A Qualitative Study of Behavioral Determinants Influencing CPD Implementation in Healthcare Practice

A Qualitative Study of Behavioral Determinants Influencing CPD Implementation in Healthcare Practice | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Qualitative Study of Behavioral Determinants Influencing CPD Implementation in Healthcare Practice Heba Al-Omary, Abderrezzaq Soltani, Derek Stewart, Zachariah Nazar This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7638468/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 16 Jan, 2026 Read the published version in International Journal of Clinical Pharmacy → Version 1 posted 10 You are reading this latest preprint version Abstract Introduction: The integration of learning from continuing professional development (CPD) activities into practice is shaped by behavioral, organizational, and broader system-level factors. However, there is scarce research utilizing theory to provide a comprehensive understanding of prevalent behavioral determinants. Aim: To investigate key behavioral determinants that influence CPD participants’ implementation of learning into their practice following participation in CPD activities. Method: Eleven semi-structured interviews were conducted with healthcare professionals 4–6 weeks after they participated in a live, interactive CPD workshop. Interview questions were guided by the COM-B model to elucidate behavioral determinants; emerging themes were subsequently mapped to the COM-B domains. Recommended interventions were derived to optimize CPD outcomes using the Behavior Change Wheel (BCW). Results: Most participants reported applying their CPD learning in practice. Analysis revealed that while Capability, Opportunity , and Motivation were all perceived to influence implementation, Motivation was an important driver, with professional responsibility and satisfaction from positive patient outcomes were also perceived to influence behavior. Opportunity was particularly challenging in community pharmacy settings due to time constraints, workload, and organizational factors. These findings informed targeted recommendations to optimize CPD implementation. Conclusion: This study highlights the complex interplay of behavioral determinants that are perceived to influence the translation of CPD learning into routine clinical practice. Effective CPD programs should incorporate strategies to address setting-specific barriers—such as time constraints, emotional pressures, and organizational support to foster motivation and facilitate sustained practice change. Tailoring CPD design to these behavioral determinants can improve the integration of learning into practice and ultimately enhance patient care. Continuing Education Professional Practice Health Personnel Behavior Change Implementation. Impact statements CPD programs should move beyond knowledge delivery by creating opportunities for reflection, patient-centered counseling practice, and peer discussion to support real-world application. Organizational and managerial backing, including protected time, supportive workplace culture, and recognition of CPD efforts, is critical for successful implementation. Patient engagement strategies (e.g., building trust, tailoring education to literacy and language needs) should be emphasized within CPD design and follow-up. Intrinsic motivators such as professional responsibility and personal satisfaction can be leveraged by aligning CPD content with professionals’ values and sense of duty. Local economic and resource contexts should be acknowledged, as commercial pressures may either support or undermine CPD implementation. Introduction Continuing Professional Development (CPD) is an ongoing process through which healthcare professionals maintain and enhance their knowledge, skills, and competencies to meet evolving clinical standards and ensure safe and effective patient care[ 1 , 2 ]. Beyond developing technical expertise, CPD fosters personal and professional growth, enabling providers to deliver high-quality services that meet the complex needs of patients and communities[ 2 – 4 ]. A growing body of evidence has consistently shown that CPD contributes to healthcare quality improvement and patient outcomes by facilitating the adoption of evidence-based practices and supporting knowledge translation into clinical care[ 5 ]. Although CPD has demonstrated benefits, its impact on routine clinical practice is often inconsistent. Healthcare professionals may struggle to apply newly acquired knowledge and skills due to barriers such as time constraints, limited resources, and lack of organizational support [ 5 ] Implementation science emphasizes that knowledge acquisition alone does not ensure practice change or improved patient outcomes[ 6 ]. Successful implementation requires integration of evidence-based interventions into real-world settings, along with reflection on how new learning shapes care delivery[ 7 , 8 ]. Reviews further highlight the influence of individual attitudes, competing demands, organizational culture, and economic considerations, though methodological variability limits generalizability and underscores the need to understand the mechanisms enabling successful implementation[ 9 , 10 ]. The integration of CPD learning into practice is shaped by behavioral, organizational, and broader system-level factors. At the behavioral level, active engagement is needed, as passive participation rarely leads to change[ 11 , 12 ]. At the organizational level, factors such as workplace culture and managerial support can facilitate or hinder implementation[ 13 , 14 ]. At the system level, issues such as national policies, healthcare financing, and regulatory structures can constrain the sustainability of CPD impact. A recent scoping review highlighted the limited understanding of how these layers interact and emphasized the need for CPD initiatives to support both individual behavior change and wider system improvements[ 15 ] Despite the numerous studies to report on the barriers that hinder the implementation of skills and knowledge from CPD activities, much of this research has been largely descriptive and not grounded in theory[ 16 , 17 ] The COM-B model is particularly useful in this context, as it conceptualizes behavior as the interaction of Capability (knowledge and skills), Opportunity (environmental and social context), and Motivation (goals, emotions, and beliefs)[ 18 ]. Applying COM-B to CPD implementation allows for comprehensive identification of barriers and facilitators, while linking them to evidence-based behavior change techniques[ 19 , 20 ]. This model has been successfully applied to diverse health behaviors such as medication adherence, physical activity, and healthy eating[ 21 – 25 ], but its use in CPD implementation research remains limited. Leveraging behavioral theory in this field therefore represents an important opportunity to generate deeper understanding and develop interventions that are both meaningful and sustainable[ 18 , 26 ] Aim: This study utilizes an implementation science approach to explore the barriers and facilitators to applying CPD-acquired knowledge in clinical settings. Focusing on a CPD workshop on asthma care in Qatar, the study applies the COM-B model to systematically identify determinants of practice change. Research question: What are the key behavioral determinants that influence CPD participants’ implementation of learning into their practice? Method Study Design This study employed a qualitative descriptive design and is reported in line with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist[ 27 ]. Participants selection and sampling Participants were licensed pharmacists and nurses practicing in Qatar with regular clinical contact with asthma patients, who attended one of