Barriers and facilitators to pressure ulcer prevention behaviours by older people living in their own homes and their lay carers: a qualitative study.

OBJECTIVE: To identify barriers and facilitators to pressure ulcer prevention behaviours in community-dwelling older people and their lay carers. DESIGN: Theoretically informed qualitative interviews with two-phase, deductive then inductive, thematic analysis. SETTING: The study was conducted in one geographical region in the UK, spanning several community National Health Service Trusts. PARTICIPANTS: Community-dwelling older patients at risk of pressure ulcer development (n=10) and their lay carers (n=10). RESULTS: Six themes and subthemes were identified: (1) knowledge and beliefs about consequences (nature, source, timing and taboo); (2) social and professional role and influences (who does what, conflicting advice and disagreements); (3) motivation and priorities (competing self-care needs and carer physical ability); (4) memory; (5) emotion (carer exhaustion and isolation, carergiver role conflict and patient feelings) and (6) environment (human resource shortage and equipment). CONCLUSIONS: There is minimal research in pressure ulcer prevention in community-dwelling older people. This study has robustly applied the theoretical domains framework to understanding barriers and facilitators to pressure ulcer prevention behaviours. Our findings will support co-design of strategies to promote preventative behaviours and are likely to be transferable to comparable healthcare systems nationally and internationally.

Use of nominal group technique methods in the virtual setting: A reflective account and recommendations for practice.

Nominal group technique methods involve the use of structured activities within groups comprised of purposefully selected stakeholders (nominal groups), with the broad aim of achieving a level of consensus and prioritising information. In this paper, we will report how we facilitated nominal groups, using Microsoft Teams, to prioritise content for a theory-based behaviour change intervention to improve responses to clinically deteriorating patients. Our methods incorporated development and piloting of research materials, facilitation of online nominal groups with different stakeholders, and a structured approach to ranking behaviour change strategies. Practical suggestions are offered based on our experience of using this method in a virtual context.

Barriers and facilitators to skin hygiene care and emollient use in residential care homes: Instrument design and survey.

BACKGROUND: The older person care home population is increasing. As skin ages, it becomes vulnerable to dryness, itching, cracks and tears. These are experienced by most older people, they impair quality of life and can lead skin breakdown, increased dependency, hospital stays and greater financial and human costs. Dryness, itching, cracks and tears can be prevented, but despite best practice guidance, concordance is suboptimal. OBJECTIVES: (i) develop and test a theory-based diagnostic instrument to accurately and prospectively assess barriers and facilitators and (ii) survey barriers and facilitators to care home staff in the delivery of skin hygiene care. METHODS: Instrument development and survey. Barriers and facilitators identified from the literature and pilot study were categorised in a Delphi survey of experts (n = 8) to the Theoretical Domains Framework. This model was tested in three rounds for face validity (n = 38), construct validity (n = 235) and test-retest reliability (n = 11). Barriers and facilitators were surveyed in Round 2 and reported in accordance with TRIPOD. RESULTS: A 29-item valid and reliable instrument (SHELL-CH) resulted (χ2/df = 1.539, RMSEA = 0.047, CFA = 0.872). Key barriers were delivering skin hygiene care to agitated or confused residents, pressure to rush or engage in other tasks from colleagues, being busy and the unrealistic expectations of relatives. Knowledge of skin hygiene care was a facilitator. CONCLUSION: This study has international significance having identified barriers and facilitators to skin hygiene care including barriers previously unreported.

Designing an intervention to help the quitters quit: A qualitative, intervention co-design study.

Objective: E-cigarettes are increasingly being provided by publicly funded stop smoking services. Our objectives were to understand the challenges and establish the means by which services could best support the use and subsequent discontinuation of e-cigarettes for this purpose. Methods: Semi-structured interviews and co-design workshops with service users and providers of a stop smoking service. Results: Thematic analysis was conducted. Interviews identified: 1. a reluctance to use e-cigarettes for cessation, 2. struggle to quit e-cigarettes (dependency, fear of relapse, compensatory "puffing") and 3. service development needs (consistency of approach). Co-design workshops suggested: 1. facilitation of e-cigarette use through understanding previous failed attempts, 2. offering a longer, two-staged approach to tobacco then e-cigarette cessation, careful timing of behavioural strategies and 3. enhanced communication between providers. Conclusions: Our study suggests additional modifications to smoking cessation support measures when e-cigarettes are used for smoking cessation to address the challenges posed by public health guidance: "smokers should switch to vaping and vapers should stop smoking completely". Innovation: Our study is the first to consider experiences of service users and providers about the challenges of using e-cigarettes for cessation; our co-design group of providers informed nine strategies needed to support this approach in practice.

