Table 2 Codes related to detection and diagnosis of agitation and/or aggression, mapped to the TDF and linked to the COM-B model [24]
COM-B | TDF Domain | Codes | Barrier or Facilitator | |
|---|---|---|---|---|
Capability | Psychological | Knowledge | Healthcare provider familiarity with agitation diagnostic tools affects comfort or competence with using tools | Barrier |
Difficulties among healthcare providers in understanding how agitation diagnostic tests works | Barrier | |||
Lack of available diagnostic tests for agitation and/or aggression | Barrier | |||
Residents are unique and agitation is especially unpredictable and fluctuates over time | Barrier | |||
Diagnostic practices overlook hypoactive behaviours | Barrier | |||
No formal criterion for agitation are used | Barrier | |||
Use of Diagnostic test to diagnose agitation (E.g. RAI) | Facilitator | |||
Providing adequate training for healthcare providers to use agitation screening tools | Facilitator | |||
When to involve geriatric medicine or geriatric psychiatry (e.g. on a referral basis) | Facilitator | |||
Diagnosis for agitation and/or aggression is made during the process of the dementia diagnosis | Facilitator | |||
Documenting and recording agitation events in many places | Facilitator | |||
Reviewing experiences of all care team members working with the resident to create a diagnosis of agitation and/or aggression | Facilitator | |||
| Â | Â | Cognitive and Interpersonal skills | Healthcare provider familiarity with agitation diagnostic tools affects comfort or competence with using tools | Barrier |
Difficulties among healthcare providers in understanding how agitation diagnostic tests works | Barrier | |||
Drawbacks of using tools to diagnose agitation (e.g. time consuming, healthcare provider availability, oversimplifying behaviours) | Barrier | |||
Residents are unique and agitation is especially unpredictable and fluctuates over time | Barrier | |||
No formal criterion for agitation are used | Barrier | |||
Diagnostic practices overlook hypoactive behaviours | Barrier | |||
Providing adequate training for healthcare providers to use agitation screening tools | Facilitator | |||
Counting number of aggressive or agitated incidents to diagnose agitation | Facilitator | |||
When to involve geriatric medicine or geriatric psychiatry (e.g. on a referral basis) | Facilitator | |||
Documenting and recording agitation events in many places | Facilitator | |||
Diagnosis for agitation and/or aggression is made during the process of the dementia diagnosis | Facilitator | |||
| Â | Â | Memory, Attention and Decision Making Processes | Administering diagnostic tests may prove difficult because they are not adapted for persons with cognitive impairment | Barrier |
| Â | Â | Behavioural Regulation | Diagnostic practices overlook hypoactive behaviours | Barrier |
Residents are unique and agitation is especially unpredictable and fluctuates over time | Barrier | |||
| Â | Physical | Physical Skills | - | - |
Opportunity | Social | Social influences | Unclear awareness or availability of geriatric medicine or geriatric psychiatry services | Barrier |
| Â | Physical | Environmental Context and Resources | Drawbacks of using tools to diagnose agitation (e.g. time consuming, healthcare provider availability, oversimplifying behaviours) | Barrier |
| Â | Â | Â | Diagnosis of cognitive issues takes a long time, which delays diagnosis of agitation and/or aggression | Barrier |
| Â | Â | Â | Lack of available diagnostic tests for agitation and/or aggression | Barrier |
Unclear awareness or availability of geriatric medicine or geriatric psychiatry services | Barrier | |||
Motivation | Reflective | Social/Professional Role and Identity | Less referrals needed in LTC centres where physicians are more actively involved in care | Facilitator |
Healthcare provider familiarity with agitation diagnostic tools affects comfort or competence with using tools | Barrier | |||
Drawbacks of using tools to diagnose agitation (e.g. time consuming, healthcare provider availability, oversimplifying behaviours) | Barrier | |||
Specialized care teams helped with diagnoses | Facilitator | |||
Providing adequate training for healthcare providers to use agitation screening tools | Facilitator | |||
When to involve geriatric medicine or geriatric psychiatry (e.g. on a referral basis) | Facilitator | |||
Less referrals needed in LTC centres where physicians are more actively involved in care | Facilitator | |||
Diagnosis is made by a physician | Facilitator | |||
Unclear awareness or availability of geriatric medicine or geriatric psychiatry services | Barrier | |||
Reviewing experiences of all care team members working with the resident to create a diagnosis of agitation and/or aggression | Facilitator | |||
| Â | Â | Beliefs about capabilities | Easy to administer agitation tools across different healthcare providers and produce easy-to-understand results | Facilitator |
Advantages to using a diagnostic test (e.g. being able to compare agitation between residents, objective measures) | Facilitator | |||
Drawbacks to tools to monitor agitation symptoms (e.g. not informative enough) | Barrier | |||
Preference among healthcare providers for screening tools | Facilitator | |||
| Â | Â | Optimism | Easy to administer agitation tools across different healthcare providers and produce easy-to-understand results | Facilitator |
| Â | Â | Beliefs about Consequences | Drawbacks to tools to monitor agitation symptoms (e.g. not informative enough) | Barrier |
| Â | Â | Intentions | Use of tools for diagnosing agitation and/or aggression symptoms (e.g. DSM-Ts, daily behavioural mapping, RAI assessment etc.) | Facilitator |
Use of Diagnostic test to diagnose agitation (E.g. RAI) | Facilitator | |||
Counting number of aggressive or agitated incidents to diagnose agitation | Facilitator | |||
| Â | Â | Goals | Use of tools for diagnosing agitation and/or aggression symptoms (e.g. DSM-Ts, daily behavioural mapping, RAI assessment etc.) | Facilitator |
Use of Diagnostic test to diagnose agitation (E.g. RAI) | Facilitator | |||
Documenting and recording agitation events in many places | Facilitator | |||
Counting number of aggressive or agitated incidents to diagnose agitation | Facilitator | |||
| Â | Automatic | Reinforcement | Specialized care teams helped with diagnoses | Facilitator |
Drawbacks to tools to monitor agitation symptoms (e.g. not informative enough) | Barrier | |||
Unclear awareness or availability of geriatric medicine or geriatric psychiatry services | Barrier | |||
Diagnosis for agitation and/or aggression is made during the process of the dementia diagnosis | Facilitator | |||
The high volume of assessments for other behavioural issues is part of the assessment for agitation | Facilitator | |||
Documenting and recording agitation events in many places | Facilitator | |||
Reviewing experiences of all care team members working with the resident to create a diagnosis of agitation and/or aggression | Facilitator | |||
| Â | Â | Emotion | Diagnostic practices overlook hypoactive behaviours | Barrier |
Residents are unique and agitation is especially unpredictable and fluctuates over time | Barrier | |||
Residents' lack of awareness or expression | Barrier | |||