two CPD asthma workshops held between November 2023 and January 2024. Following the workshop, attendees received an information sheet outlining the study objectives and procedures, and a form seeking consent to be contacted for interviews. Consenting participants were invited for one-on-one interviews 4–6 weeks post-workshop, allowing sufficient time to reflect on and apply learning in practice. Participation was therefore based on an open invitation, and the final group reflected a self-selected sample rather than purposive recruitment. Recruitment continued until informational redundancy was reached, defined as the point at which additional interviews yielded no substantively new insights, consistent with established qualitative research guidance[ 28 ]. Development of Data Collection Tools The semi-structured interview guide was developed following a five-phase process [ 29 ] involving the identification of prerequisites, literature review, preliminary formulation, pilot testing, and finalization. The guide was explicitly aligned with the COM-B model to capture behavioral determinants influencing implementation of learning. To enhance the credibility and trustworthiness of the interview guide, it was reviewed by three local experts in behavioral science and qualitative research. Two pilot interviews were conducted with practicing pharmacists and one with a nurse to refine question clarity, flow, and comprehensiveness, ensuring participants could engage meaningfully and provide rich data. Data collection Data were collected through one-on-one, semi-structured interviews, conducted either in person or via secure Microsoft Teams, depending on participant preference. Interviews were audio-recorded with informed consent and lasted approximately 30–45 minutes, as indicated in the participant information sheet. Brief field notes and reflective memos were documented during and after each interview to capture contextual details, initial impressions, and emerging ideas, supporting the trustworthiness of the data. The primary researcher (HAO) had formal training in qualitative research and semi-structured interviewing, including coursework and workshops addressing ethical considerations, interview skills, and data management. Supervision and methodological oversight were provided by an experienced qualitative researcher (ZN) throughout the data collection process. Researchers had no prior relationships with participants, minimizing potential bias and enhancing the independence of data collection. Data Analysis A deductive framework analysis approach was applied using the COM-B model to systematically link participant experiences to pre-established theoretical constructs [ 30 ]. Audio recordings were transcribed verbatim and verified for accuracy. Coding was conducted in Excel using color-coding to differentiate themes. Preliminary Coding: Two researchers (ZN, HAO) coded transcripts deductively based on COM-B components—Capability, Opportunity, and Motivation—to categorize facilitators and barriers to behavior change. Discrepancies were resolved through detailed discussion, with unresolved issues escalated to team discussions (HAO, ZN, DS, AS) to ensure consensus. Sub-theme Identification: Emergent sub-themes were linked to COM-B subcomponents (e.g., physical vs. psychological capability, social vs. physical opportunity, reflective vs. automatic motivation). Integration and Verification: Collaborative team discussions resolved coding discrepancies, ensuring trustworthiness and conceptual consistency. Identified COM-B subcomponents informed subsequent mapping to intervention functions within the Behavior Change Wheel (BCW) to guide the development of targeted strategies for promoting CPD implementation[ 18 ] Trustworthiness and Rigor Several strategies were employed to enhance rigor and ensure credibility as advocated by Shenton [ 31 ]. Maintaining an audit trail documenting all research steps. Conducting inter-coder reliability checks to ensure consistency in coding. Engaging in regular peer review with supervisors. Keeping comprehensive records of transcripts, field notes, reflective memos, and coding decisions. Ethics approval Ethical approval was obtained in November 2023 from the Institutional Review Board (IRB) at Qatar University [QU-IRB 1985-EA/23]. Results Demographic characteristics Seventy-six healthcare professionals (HCPs) attended the asthma care workshop, all of whom were contacted afterward and invited to participate in the study. Initially eight HCPs agreed to participate; however, recruitment continued with two follow-up invitations until informational redundancy was achieved. A total of 11 HCPs (8 pharmacists and 3 nurses) were interviewed. The participants represented a range of healthcare settings, including hospitals (45.5%), community pharmacies (18.2%), private healthcare settings (27.3%), and primary health care centers (9.1%). Most participants were female (72.7%), and the majority had between 5–10 years of professional experience, with the full distribution presented in Table 1 . Participants varied in professional roles, including clinical pharmacists, community pharmacists, and specialized nurses, ensuring a diverse representation of perspectives. (Further details of participants are provided in Appendix.) Table 1 Participants’ demographic characteristics. Characteristic Category Participants (n = 11) Gender Male 3 Female 8 Profession Pharmacists (n = 8) Clinical Pharmacist 5 Community Pharmacist 2 Staff Pharmacist 1 Nurse (n = 3) Specialist nurses 1 Community nurse 2 Healthcare Setting Hospital 5 Community Pharmacy 2 Private Sector (Medical Center or Home Care) 3 Primary Health Care Center (PHCC) 1 Qualitative Themes and Codes Mapped to COM-B Components All the interviewed participants indicated that they were able to implement their learning from the CPD activity into their practice either in part or fully. Analysis of the qualitative interviews identified seven overarching themes reflecting the facilitators and barriers experienced by healthcare professionals when implementing CPD learning into practice. These themes were systematically mapped to the COM-B model components (Capability, Opportunity, and Motivation) to provide a structured understanding of behavioral determinants. The mapping also informed potential intervention strategies using the Behavior Change Wheel (BCW), highlighting how individual, social, and organizational factors interact to influence the translation of learning into clinical practice. Table 3 presents the identified themes, its associated codes, and the corresponding COM-B components. Table 3 Qualitative Themes with Codes Mapped to COM-B Components and Their Influence (Facilitators or Barriers) Theme Code COM-B Component Facilitator (✔) / Barrier (X) Knowledge and Skills for Implementing CPD Learning Practical Skills Physical Capability ✔ Previous Experience and Expertise Physical Capability ✔ Need for Additional Skills Physical Capability X Acquired Knowledge from CPD Psychological Capability ✔ Knowledge Gaps Pre-CPD Psychological Capability X Time Constraints and Competing Workload Demands Prioritizing Key Information Psychological Capability ✔ Lack of Time for Counseling Physical Opportunity X Rush Hours Physical Opportunity X Time Management Challenges Psychological Capability X Engaging and Educating Patients in Asthma Care Patient Feedback Automatic Motivation ✔ Building Trust Social Opportunity ✔ Personalized Counseling Psychological Capability ✔ Patient Willingness Social Opportunity X Language Barriers Physical Opportunity X Patient Cognition Psychological Capability X Organizational and Managerial Support Systems Management Support Social Opportunity ✔ Colleague Encouragement Social Opportunity ✔ Lack of Incentives Automatic Motivation X Disinterest