A Systematic Review of Women's Experiences of Interventions to Prevent Excessive Gestational Weight Gain.

OBJECTIVE: To synthesize research on women's experiences of interventions to prevent excessive gestational weight gain. DATA SOURCES: A systematic search of the following databases was conducted: CINAHL Complete, Maternity and Infant Care Database, American Psychological Association PsycArticles, American Psychological Association PsycInfo, and MEDLINE. STUDY SELECTION: Studies were included if they involved primary research regarding the experiences of women who were pregnant or up to 1 year postpartum when reflecting on their involvement in interventions to prevent excessive weight gain during pregnancy. Nonempirical studies and those that examined the experiences of women who were not pregnant or who were beyond 1 year postpartum were excluded. DATA EXTRACTION: Information was extracted and captured in a summary table that included the study aim, participants, study design, intervention, findings, and summary score, with exceptions to quality. DATA SYNTHESIS: Data were synthesized thematically into three themes: (a) Intervention Qualities Valued by Women, (b) Challenges Faced by Women, and (c) Perceived Benefits and Recommendations for Modifications. CONCLUSION: Interventions intended to help women prevent excessive gestational weight gain should be tailored to individuals' unique needs to ensure that the interventions are acceptable and effective.

Midwives and service users' perspectives on implementing a dialogue about alcohol use in antenatal care: A qualitative study.

AIM: There are barriers to midwives engaging in conversations about alcohol with pregnant women. Our aim was to capture the views of midwives and service users to co-create strategies to address these barriers. DESIGN: Qualitative description. METHODS: Structured Zoom-based focus group interviews of midwives and service users where we presented known barriers and sought solutions to midwives discussing alcohol use in antenatal settings. Data collection took place between July and August 2021. RESULTS: Fourteen midwives and six service users attended five focus groups. Barriers considered were as follows: (i) lack of awareness of guidelines, (ii) poor skills in difficult conversations, (iii) lack of confidence, (iv) lack of belief in existing evidence, (v) women would not listen to their advice, and (vi) alcohol conversations were not considered part of their role. Five strategies to address barriers to midwives discussing alcohol with pregnant women were identified. These were as follows: Training that included mothers of children with Foetal Alcohol Spectrum Disorder, champion midwives, a service user questionnaire about alcohol for completion before the consultation, questions about alcohol added to the maternity data capture template and a structured appraisal to provide a means of audit and feedback on their alcohol dialogue with women. CONCLUSIONS: Co-creation involving providers and users of maternity services yielded theoretically underpinned pragmatic strategies to support midwives to ask advise assist about alcohol during antenatal care. Future research will test if the strategies can be delivered in antenatal care settings, and if they are acceptable to service providers and service users. IMPACT: If these strategies are effective in addressing barriers to midwives discussing alcohol with pregnant women, this could support women to abstain from alcohol during pregnancy, thus reducing alcohol-related maternal and infant harm. PATIENT AND PUBLIC CONTRIBUTION: Service users were involved in the design and execution of the study, considering data, supporting intervention design and delivery and dissemination.

The barriers and facilitators to hand hygiene practices in Nigeria: A qualitative study: "There are so many barriers ... the barriers are limitless."

BACKGROUND: Health care associated infections (HCAIs) are a global challenge and hand hygiene is the primary measure to reduce these. In developing countries, patients are between 2 and 20 times more likely to acquire an HCAI compared with developed countries. Estimates of hand hygiene in Sub-Saharan Africa suggests 21% concordance. There are few studies investigating barriers and facilitators and those published tend to be surveys. This study aimed to understand barriers and facilitators to hand hygiene in a hospital in Nigeria. METHODS: A theoretically underpinned in-depth qualitative interview study with thematic analysis of nurses and doctors working in surgical wards. RESULTS: There were individual and institutional factors constituting barriers or facilitators: (1) knowledge, skills, and education, (2) perceived risks of infection to self and others, (3) memory, (4) the influence of others and (5) skin irritation. Institutional factors were (1) environment and resources and (2) workload and staffing levels. CONCLUSIONS: Our study presents barriers and facilitators not previously reported and offers nuances and detail to those already reported in the literature. Although the primary recommendation is adequate resources, however small local changes such as gentle soap, simple skills and reminder posters and mentorship or support could address many of the barriers listed.

