6 Recommendations on behavior change techniques (as per Michie 2008[4] see original article for description of each technique category) for each underlying determinant within the three most substantive gaps, challenges and barriers identified

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

TDF Domain Identified challenges (underlying determinant) Techniques Recommendations (All other techniques are in the "agreed non-use" category)
1 - Knowledge Challenges in overcoming patient barriers and resistance (Lack of knowledge of tools to facilitate patient – provider communication) Agreed use: Information regarding behavior, outcome
  Uncertain: goal/target specified: behavior or outcome//Persuasive communication
  Challenges with the treatment decision-tree (Extent to which short-term adverse side-effects compare to long term benefits of treatment in patients with AGHD) Disagreement: Personalized message//Homework
  Challenges associated with the transition from childhood to teen years, to adulthood (Consequences of inappropriate cessation of GH therapy)  
2 -Skills Challenges in overcoming patient barriers and resistance (Lack of communication skills) Agreed use: goal/target specified: behavior or outcome//Monitoring//Self-monitoring//rewards & incentives//Graded tasks//problem-solving, decision-making, goal-setting//Rehearsal//Modeling, demonstration of behavior//Homework//perform behavior in different settings//problem-solving
  Challenges with the treatment decision-tree (balancing long term benefits of treatment with short-term adverse effects)
  Challenges associated with the transition from childhood to teen years, to adulthood (Lack of skills in addressing compliance during teenage years) Uncertain: Stress management//Planning, implementation
   Disagreement: Coping skills//Role-play//Feedback//Shaping of behavior
3 - Social/Professional Role and Identity Challenges associated with the transition from childhood to teen years, to adulthood (Lack of clarity on which tests should be done at primary care levels and which ones should be done by specialists) Agreed use: Social process of encouragement, pressure, support
  Uncertain: Contract//rewards & incentives//problem-solving, decision-making, goal-setting//Role-play//Environmental changes//Persuasive communication//Personalized message//feedback
   Disagreement: Information regarding behavior, outcome//Modeling, demonstration of behavior//Cognitive restructuring
4 - Beliefs about Capabilities Challenges in overcoming patients’ barriers and resistances (Lack of confidence) Agreed use: Self-monitoring//Graded tasks//problem-solving, decision-making, goal-setting//Social process of encouragement, pressure, support//Feedback//self-talk//Motivational interviewing
  Challenges with the treatment decision-tree (Lack of confidence)
  Challenges associated with the transition from childhood to teen years, to adulthood (General pediatricians preferring to refer because of lack of confidence) Uncertain: Monitoring//rewards & incentives//Coping skills//Rehearsal//Stress management//Information regarding behavior, outcome//Personalized message//Experiential//Use of imagery//perform behavior in different settings//Shaping of behavior//Relapse prevention//Identify-prepare for difficult situations, problems
   Disagreement: -
5 - Optimism Challenges in overcoming patients’ barriers and resistances (Underestimation of impacts of miscommunications) Agreed use: Self-monitoring//Graded tasks//problem-solving, decision-making, goal-setting//Social process of encouragement, pressure, support//Feedback//self-talk//Motivational interviewing
   Uncertain: Monitoring//rewards & incentives//Coping skills//Rehearsal//Stress management//Information regarding behavior, outcome//Personalized message//Experiential//Use of imagery//perform behavior in different settings//Shaping of behavior//Relapse prevention//Identify-prepare for difficult situations, problems
   Disagreement: Role-Play//Persuasive communication//Modeling, demonstration of behavior//Homework//Personal experiments//Cognitive restructuring
6 - Beliefs about Consequences Challenges in overcoming patients’ barriers and resistances (Underestimation of impacts of miscommunications) Agreed use: Self-monitoring//Persuasive communication//Information regarding behavior, outcome//Feedback
  Challenges associated with the transition from childhood to teen years, to adulthood (Underestimation of impact of growth hormone treatment cessation) Uncertain: Monitoring//rewards & incentives//Role-play//Personalized message//Personal experiments
  Disagreement: goal/target specified: behavior or outcome//Homework//Motivational interviewing//Cognitive restructuring
9 - Goals Challenges with the treatment decision-tree (prioritization between proximal goal of avoiding side effects and distal goal of avoiding long-term consequences of disorder) Agreed use: Social process of encouragement, pressure, support//Modeling, demonstration of behavior
   Uncertain: Monitoring//rewards & incentives//Role-play//persuasive communication//homework
   Disagreement: Contract
10 - Memory, Attention, and Decision Processes Challenges with the treatment decision-tree (Specific challenges in the clinical reasoning process) Agreed use: Self-monitoring//Planning, implementation//Prompts, triggers, cues
   Uncertain: Monitoring//rewards & incentives//Graded tasks//problem-solving, decision-making, goal-setting//stress management//Rehearsal//Personalized message//Personal experiments//feedback//self-talk//use of imagery//perform behavior in different settings//Time management
   Disagreement: Environmental changes
11 - Environmental Context and Resources Challenges associated with the transition from childhood to teen years, to adulthood (Lack of adult-treating Endocrinologists forcing Pediatric Endocrinologists to keep patients under their management longer) Agreed use: Environmental changes
Uncertain: Prompts, triggers, cues
Disagreement: -