Using the theoretical domains framework to identify barriers and enabling factors to implementation of guidance for the diagnosis and management of non-alcoholic fatty liver disease: A qualitative study

Background: NAFLD is the most common liver condition worldwide and is steadily on the increase. In response, national and international guidance have been developed to standardise diagnosis and guide management of the condition. However, research has highlighted a discordance between published guidance and clinical practice.

Purpose: To identify barriers and enabling factors to implementation of guidance to inform the development of an intervention.
Methods: We interviewed 21 healthcare professionals and 12 patients with NAFLD. Topic guides were developed with reference to national and international guidance. Data were content analysed using the Theoretical Domains Framework.

Results: Beliefs about consequences and professional role and identity were the most prominent domains identified from healthcare professionals in the context of diagnosis and management of NAFLD. Environmental context and resources, memory, attention and decision processes, goals, behavioural regulation, knowledge and skills emerged as important barriers/facilitators to implementation of guidance targeting management of NAFLD. Knowledge and beliefs about consequences were the most prominent domains from the perspective of patients. Social influences, environmental context and resources and behavioural regulation were most prominent in the context of NAFLD management.

Conclusions: Guideline implementation can be improved by use of interventions that target standardised use of diagnostic criteria by healthcare professionals. Training of healthcare professionals was identified as important to improve care delivered to patients in order to effectively manage NAFLD. Interventions targeting knowledge of patients, in particular, raising awareness that NAFLD can be progressive when not actively managed would facilitate implementation of guidance.