Implementation and clinical utility of a Computer-Aided Risk Score for Mortality (CARM): a qualitative study.

OBJECTIVES: The Computer-Aided Risk Score for Mortality (CARM) estimates the risk of in-hospital mortality following acute admission to the hospital by automatically amalgamating physiological measures, blood tests, gender, age and COVID-19 status. Our aims were to implement the score with a small group of practitioners and understand their first-hand experience of interacting with the score in situ. DESIGN: Pilot implementation evaluation study involving qualitative interviews. SETTING: This study was conducted in one of the two National Health Service hospital trusts in the North of England in which the score was developed. PARTICIPANTS: Medical, older person and ICU/anaesthetic consultants and specialist grade registrars (n=116) and critical outreach nurses (n=7) were given access to CARM. Nine interviews were conducted in total, with eight doctors and one critical care outreach nurse. INTERVENTIONS: Participants were given access to the CARM score, visible after login to the patients' electronic record, along with information about the development and intended use of the score. RESULTS: Four themes and 14 subthemes emerged from reflexive thematic analysis: (1) current use (including support or challenge clinical judgement and decision making, communicating risk of mortality and professional curiosity); (2) barriers and facilitators to use (including litigation, resource needs, perception of the evidence base, strengths and limitations), (3) implementation support needs (including roll-out and integration, access, training and education); and (4) recommendations for development (including presentation and functionality and potential additional data). Barriers and facilitators to use, and recommendations for development featured highly across most interviews. CONCLUSION: Our in situ evaluation of the pilot implementation of CARM demonstrated its scope in supporting clinical decision making and communicating risk of mortality between clinical colleagues and with service users. It suggested to us barriers to implementation of the score. Our findings may support those seeking to develop, implement or improve the adoption of risk scores.

Barriers and facilitators to delivering everyday personal hygiene care in residential settings: A systematic review.

INTRODUCTION: Globally, the population is ageing, and more people live in residential care. Best practice in personal hygiene care may reduce distressing and debilitating skin and oral problems and improve resident outcomes. Although there is guidance on personal hygiene care, implementation may be a challenge. AIM: To identify barriers and facilitators to delivering personal hygiene care for older persons in residential care settings. METHODS: Systematic review reported according to PRISMA 2020 guidance. Databases MEDLINE, CIHAHL and PsychINFO were systematically searched using terms and synonyms 'barriers', 'facilitators', 'hygiene', 'older adults' and 'residential care'. Only empirical studies, reporting everyday skin and oral care, in English, peer reviewed and published from 2000 to 2021 were included. Due to methodological heterogeneity, a narrative synthesis was conducted. RESULTS: Sixteen papers yielded nine categories of barrier or facilitator. Five related to skin and oral care: (i) knowledge, (ii) skills relating to hygiene care, (iii) skills relating to supporting 'uncooperative' behaviours, (iv) lack of resources and (v) time, workload and staffing levels. The remainder related only to oral care: (vi) resident, family or carer motivation, (vii) dislike of hygiene care, (viii) carer attitudes and beliefs and (ix) social influences and communication. Six papers reported interventions to optimise care. CONCLUSION: This review highlights the persistent dearth of research into everyday personal hygiene practices, in particular skin hygiene in residential care. Existing literature identifies a range of barriers; however, there is a mismatch between these and reported interventions to improve practice. RELEVANCE TO CLINICAL PRACTICE: Advances in implementation science to support optimal care have yet to be applied to interventions to support hygiene practices in care homes and it is imperative this is addressed. Future interventions should involve: (i) systematically and theoretically assessing barriers, (ii) application of tailored behaviour change techniques (iii) using these co-design pragmatic, locally acceptable strategies.

Challenges and opportunities for cervical screening in women over the age of 50 years: a qualitative study.

