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Table 3 Barriers and Facilitators to the diagnosis of apathy in PD using the COM-B and TDF framework

From: Barriers and facilitators to diagnosing and managing apathy in Parkinson’s disease: a qualitative study

COM-B System TDF Diagnosis Related Codes Facilitator or Barrier
Capability Psychological Knowledge A variety of screening tools are used to identify neuropsychiatric symptoms other than apathy Facilitator
Apathy as dynamic changing symptom Barrier
Apathy exists as a symptom isolated from other neuropsychiatric symptoms Facilitator
Apathy is often diagnosed with other neuropsychiatric symptoms Facilitator
Apathy presents in a variety of ways Barrier
Education on apathy as a symptom in PD aids health care practitioners in making a diagnosis Facilitator
Recognizable symptoms in those with apathy in PD Facilitator
Knowing about apathy facilitates diagnosis Facilitator
Lack of awareness of apathy as a symptom hinders diagnostic and management processes Facilitator
Lack of screening tools for apathy Barrier
Health care practitioner may be aware of apathy without making a formal diagnosis Barrier
Limited utility of screening tools if there is not one definition for apathy Barrier
Need to create increased awareness that apathy is a part of the non-motor symptoms in PD Barrier
Physicians require diagnostic process prior to providing management Barrier
Skills A variety of screening tools are used to identify neuropsychiatric symptoms other than apathy Facilitator
Education on apathy as a symptom in PD aids health care practitioners in making a diagnosis Facilitator
Getting patient history helps health care practitioner make diagnosis Facilitator
Health care practitioners use varied diagnostic processes to identify apathy in PD Barrier
Recognizable symptoms in those with apathy in PD Facilitator
Knowing about apathy facilitates diagnosis Facilitator
Health care practitioner may be aware of apathy without making a formal diagnosis Barrier
Memory, attention and decision processes A variety of screening tools are used to identify neuropsychiatric symptoms other than apathy Facilitator
Apathy exists as a symptom isolated from other neuropsychiatric symptoms Facilitator
Apathy is often diagnosed with other neuropsychiatric symptoms Facilitator
Family and persons with PD communicating symptoms and behaviour changes to physician aids diagnostic process Facilitator
Getting patient history helps health care practitioner make diagnosis Facilitator
Health care practitioners use varied diagnostic processes to identify apathy in PD Barrier
Recognizable symptoms in those with apathy in PD Facilitator
Behavioural Regulation Family and persons with PD communicating symptoms and behaviour changes to physician aids diagnostic process Facilitator
Opportunity Physical Environmental Context and Resources Screening tools to overcome lack of knowledge or experience Facilitator
Lack of screening tools for apathy Barrier
Motivation Reflective Beliefs about capabilities A range of health care practitioners should be able to identify apathy to aid diagnosis Facilitators
Physicians require diagnostic process prior to providing management Barrier
Screening tools may interfere with physician expertise and judgment Barrier
Screening tools to overcome lack of knowledge or experience Facilitator
Inherent lack of engagement in those with apathy makes diagnosis difficult Barrier
Lack of awareness of apathy as a symptom hinders diagnostic and management processes Barrier
Limited utility of screening tools if there is not one definition for apathy Barrier
Social/professional role and identity A range of health care practitioners should be able to identify apathy to aid diagnosis Facilitator
Lack of awareness of apathy as a symptom hinders diagnostic and management processes Barrier
Intentions Apathy in care facility may purposefully go underreported Barrier
Beliefs about consequences Apathy in care facility may purposefully go underreported Barrier
Need for a diagnostic tool for apathy Barrier
Optimism Apathy symptoms are difficult to see Barrier
Goals Need for a diagnostic tool for apathy Barrier
Need to create increased awareness that apathy is a part of the non-motor symptoms in PD Barrier
Automatic Social/Professional Role and Identity Screening tools may interfere with physician expertise and judgment Barrier
Family and persons with PD communicating symptoms and behaviour changes to physician aids diagnostic process Facilitator
Reinforcement Family and persons with PD communicating symptoms and behaviour changes to physician aids diagnostic process Facilitator
Emotion Inherent lack of engagement in those with apathy makes diagnosis difficult Barrier