from Colleagues Social Opportunity X Professional Responsibility and Accountability Obligation to patient care Reflective Motivation ✔ Ethical commitment Reflective Motivation ✔ Management’s focus on profit Reflective Motivation X Economic and Resource Considerations Increased profit through compliance Social Opportunity ✔ Trust Building Leads to Business Growth Social Opportunity ✔ Profit over Patient Care Reflective Motivation X Personal Satisfaction and Professional Motivation Professional Satisfaction Reflective Motivation ✔ Positive Feedback from Patients Automatic Motivation ✔ Sense of Achievement Reflective Motivation ✔ Emotional Pressure Automatic Motivation X Theme 1: Knowledge and Skills for Applying CPD Learning Participants described how CPD workshops improved their knowledge and counseling skills, which supported effective asthma care (facilitator). For example, one nurse shared: “So together, the patient and I assess… they are more self-aware now than before, so that was the good thing I gained with this workshop.” (P7, Nurse). However, gaps remained, with some reporting limited confidence in managing complex cases (barrier): “Now I can share my knowledge with them… but I need more experience when dealing with children with asthma.” (P9, Nurse). Theme 2: Time Pressures and Competing Workload Demands Heavy patient loads and long shifts restricted opportunities for in-depth counseling (barrier). As one pharmacist explained: “Sometimes because we have rush hours in the community pharmacy… during those times, it’s hard to find time for in-depth counseling.” (P1, Pharmacist). At the same time, participants highlighted strategies to prioritize essential information and streamline consultations (facilitator): “It organized my line of thoughts… What will I address first about asthma?” (P2, Pharmacist). Theme 3: Patient Engagement and Counseling Approaches Building trust, tailoring information, and responding to patient feedback encouraged adherence (facilitator): “So when I am counseling and using the chart, they think that I am caring… We have a trust, and they will improve and come back.” (P1, Pharmacist). Yet, engagement was sometimes hindered by patient disinterest, language barriers, or limited health literacy (barrier): “It depends on the patient… Some patients don’t like comprehensive information and aren’t interested in listening.” (P2, Pharmacist). Theme 4: Organizational and Managerial Support Supportive workplace cultures and peer collaboration were seen as enablers: “Applying new steps… we educate each other more. This supports the enhancement of care delivery overall.” (P11, Pharmacist). In contrast, absence of managerial backing, lack of incentives, or unsupportive environments—particularly in private settings—restricted implementation (barrier): “This is the private sector… There is no support.” (P8, Pharmacist). Theme 5: Professional Responsibility and Ethical Duty A strong sense of professional obligation motivated participants to integrate asthma education into care (facilitator). As one nurse reflected: “It makes me feel like being a nurse is not only a job, but there is a bigger mission with this job.” (P7, Nurse). However, this was undermined when organizational priorities emphasized profit over patient education (barrier): “In the private sector, there is no encouragement… It’s a business, it’s commercial.” (P8, Pharmacist). Theme 6: Economic and Resource Considerations Financial drivers operated in both directions. On one hand, trust-building and effective education increased adherence, benefiting both patients and organizations (facilitator): “I have my profit to increase my sales, but at the same time, I am building trust with my patients.” (P1, Pharmacist). Conversely, a profit-first mindset reduced emphasis on patient education (barrier). Theme 7: Personal Satisfaction and Professional Motivation Professional fulfillment, confidence, and patient loyalty reinforced the value of applying CPD learning (facilitator): “After I finish the discussion, I feel confident whenever I have a patient with asthma, and I feel capable of handling it on my own.” (P2, Pharmacist). However, some participants reported emotional strain or self-doubt when dealing with complex cases (barrier): “I’m not too confident, especially when dealing with children with asthma. I need more experience and exposure.” (P9, Nurse) Collectively, these seven themes illustrate the complex interplay of capability, opportunity, and motivation in shaping healthcare professionals’ ability to implement their CPD learning into practice. While facilitators such as enhanced knowledge and skills, patient trust, professional responsibility, and personal satisfaction were strongly emphasized, these were frequently offset by barriers including time constraints, lack of systemic support, and competing economic priorities. Mapping COM-B Components to Proposed Interventions via the Behavior Change Wheel Table 3 shows how the COM-B components identified in the qualitative data were mapped to the Behavior Change Wheel (BHW) which informed targeted intervention strategies. Capability-related factors (e.g., knowledge and skills gaps) were linked to interventions focused on education and training. Opportunity-related factors (e.g., time constraints, management support, peer encouragement) aligned with recommendations for environmental restructuring and social support. Motivation-related factors (e.g., ethical commitment, profit motives, personal satisfaction) mapped to recommended interventions including persuasion, incentivization, reinforcement, and modeling. Table 3 Mapping of Themes and Codes to COM-B Components, and Proposed Behavior Change Wheel (BCW) Intervention Functions Theme COM-B Component Intervention Function (BCW) Knowledge and Skills Capability (physical/psychological) Education, Training Time Constraints Opportunity (physical), Capability (psychological) Environmental restructuring, Training Patient Engagement Opportunity (social), Capability (psychological), Motivation (automatic) Social support, Persuasion, Modeling Support Systems Opportunity (social), Motivation (automatic) Environmental restructuring, Social support, Incentivization Professional Responsibility Motivation (reflective) Persuasion, Modeling Economic considerations Opportunity (social), Motivation (reflective) Incentivization, Persuasion Personal Satisfaction Motivation (reflective & automatic) Reinforcement, Modeling Discussion Summary of key findings This study explored perceived behavioral determinants influencing HCPs ability to implement learning from an asthma CPD workshop into practice. Eleven participants (pharmacists and nurses) contributed perspectives across hospital, community, private, and primary care settings. The deductive analysis identified seven themes that reflected both facilitators and barriers to implementation. While CPD enhanced knowledge and skills, external pressures such as time constraints, lack of incentives, and unsupportive colleagues limited application. Conversely, professional responsibility, patient engagement, and personal satisfaction served as intrinsic motivators. Linking these findings to COM-B revealed that capability was shaped by knowledge and skills as well as time management, opportunity was influenced by organizational and social contexts, and motivation was driven by intrinsic factors (ethical commitment, satisfaction) and extrinsic barriers (profit focus, limited incentives). Overall, the findings illustrate that while CPD successfully builds capability, sustainable implementation requires supportive opportunities and reinforced motivation at both individual and organizational levels. Interpretation of findings and implications This study demonstrates that implementing CPD learning is shaped by the