BACKGROUND: Cervical cancer is a preventable disease. Cases in women age >50 years are predicted to rise by 60% in the next two decades, yet this group are less likely to attend for screening than younger women. AIM: To seek novel solutions to the challenges of cervical screening in women >50 years of age by examining practitioner and service-user experiences. DESIGN AND SETTING: Semi-structured interviews were conducted with 28 practitioners and 24 service users >50 years of age, recruited via UK primary care networks in Northern England in 2016-2017, to explore experiences related to cervical screening. METHOD: An inductive thematic analysis was conducted to explore the data. RESULTS: Findings are presented under three key themes. The first, exploring the barriers to successful cervical screening, examines the influences of sexuality and early experiences of screening on attendance, and how preventive health care becomes a low priority as women age. The second, the role of relationships, explores how peer talk shapes attitudes towards cervical screening, how teamwork between practitioners engenders investment in cervical screening, and how interactions between service users and primary care over time can significantly affect intentions to screen. The third, what constitutes good practice, describes practical and sensitive approaches to screening tailored to women aged >50 years. CONCLUSION: Good practice involves attention to structural and practical challenges, and an understanding of the role of relationships in shaping screening intentions. Experienced practitioners adapt procedures to increase sensitivity, and balance time invested in problem solving against the benefits of reaching practice targets for attendance. Building networks of expertise across multiple practices can increase practitioner skill in screening this age group.

More than signposting: Findings from an evaluation of a social prescribing service.

This paper presents findings from an evaluation of a social prescribing service, undertaken between January 2019 and December 2020. Data was collected through interviews and focus groups with a range of groups including social prescribing managers, link workers (LWs), referrers (GPs and social work practitioners), clients, Voluntary and Community Sector (VCS) agencies and groups. Thematic analysis of data was undertaken, and findings were presented in respect of clients' journeys into social prescribing; the support received from LWs; their onward journeys to VCS support. The findings highlight the challenges for individuals in contacting new agencies/groups and the importance of practitioner referral into and onwards from social prescribing, as well as buddying to support clients on initial agency visits. The depth of the LW role is highlighted, as well as the complexity of client circumstances, highlighting a need for 'more than signposting', and challenging the notion of self-referral as an indicator of motivation. Social prescribing has been positioned as amongst the solutions to the challenges of primary care. However, referrals from GPs were low and significantly outnumbered by those from social workers; this suggests a need to explore in greater depth the use of social prescribing by social workers, who have, to date, been absent from social prescribing research.

Selecting intervention content to target barriers and enablers of recognition and response to deteriorating patients: an online nominal group study.

BACKGROUND: Patients who deteriorate in hospital wards without appropriate recognition and/or response are at risk of increased morbidity and mortality. Track-and-trigger tools have been implemented internationally prompting healthcare practitioners (typically nursing staff) to recognise physiological changes (e.g. changes in blood pressure, heart rate) consistent with patient deterioration, and then to contact a practitioner with expertise in management of acute/critical illness. Despite some evidence these tools improve patient outcomes, their translation into clinical practice is inconsistent internationally. To drive greater guideline adherence in the use of the National Early Warning Score tool (a track-and-trigger tool used widely in the United Kingdom and parts of Europe), a theoretically informed implementation intervention was developed (targeting nursing staff) using the Theoretical Domains Framework (TDF) version 2 and a taxonomy of Behaviour Change Techniques (BCTs). METHODS: A three-stage process was followed: 1. TDF domains representing important barriers and enablers to target behaviours derived from earlier published empirical work were mapped to appropriate BCTs; 2. BCTs were shortlisted using consensus approaches within the research team; 3. shortlisted BCTs were presented to relevant stakeholders in two online group discussions where nominal group techniques were applied. Nominal group participants were healthcare leaders, senior clinicians, and ward-based nursing staff. Stakeholders individually generated concrete strategies for operationalising shortlisted BCTs ('applications') and privately ranked them according to acceptability and feasibility. Ranking data were used to drive decision-making about intervention content. RESULTS: Fifty BCTs (mapped in stage 1) were shortlisted to 14 (stage 2) and presented to stakeholders in nominal groups (stage 3) alongside example applications. Informed by ranking data from nominal groups, the intervention was populated with 12 BCTs that will be delivered face-to-face, to individuals and groups of nursing staff, through 18 applications. CONCLUSIONS: A description of a theory-based behaviour change intervention is reported, populated with BCTs and applications generated and/or prioritised by stakeholders using replicable consensus methods. The feasibility of the proposed intervention should be tested in a clinical setting and the content of the intervention elaborated further to permit replication and evaluation.

Translating qualitative data into intervention content using the Theoretical Domains Framework and stakeholder co-design: a worked example from a study of cervical screening attendance in older women.

