AUTHOR=Joseph Linju , Greenfield Sheila , Lavis Anna , Lekha T. R. , Panniyammakal Jeemon , Manaseki-Holland Semira 

TITLE=Exploring Factors Affecting Health Care Providers' Behaviors for Maintaining Continuity of Care in Kerala, India; A Qualitative Analysis Using the Theoretical Domains Framework

JOURNAL=Frontiers in Public Health

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.891103

DOI=10.3389/fpubh.2022.891103

ISSN=2296-2565

ABSTRACT=Introduction
Access to patients’ documented medical information is necessary for building informational continuity across different healthcare providers (HCP). Patient-held health records (PHR) have important documented medical information, which can contribute to informational continuity in the outpatient settings in Kerala. We aimed to identify the perceived HCP factors influencing informational and management continuity for patients with diabetes and hypertension using the theoretical domains framework (TDF).
Methods
We re-analysed the semi-structured interview data from 17 HCPs working in public health facilities in Kerala, collected for a large qualitative study to explore patients, carers, and HCPs' experiences using PHRs. Interview transcripts were deductively coded based on a coding framework based on the 14 domains of TDF. Specific beliefs were generated from the data grouped into the domains.
Results 
Data were coded into the 14 domains of TDF and generated 33 specific beliefs regarding maintaining informational and management continuity of care. Seven domains were judged to be acting as facilitators for recording in PHRs and maintaining continuity. The two domains memory, attention and decision process, and environmental context and resources depicted the barriers identified by HCPs for informational continuity of care. 
Conclusion
In this exploration of recording patients’ medical information in PHRs, HCPs attributions of sub-optimal recording were used to identify domains that may be targeted for further development of supporting intervention. Overall, nine domains were likely to impact the barriers and facilitators for HCPs in recording in PHRs and subsequently maintaining informational and management continuity of care. This study showed that many underlying beliefs regarding informational continuity of care were based on HCPs’ experiences with patient behaviours. Further research is needed for developing the content and appropriate support interventions for using PHRs to maintain informational continuity.