Additional materials
Data analysis-qualitative approach
The deductive approach looks for themes in the data based on a predefined framework. The inductive approach, called the constructivist Grounded Theory (GT) approach, implies development of theory from the data, i.e.
theory ‘emerges’ from the data through a process of rigorous and structured analysis (27). The combination of both approaches ensures a comprehensive data analysis. By gradually aggregating and refining preliminary codes, themes or clusters of experience are identified.
As a first step, the transcribed interviews from each setting were thoroughly read by the researcher from each center in the local language, to ensure that they were well understood. As a second step, a line-by-line coding of barriers and facilitators was performed, followed by a second coding of emerging codes matched with a list based on the Flottorp framework (see below). We repeatedly compared data and coding across settings in order to assure a consistent approach. In the third step, a second cycle of coding was performed with special attention to concepts resulting from the data missed during the first cycle. Once the whole dataset was coded, a final set of codes was obtained. By merging the codes, 7 final themes emerged.
Seven domains of the Flottorp framework Guideline factors
Individual health professional 1
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
factors
Patient factors
Professional interactions Incentives and resources Capacity for organizational change
Social, political and legal factors
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