BACKGROUND: Previous screening interventions have demonstrated a series of features related to social determinants which have increased uptake in targeted populations, including the assessment of health beliefs and barriers to screening attendance as part of intervention development. Many studies cite the use of theory to identify methods of behaviour change, but fail to describe in detail how theoretical constructs are transformed into intervention content. The aim of this study was to use data from a qualitative exploration of cervical screening in women over 50 in the UK as the basis of intervention co-design with stakeholders using behavioural change frameworks. We describe the identification of behavioural mechanisms from qualitative data, and how these were used to develop content for a service-user leaflet and a video animation for practitioner training. The interventions aimed to encourage sustained commitment to cervical screening among women over 50, and to increase sensitivity to age-related problems in screening among primary care practitioners. METHODS: Secondary coding of a qualitative data set to extract barriers and facilitators of cervical screening attendance. Barrier and facilitator statements were categorised using the Theoretical Domains Framework (TDF) to identify relevant behaviour change techniques (BCTs). Key TDF domains and associated BCTs were presented in stakeholder focus groups to guide the design of intervention content and mode of delivery. RESULTS: Behavioural determinants relating to attendance clustered under three domains: beliefs about consequences, emotion and social influences, which mapped to three BCTs respectively: (1) persuasive communication/information provision; (2) stress management; (3) role modelling and encouragement. Service-user stakeholders translated these into three pragmatic intervention components: (i) addressing unanswered questions, (ii) problem-solving practitioner challenges and (iii) peer group communication. Based on (ii), practitioner stakeholders developed a call to action in three areas - clinical networking, history-taking, and flexibility in screening processes. APEASE informed modes of delivery (a service-user leaflet and a cartoon animation for practitioners). CONCLUSION: The application of the TDF to qualitative data can provide an auditable protocol for the translation of qualitative data into intervention content.

An observational study of hand hygiene compliance of surgical healthcare workers in a Nigerian teaching hospital.

Background: Patients sometimes contract healthcare associated infections (HCAI) which are unrelated to their primary reasons for hospital admission. Surgical site infections are the most investigated and most recurrent type of HCAI in developing countries, affecting up to one-third of surgical patients. Objective: This study aimed to assess and offer context to the hand hygiene resources available in a Nigerian teaching hospital through ward infrastructure survey, and to determine the hand hygiene compliance rate among surgical healthcare workers (HCWs) in a Nigerian teaching hospital through hand hygiene observations. Methods: Ward infrastructure survey was conducted in the two adult surgical wards of the hospital using the World Health Organisation (WHO) hand hygiene ward infrastructure survey form. Hand hygiene observations were monitored over seven days in the surgical wards using a modified WHO hand hygiene observation form. Results: Hand hygiene resources were insufficient, below the WHO recommended minimum standards. Seven hundred hand hygiene opportunities were captured. Using SPSS version 24.0, we conducted a descriptive analysis of audit results, and results were presented according to professional group, seniority and hand hygiene opportunities of the participants. Overall hand hygiene compliance was 29.1% and compliance was less than 40% across the three professional groups of doctors, nurses and healthcare assistants. Conclusion: Hand hygiene compliance rates of the surgical HCWs are comparable to those in other Sub-Saharan African countries as well as in developed countries.

How and how well have older people been engaged in healthcare intervention design, development or delivery using co-methodologies: A scoping review with narrative summary.

Co-methodological working is gaining increasing traction in healthcare, but studies with older people have been slower to develop. Our aim was to investigate how and how well older people have been engaged in healthcare intervention design, development or delivery using co-methodologies. We conducted a systematic search of four electronic databases to identify international literature published between 2009 and November 2019. We included peer-reviewed empirical research of any design. Three authors screened papers. Our review is reported in accordance with the Joanna Briggs Institute manual for scoping reviews, we have referred to the preferred reporting items for systematic reviews and meta-analyses statement. We data extracted to a bespoke spreadsheet and used the Co:Create Co-production Matrix to guide quality appraisal. Included studies (n = 48) were diverse in nature of interventions, co-methodologies and reporting. We offer a narrative summary of included papers. Establishing how older people were engaged in co-methodological work was largely straightforward. How well this was done was more challenging, however we have identified gems of good practice and offered directions for future practice. The Co:Create Co-Production Matrix was the best fit for evaluating papers, however it is not intended as a measure per se. In essence we argue that notions of 'best' and 'scores' are an oxymoron in co-methodological working, what is important that: (a) researchers embrace these methods, (b) incremental change is the way forward, (c) researchers need to do what is right for people and purpose and (d) have time to consider and articulate why they are choosing this approach and how best this can be achieved for their particular situation. Future evaluation of participant's experience of the process would enable others to learn about what works for who and in what circumstances.