interplay of capability, opportunity, and motivation, rather than knowledge alone. While participants reported that CPD enhanced their knowledge and confidence, the sustainability of practice change was influenced by contextual and motivational factors. Capability was strengthened through knowledge acquisition and improved confidence in patient counseling. Similar findings have been reported in CPD research with midwives [ 32 ] and with dietetic counseling for cancer survivors[ 33 ]. However, gaps in practical skills limited translation into practice, echoing calls for CPD programs to incorporate hands-on training to ensure that HCPs can apply knowledge in real-world settings[ 34 ]. This finding supports recommendations that CPD should go beyond information delivery and include interactive, skills-based components such as simulation, case-based learning, and supervised practice to strengthen physical capability[ 35 – 38 ] Opportunity, particularly time and workload, was a commonly cited barrier. This aligns with the Environmental Context and Resources domain, where limited time and staffing consistently undermine implementation[ 39 , 40 ] Social opportunity also played a pivotal role: managerial and peer support enabled change, while disengaged colleagues and unsupportive leadership hindered it. These findings are consistent with prior research showing that organizational culture and leadership support are essential for embedding evidence-based practice[ 32 , 33 ].To maximize CPD impact, organizational leaders must address systemic barriers such as workload distribution, provide formal recognition or protected time for learning, and foster peer networks that normalize new practices. Automatic motivation was often undermined by emotional pressures, including stress and patient demands, reflecting the Emotion domain[ 33 , 41 ] Yet reflective motivation, tied to professional responsibility and ethical duty, was also a facilitator, consistent with evidence that professional identity and beliefs about consequences are critical for sustained behavior change[ 18 , 40 ] Patient feedback provided reinforcement that strengthened motivation, but patient resistance or language barriers acted as deterrents, highlighting the complexity of interpersonal dynamics[ 32 ]. These findings suggest that CPD should explicitly address motivational factors by incorporating strategies to build resilience, enhance communication skills, and reinforce professional identity. At the organizational level, systems of feedback, recognition, and incentivization can help sustain motivation and counteract emotional fatigue. Economic considerations had a dual influence. In some settings, financial incentives reinforced implementation. However, when profit motives conflicted with patient care, they undermined intrinsic motivators such as professional responsibility[ 42 ]. To address this, policymakers and healthcare organizations should carefully balance the use of financial incentives with measures that support professional values, ensuring that commercial priorities do not erode patient-centered care. Overall, these findings reinforce that CPD can effectively build capability, but lasting impact depends on addressing opportunity and motivation through multilevel interventions. CPD design should therefore adopt a systems perspective, integrating educational content with organizational and policy-level strategies that tackle barriers and reinforce facilitators. Strengths and limitations A notable strength is the theoretical grounding of the study. The use of the COM-B model provided a systematic framework for data collection, analysis, and interpretation, ensuring that findings were not only descriptive but also mapped to established behavior change theory. This enhanced the credibility of the findings and strengthened their potential to inform targeted interventions via the BCW. The study also benefited from qualitative depth, capturing barriers and facilitators across diverse healthcare settings, which supports confirmability by grounding interpretations in rich participant accounts. Limitations include the small sample size, which may not reflect the perspectives of all healthcare professionals and therefore constrains transferability beyond similar contexts. Self-selection bias is possible, as those more motivated or engaged with CPD may have been more likely to participate, potentially under-representing less engaged individuals. The gender imbalance in the sample, with fewer male participants, may also have limited the diversity of perspectives. Finally, as a local study based on a single CPD activity, the findings may not generalize to other professional groups, specialties, or national settings. These factors should be considered when interpreting the results. Nonetheless, by applying theory and drawing on diverse practice settings, the study offers insights with practical relevance and contributes to the trustworthiness of evidence on CPD implementation. Recommendations for future studies Future research should extend beyond individual healthcare professionals to include the perspectives of administrators, managers, and policymakers. Understanding how organizational culture, leadership, and resource allocation influence CPD implementation could help identify structural changes needed to address barriers such as workload, time pressure, and lack of support. Building on this study, there is also a need to design and test tailored interventions that target specific determinants of behavior using the COM-B model. Potential strategies include time-management tools, stress-reduction initiatives, workload adjustments, and peer-support mechanisms to strengthen both opportunity and motivation for applying CPD learning. Finally, to enhance generalizability, future studies should adopt mixed-methods approaches. Large-scale surveys could establish the prevalence of identified barriers and facilitators across different settings, while qualitative interviews or focus groups would add depth and contextual understanding. Such approaches would validate these findings and support the development of scalable, evidence-informed strategies for CPD implementation in diverse healthcare environments. Conclusion This study contributes new evidence on the behavioral determinants influencing the implementation of CPD learning, highlighting that its success depends not only on enhanced knowledge and skills but also on addressing motivational and organizational factors. Motivation—through professional responsibility, patient engagement, and personal satisfaction—was a strong facilitator, while opportunity-related barriers such as time constraints, workload, and limited management support hindered change. These findings emphasize that CPD initiatives must move beyond knowledge delivery to incorporate strategies that strengthen opportunity and reinforce motivation. By applying the COM-B model, this research provides a theory-driven framework to guide the design of targeted interventions, with the BCW offering practical solutions for addressing barriers and enhancing facilitators. For healthcare organizations, aligning CPD with supportive structures and incentives can promote sustained behavior change, leading to improved patient care and the advancement of healthcare practice. Statements & Declarations Abbreviations Continuing Professional Development (CPD), COM-B model Capability, Opportunity, Motivation Declarations Funding: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Competing Interests: The authors have no relevant financial or non-financial interests to disclose. Authors' contributions: HAO, ZN contributed to the study conception and design. Material preparation, data collection and analysis were performed by HAO, DS, AS, ZN. The first draft of the manuscript was written by HAO, ZN and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Availability of data and materials: All data supporting the findings of this study are provided in the results section of the article. Ethics approval and consent to participate : Ethical approval was obtained from the Institutional Review Board (IRB) at Qatar University [QU-IRB 1985-EA/23]. Consent to participate: Informed consent was obtained from all individual participants included in the study Consent to publish: Not applicable Acknowledgements: Not applicable References Sargeant J, Wong BM, Campbell CM. CPD of the future: a partnership between quality improvement and competency-based education. 