Exploration of Factors Influencing Participation of Primary Eye Care Clinicians in Low Vision Services

Low vision (LV) services are likely to become more in demand as the prevalence of vision impairment increases. Primary eye care clinicians represent a substantially underutilised resource for LV service provision and increasing their participation could considerably improve service capacity and accessibility. This study aimed to gain a comprehensive in-depth theory-based understanding of factors influencing participation of primary eye care clinicians in LV services to inform the evidence base for future behaviour change intervention design.

Semi-structured one-to-one interviews using topic guides based on the capability, opportunity, motivation - behaviour (COM-B) system were conducted with a maximum variation sample of primary eye care clinicians and other relevant stakeholders. Thematic data analysis was undertaken; codes were inductively generated then mapped to domains of the theoretical domains framework (TDF) to generate themes and subthemes, which were mapped back to the COM-B system.

A total of 31 individual interviews were conducted. Multiple TDF domain themes and subthemes were found to influence primary eye care clinicians' participation in LV services, including knowledge (knowledge gaps); memory, attention and decision processes (case identification); social influences (professional support and influences, clinician-patient relationships, interprofessional relationships); environmental context and resources (funding and commissioning, practice resources); intentions (passion); beliefs about consequences (LV outcome expectations); beliefs about capabilities (confidence); goals (profitability); professional role and identity (scope of practice); reinforcement (rewards) and emotion (enjoyment, clinician wellbeing).

This is the first study to qualitatively explore factors influencing participation of primary eye care clinicians in LV services and to explicitly apply behaviour change theory to do so. It provides a novel, comprehensive, in-depth and theory-based understanding of influences on primary eye care clinicians' participation in LV services. This evidence base is fundamental to designing successful theory-informed behaviour change interventions which aim to increase primary eye care clinicians' participation and facilitate LV service expansion.