'Pushing the change': barriers, facilitators, and implementation plan for integrating individually tailored physical...

The objective of this paper was to identify determinants to implementing individually tailored physical activity (PA) counselling in rheumatology outpatient care, and secondarily, to develop a context-specific implementation plan. Together, these activities constituted the initial phase of a larger implementation research project guided by the Quality Implementation Framework (QIF).

This qualitative study was conducted in 4 rheumatology outpatient clinics in the Capital Region of Denmark. Data were collected through nonparticipant observations of clinical consultations and semistructured interviews with nurses, physicians, and managers. Data were analysed using a 2-step approach: a deductive thematic analysis guided by the Theoretical Domains Framework (TDF), followed by an inductive content analysis of all TDF-coded data. Identified determinants were mapped to implementation strategies in collaboration with local working groups.

Twelve health professionals and managers were interviewed (mean age of 44 years and an average of 11 years of experience in rheumatology care). The most prominent TDF domains were Environmental context and resources, Knowledge, and Beliefs about consequences. Four interrelated categories were identified: (i) Knowledge gaps and uncertainty in PA counselling; (ii) Role ambiguity in PA counselling; (iii) Organisational context shapes capacity and motivation; and (iv) Patient feedback as a driver of PA counselling. Barriers included knowledge gaps, limited confidence in tailoring advice, unclear role responsibilities, and insufficient structural support. Facilitators included strong professional values, leadership support for lifestyle counselling, and reinforcement through positive patient feedback. Based on these determinants, a theory-informed implementation plan was developed using Expert Recommendations for Implementing Change strategies.

Integrating PA counselling into rheumatology care requires addressing determinants at individual, professional, and organisational levels. Combining the QIF and TDF enabled a systematic and context-specific approach to early-phase implementation planning.