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Qualitative data analysis for applied policy research. Analyzing qualitative data. routledge; 2002. pp. 173–94. Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educ Inform. 2004;22(2):63–75. De Leo A, Bayes S, Bloxsome D, et al. Exploring the usability of the COM-B model and Theoretical Domains Framework (TDF) to define the helpers of and hindrances to evidence-based practice in midwifery. Implement Sci Commun. 2021;2(1):7. https://doi.org/10.1186/s43058-020-00100-x . Keaver L, Douglas P, O'Callaghan N. Perceived Barriers and Facilitators to a Healthy Diet among Cancer Survivors: A Qualitative Exploration Using the TDF and COM-B. Dietetics. 2023;2:123–39. https://doi.org/10.3390/dietetics2010010 . Turner R, Hart J, Ashiru-Oredope D, et al. A qualitative interview study applying the COM-B model to explore how hospital-based trainers implement antimicrobial stewardship education and training in UK hospital-based care. BMC Health Serv Res. 2023;23(1):770. https://doi.org/10.1186/s12913-023-09559-5 . Lee SJ, Park MS, Kwon DY et al. The Development and Effectiveness of Combining Case-Based Online Lecture and Simulation Programs to Facilitate Interprofessional Function Care Training in Nursing Homes. Computers, informatics, nursing: CIN. 2020;38(12):646–56. https://doi.org/10.1097/cin.0000000000000655 Alharbi A, Nurfianti A, Mullen RF. The effectiveness of simulation-based learning (SBL) on students’ knowledge and skills in nursing programs: a systematic review. BMC Med Educ. 2024;24(1):1099. https://doi.org/10.1186/s12909-024-06080-z . Leung JS, Brar M, Eltorki M. Development of an in situ simulation-based continuing professional development curriculum in pediatric emergency medicine. Adv Simul. 2020;5(1):12. https://doi.org/10.1186/s41077-020-00129-x . Bray L, Krogh TB, Østergaard D. Simulation-based training for continuing professional development within a primary care context: a systematic review. Education for primary care: an official publication of the Association of Course Organisers, National Association of GP Tutors. World Organisation Family Doctors. 2023;34(2):64–73. https://doi.org/10.1080/14739879.2022.2161424 . Rosário F, Santos MI, Angus K, et al. Factors influencing the implementation of screening and brief interventions for alcohol use in primary care practices: a systematic review using the COM-B system and Theoretical Domains Framework. Implement science: IS. 2021;16(1):6. https://doi.org/10.1186/s13012-020-01073-0 . Alhusein N, Scott J, Neale J et al. Community pharmacists' views on providing a reproductive health service to women receiving opioid substitution treatment: A qualitative study using the TDF and COM-B. Exploratory research in clinical and social pharmacy. 2021;4:None. https://doi.org/10.1016/j.rcsop.2021.100071 Willmott TJ, Pang B, Rundle-Thiele S. Capability, opportunity, and motivation: an across contexts empirical examination of the COM-B model. BMC Public Health. 2021;21(1):1014. https://doi.org/10.1186/s12889-021-11019-w . Reeves P, Edmunds K, Searles A, et al. Economic evaluations of public health implementation-interventions: a systematic review and guideline for practice. Public Health. 2019. org/10.1016/j.puhe.2019.01.012 . https://doi.org/https://doi. . 169:101 – 13. Additional Declarations No competing interests reported. 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15:45:40","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":126077,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7638468/v1/62334907e1ecb5e5530082fc.html"},{"id":100614740,"identity":"bc3b6f22-27c4-4617-91dd-5ef69620e113","added_by":"auto","created_at":"2026-01-19 17:23:44","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1035667,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7638468/v1/77b05a27-986d-47ad-8386-54b388274d75.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Qualitative Study of Behavioral Determinants Influencing CPD Implementation in Healthcare Practice","fulltext":[{"header":"Impact statements","content":"\u003cul\u003e\n \u003cli\u003eCPD programs should move beyond knowledge delivery by creating opportunities for reflection, patient-centered counseling practice, and peer discussion to support real-world application.\u003c/li\u003e\n \u003cli\u003eOrganizational and managerial backing, including protected time, supportive workplace culture, and recognition of CPD efforts, is critical for successful implementation.\u003c/li\u003e\n \u003cli\u003ePatient engagement strategies (e.g., building trust, tailoring education to literacy and language needs) should be emphasized within CPD design and follow-up.\u003c/li\u003e\n \u003cli\u003eIntrinsic motivators such as professional responsibility and personal satisfaction can be leveraged by aligning CPD content with professionals\u0026rsquo; values and sense of duty.\u003c/li\u003e\n \u003cli\u003eLocal economic and resource contexts should be acknowledged, as commercial pressures may either support or undermine CPD implementation.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eContinuing Professional Development (CPD) is an ongoing process through which healthcare professionals maintain and enhance their knowledge, skills, and competencies to meet evolving clinical standards and ensure safe and effective patient care[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Beyond developing technical expertise, CPD fosters personal and professional growth, enabling providers to deliver high-quality services that meet the complex needs of patients and communities[\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e–\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A growing body of evidence has consistently shown that CPD contributes to healthcare quality improvement and patient outcomes by facilitating the adoption of evidence-based practices and supporting knowledge translation into clinical care[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAlthough CPD has demonstrated benefits, its impact on routine clinical practice is often inconsistent. Healthcare professionals may struggle to apply newly acquired knowledge and skills due to barriers such as time constraints, limited resources, and lack of organizational support [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Implementation science emphasizes that knowledge acquisition alone does not ensure practice change or improved patient outcomes[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Successful implementation requires integration of evidence-based interventions into real-world settings, along with reflection on how new learning shapes care delivery[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Reviews further highlight the influence of individual attitudes, competing demands, organizational culture, and economic considerations, though methodological variability limits generalizability and underscores the need to understand the mechanisms enabling successful implementation[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe integration of CPD learning into practice is shaped by