Helping the quitters quit: A systematic review and narrative synthesis of the barriers and facilitators to e-cigarette cessation and the support that is needed.

OBJECTIVE: To investigate the barriers and facilitators to and support needed for e-cigarette cessation. METHODS: We systematically searched the subject-specific databases MEDLINE, CINAHL complete and psycINFO and the Cochrane database using synonyms relating to the terms e-cigarettes and cessation including English language, empirical, peer reviewed research papers, published from 2010 to 2021. We included papers that addressed the research question in its broadest sense, including papers reporting reasons for and interventions to support e-cigarette cessation. Data extraction was completed two authors independently using a bespoke spreadsheet. We conducted a narrative synthesis of all data and we were able to extract and combine descriptive quantitative data from included survey papers. RESULTS: After reviewing 2593 titles 10 papers fit our criteria. Barriers to e-cigarette cessation were: a fear of returning to tobacco, dependency and stress reduction. Barriers or facilitators were: health and hazard beliefs, degree of enjoyment, social influences and environmental factors. A number of e-cigarette smoking support measures were suggested by participants. PRACTICE IMPLICATIONS: E-cigarette cessation poses similar and additional challenges to that of tobacco cessation. E-cigarettes are not the final step on a journey to smoking cessation. Addressing barriers specific to e-cigarettes need to be considered in intervention design.

What are the barriers to nurses mobilising adult patients in intensive care units? An integrative review.

OBJECTIVES: There is a need for early mobilisation of patients in intensive care units to prevent acquired weaknesses which can have a long-term impact on health and quality of life. This need is not always fulfilled. We therefore sought to conduct an integrative review of international evidence to answer the question: What are the barriers to nurses mobilising adult patients in intensive care units? REVIEW METHOD USED: We conducted a systematic search and thematic analysis. We were able to present a descriptive quantitative synthesis of the survey articles included. DATA SOURCES: We searched CINAHL, MEDLINE, and PsycINFO databases between and including 2010 and 2020 using search terms synonymous with "intensive care unit" and "nurse" and "early mobilisation" and "barrier using Boolean operators" and "truncation". We completed backwards and forwards citation searches on included studies. RESULTS: We included seven articles which we synthesised into three themes and 13 subthemes as follows: (i) organisational barriers (subthemes were staffing levels, time and workload, resources, and care coordination), (ii) individual barriers (subthemes were self and team safety, knowledge and training, beliefs about the consequences of early mobilisation, stress, and other barriers), and (iii) patient-related barriers (subthemes were medical instability/physical status, patient safety, neurological deficits and sedation, and nonconcordance of patients). CONCLUSION: Nurses' barriers were wide ranging, and interventions to improve concordance with early mobilisation need to be tailored to address this group's specific barriers.

Supporting medicines management for older people at care transitions - a theory-based analysis of a systematic review of 24 interventions.

BACKGROUND: Older patients are at severe risk of harm from medicines following a hospital to home transition. Interventions aiming to support successful care transitions by improving medicines management have been implemented. This study aimed to explore which behavioural constructs have previously been targeted by interventions, which individual behaviour change techniques have been included, and which are yet to be trialled. METHOD: This study mapped the behaviour change techniques used in 24 randomised controlled trials to the Behaviour Change Technique Taxonomy. Once elicited, techniques were further mapped to the Theoretical Domains Framework to explore which determinants of behaviour change had been targeted, and what gaps, if any existed. RESULTS: Common behaviour change techniques used were: goals and planning; feedback and monitoring; social support; instruction on behaviour performance; and prompts/cues. These may be valuable when combined in a complex intervention. Interventions mostly mapped to between eight and 10 domains of the Theoretical Domains Framework. Environmental context and resources was an underrepresented domain, which should be considered within future interventions. CONCLUSION: This study has identified behaviour change techniques that could be valuable when combined within a complex intervention aiming to support post-discharge medicines management for older people. Whilst many interventions mapped to eight or more determinants of behaviour change, as identified within the Theoretical Domains Framework, careful assessment of the barriers to behaviour change should be conducted prior to intervention design to ensure all appropriate domains are targeted.