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

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