behavioral, organizational, and broader system-level factors. At the behavioral level, active engagement is needed, as passive participation rarely leads to change[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. At the organizational level, factors such as workplace culture and managerial support can facilitate or hinder implementation[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. At the system level, issues such as national policies, healthcare financing, and regulatory structures can constrain the sustainability of CPD impact. A recent scoping review highlighted the limited understanding of how these layers interact and emphasized the need for CPD initiatives to support both individual behavior change and wider system improvements[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eDespite the numerous studies to report on the barriers that hinder the implementation of skills and knowledge from CPD activities, much of this research has been largely descriptive and not grounded in theory[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThe COM-B model is particularly useful in this context, as it conceptualizes behavior as the interaction of Capability (knowledge and skills), Opportunity (environmental and social context), and Motivation (goals, emotions, and beliefs)[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Applying COM-B to CPD implementation allows for comprehensive identification of barriers and facilitators, while linking them to evidence-based behavior change techniques[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This model has been successfully applied to diverse health behaviors such as medication adherence, physical activity, and healthy eating[\u003cspan additionalcitationids=\"CR22 CR23 CR24\" citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e–\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], but its use in CPD implementation research remains limited. Leveraging behavioral theory in this field therefore represents an important opportunity to generate deeper understanding and develop interventions that are both meaningful and sustainable[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/p\u003e\n\u003ch3\u003eAim:\u003c/h3\u003e\n\u003cp\u003eThis study utilizes an implementation science approach to explore the barriers and facilitators to applying CPD-acquired knowledge in clinical settings. Focusing on a CPD workshop on asthma care in Qatar, the study applies the COM-B model to systematically identify determinants of practice change.\u003c/p\u003e\u003cp\u003eResearch question: What are the key behavioral determinants that influence CPD participants’ implementation of learning into their practice?\u003c/p\u003e"},{"header":"Method","content":"\u003ch2\u003eStudy Design\u003c/h2\u003e\u003cp\u003eThis study employed a qualitative descriptive design and is reported in line with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003ch3\u003eParticipants selection and sampling\u003c/h3\u003e\u003cp\u003eParticipants were licensed pharmacists and nurses practicing in Qatar with regular clinical contact with asthma patients, who attended one of two CPD asthma workshops held between November 2023 and January 2024. Following the workshop, attendees received an information sheet outlining the study objectives and procedures, and a form seeking consent to be contacted for interviews. Consenting participants were invited for one-on-one interviews 4–6 weeks post-workshop, allowing sufficient time to reflect on and apply learning in practice.\u003c/p\u003e\u003cp\u003eParticipation was therefore based on an open invitation, and the final group reflected a self-selected sample rather than purposive recruitment. Recruitment continued until informational redundancy was reached, defined as the point at which additional interviews yielded no substantively new insights, consistent with established qualitative research guidance[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003ch3\u003eDevelopment of Data Collection Tools\u003c/h3\u003e\u003cp\u003eThe semi-structured interview guide was developed following a five-phase process [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] involving the identification of prerequisites, literature review, preliminary formulation, pilot testing, and finalization. The guide was explicitly aligned with the COM-B model to capture behavioral determinants influencing implementation of learning.\u003c/p\u003e\u003cp\u003eTo enhance the credibility and trustworthiness of the interview guide, it was reviewed by three local experts in behavioral science and qualitative research. Two pilot interviews were conducted with practicing pharmacists and one with a nurse to refine question clarity, flow, and comprehensiveness, ensuring participants could engage meaningfully and provide rich data.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eData were collected through one-on-one, semi-structured interviews, conducted either in person or via secure Microsoft Teams, depending on participant preference. Interviews were audio-recorded with informed consent and lasted approximately 30\u0026ndash;45 minutes, as indicated in the participant information sheet. Brief field notes and reflective memos were documented during and after each interview to capture contextual details, initial impressions, and emerging ideas, supporting the trustworthiness of the data.\u003c/p\u003e\u003cp\u003eThe primary researcher (HAO) had formal training in qualitative research and semi-structured interviewing, including coursework and workshops addressing ethical considerations, interview skills, and data management. Supervision and methodological oversight were provided by an experienced qualitative researcher (ZN) throughout the data collection process. Researchers had no prior relationships with participants, minimizing potential bias and enhancing the independence of data collection.\u003c/p\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eA deductive framework analysis approach was applied using the COM-B model to systematically link participant experiences to pre-established theoretical constructs [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Audio recordings were transcribed verbatim and verified for accuracy. Coding was conducted in Excel using color-coding to differentiate themes.\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003ePreliminary Coding: Two researchers (ZN, HAO) coded transcripts deductively based on COM-B components\u0026mdash;Capability, Opportunity, and Motivation\u0026mdash;to categorize facilitators and barriers to behavior change. Discrepancies were resolved through detailed discussion, with unresolved issues escalated to team discussions (HAO, ZN, DS, AS) to ensure consensus.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eSub-theme Identification: Emergent sub-themes were linked to COM-B subcomponents (e.g., physical vs. psychological capability, social vs. physical opportunity, reflective vs. automatic motivation).\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eIntegration and Verification: Collaborative team discussions resolved coding discrepancies, ensuring trustworthiness and conceptual consistency. Identified COM-B subcomponents informed subsequent mapping to intervention functions within the Behavior Change Wheel (BCW) to guide the development of targeted strategies for promoting CPD implementation[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eTrustworthiness and Rigor\u003c/h2\u003e\u003cp\u003eSeveral strategies were employed to enhance rigor and ensure credibility as advocated by Shenton [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eMaintaining an audit trail documenting all research steps.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eConducting inter-coder reliability checks to ensure consistency in coding.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEngaging in regular peer review with supervisors.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eKeeping comprehensive records of transcripts, field notes, reflective memos, and coding decisions.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eEthics approval\u003c/span\u003e\u003c/strong\u003e\u003cp\u003e Ethical approval was obtained in November 2023 from the Institutional Review Board (IRB) at Qatar University [QU-IRB 1985-EA/23].\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eDemographic characteristics\u003c/p\u003e\u003cp\u003eSeventy-six healthcare professionals (HCPs) attended the asthma care workshop, all of whom were contacted afterward and invited to participate in the study. Initially eight HCPs agreed to participate; however, recruitment continued with two follow-up invitations until informational redundancy was achieved. A total of 11 HCPs (8 pharmacists and 3 nurses) were interviewed. The participants represented a range of healthcare settings, including hospitals (45.5%), community pharmacies (18.2%), private healthcare settings (27.3%), and primary health care centers (9.1%). Most participants were female (72.7%), and the majority had between 5\u0026ndash;10 years of professional experience, with the full distribution presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Participants varied in professional roles, including clinical pharmacists, community pharmacists, and specialized nurses, ensuring a diverse representation of perspectives. (Further details of participants are provided in Appendix.)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipants\u0026rsquo; demographic characteristics.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eParticipants (n\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e\u003cp\u003eProfession\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003ePharmacists (n\u0026thinsp;=\u0026thinsp;8)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClinical Pharmacist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCommunity Pharmacist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStaff Pharmacist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cb\u003eNurse (n\u0026thinsp;=\u0026thinsp;3)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpecialist nurses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCommunity nurse\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eHealthcare Setting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCommunity Pharmacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrivate Sector (Medical Center or Home Care)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary Health Care Center (PHCC)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eQualitative Themes and Codes Mapped to COM-B Components\u003c/p\u003e\u003cp\u003e All the interviewed participants indicated that they were able to implement their learning from the CPD activity into their practice either in part or fully. Analysis of the qualitative interviews identified seven overarching themes reflecting the facilitators and barriers experienced by healthcare professionals when implementing CPD learning into practice. These themes were systematically mapped to the COM-B model components (Capability, Opportunity, and Motivation) to provide a structured understanding of behavioral determinants. The mapping also informed potential intervention strategies using the Behavior Change Wheel (BCW), highlighting how individual, social, and organizational factors interact to influence the translation of learning into clinical practice.\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents the identified themes, its associated codes, and the corresponding COM-B components.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eQualitative Themes with Codes Mapped to COM-B Components and Their Influence (Facilitators or Barriers)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCode\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCOM-B Component\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFacilitator (✔) / Barrier (X)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003e\u003cb\u003eKnowledge and Skills for Implementing CPD Learning\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePractical Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhysical Capability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e✔\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrevious Experience and Expertise\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhysical Capability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e✔\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNeed for Additional Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhysical Capability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcquired Knowledge from CPD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePsychological Capability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e✔\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eKnowledge Gaps Pre-CPD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePsychological Capability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eTime Constraints and Competing Workload Demands\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrioritizing Key Information\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePsychological Capability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e✔\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLack of Time for Counseling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhysical Opportunity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRush Hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhysical Opportunity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime Management Challenges\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePsychological Capability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e\u003cp\u003e\u003cb\u003eEngaging and Educating Patients in Asthma Care\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatient Feedback\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAutomatic Motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e✔\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBuilding Trust\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSocial Opportunity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e✔\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePersonalized Counseling\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePsychological Capability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e✔\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatient Willingness\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSocial Opportunity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLanguage Barriers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePhysical Opportunity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatient Cognition\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePsychological Capability\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003eOrganizational and Managerial Support Systems\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eManagement Support\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSocial Opportunity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e✔\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eColleague Encouragement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSocial Opportunity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e✔\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLack of Incentives\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAutomatic Motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDisinterest from Colleagues\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSocial Opportunity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eProfessional Responsibility and Accountability\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eObligation to patient care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReflective Motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e✔\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEthical commitment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReflective Motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e✔\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eManagement\u0026rsquo;s focus on profit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReflective Motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cb\u003eEconomic and Resource Considerations\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIncreased profit through compliance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSocial Opportunity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e✔\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTrust Building Leads to Business Growth\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSocial Opportunity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e✔\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfit over Patient Care\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReflective Motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003e\u003cb\u003ePersonal Satisfaction and Professional Motivation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProfessional Satisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReflective Motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e✔\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePositive Feedback from Patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAutomatic Motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e✔\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSense of Achievement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReflective Motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e✔\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEmotional Pressure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAutomatic Motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eX\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eTheme 1: Knowledge and Skills for Applying CPD Learning\u003c/h3\u003e\n\u003cp\u003e Participants described how CPD workshops improved their knowledge and counseling skills, which supported effective asthma care (facilitator). For example, one nurse shared: \u003cem\u003e\u0026ldquo;So together, the patient and I assess\u0026hellip; they are more self-aware now than before, so that was the good thing I gained with this workshop.\u0026rdquo;\u003c/em\u003e (P7, Nurse). However, gaps remained, with some reporting limited confidence in managing complex cases (barrier): \u003cem\u003e\u0026ldquo;Now I can share my knowledge with them\u0026hellip; but I need more experience when dealing with children with asthma.\u0026rdquo;\u003c/em\u003e (P9, Nurse).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eTheme 2: Time Pressures and Competing Workload Demands\u003c/h2\u003e\u003cp\u003eHeavy patient loads and long shifts restricted opportunities for in-depth counseling (barrier). As one pharmacist explained: \u003cem\u003e\u0026ldquo;Sometimes because we have rush hours in the community pharmacy\u0026hellip; during those times, it\u0026rsquo;s hard to find time for in-depth counseling.\u0026rdquo;\u003c/em\u003e (P1, Pharmacist). At the same time, participants highlighted strategies to prioritize essential information and streamline consultations (facilitator): \u003cem\u003e\u0026ldquo;It organized my line of thoughts\u0026hellip; What will I address first about asthma?\u0026rdquo;\u003c/em\u003e (P2, Pharmacist).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eTheme 3: Patient Engagement and Counseling Approaches\u003c/h2\u003e\u003cp\u003eBuilding trust, tailoring information, and responding to patient feedback encouraged adherence (facilitator): \u003cem\u003e\u0026ldquo;So when I am counseling and using the chart, they think that I am caring\u0026hellip; We have a trust, and they will improve and come back.\u0026rdquo;\u003c/em\u003e (P1, Pharmacist). Yet, engagement was sometimes hindered by patient disinterest, language barriers, or limited health literacy (barrier): \u003cem\u003e\u0026ldquo;It depends on the patient\u0026hellip; Some patients don\u0026rsquo;t like comprehensive information and aren\u0026rsquo;t interested in listening.\u0026rdquo;\u003c/em\u003e (P2, Pharmacist).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eTheme 4: Organizational and Managerial Support\u003c/h2\u003e\u003cp\u003eSupportive workplace cultures and peer collaboration were seen as enablers: \u003cem\u003e\u0026ldquo;Applying new steps\u0026hellip; we educate each other more. This supports the enhancement of care delivery overall.\u0026rdquo;\u003c/em\u003e (P11, Pharmacist). In contrast, absence of managerial backing, lack of incentives, or unsupportive environments\u0026mdash;particularly in private settings\u0026mdash;restricted implementation (barrier): \u003cem\u003e\u0026ldquo;This is the private sector\u0026hellip; There is no support.\u0026rdquo;\u003c/em\u003e (P8, Pharmacist).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eTheme 5: Professional Responsibility and Ethical Duty\u003c/h2\u003e\u003cp\u003eA strong sense of professional obligation motivated participants to integrate asthma education into care (facilitator). As one nurse reflected: \u003cem\u003e\u0026ldquo;It makes me feel like being a nurse is not only a job, but there is a bigger mission with this job.\u0026rdquo;\u003c/em\u003e (P7, Nurse). However, this was undermined when organizational priorities emphasized profit over patient education (barrier): \u003cem\u003e\u0026ldquo;In the private sector, there is no encouragement\u0026hellip; It\u0026rsquo;s a business, it\u0026rsquo;s commercial.\u0026rdquo;\u003c/em\u003e (P8, Pharmacist).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eTheme 6: Economic and Resource Considerations\u003c/h2\u003e\u003cp\u003eFinancial drivers operated in both directions. On one hand, trust-building and effective education increased adherence, benefiting both patients and organizations (facilitator): \u003cem\u003e\u0026ldquo;I have my profit to increase my sales, but at the same time, I am building trust with my patients.\u0026rdquo;\u003c/em\u003e (P1, Pharmacist). Conversely, a profit-first mindset reduced emphasis on patient education (barrier).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eTheme 7: Personal Satisfaction and Professional Motivation\u003c/h2\u003e\u003cp\u003eProfessional fulfillment, confidence, and patient loyalty reinforced the value of applying CPD learning (facilitator): \u003cem\u003e\u0026ldquo;After I finish the discussion, I feel confident whenever I have a patient with asthma, and I feel capable of handling it on my own.\u0026rdquo;\u003c/em\u003e (P2, Pharmacist). However, some participants reported emotional strain or self-doubt when dealing with complex cases (barrier): \u003cem\u003e\u0026ldquo;I\u0026rsquo;m not too confident, especially when dealing with children with asthma. I need more experience and exposure.\u0026rdquo;\u003c/em\u003e (P9, Nurse)\u003c/p\u003e\u003cp\u003eCollectively, these seven themes illustrate the complex interplay of capability, opportunity, and motivation in shaping healthcare professionals\u0026rsquo; ability to implement their CPD learning into practice. While facilitators such as enhanced knowledge and skills, patient trust, professional responsibility, and personal satisfaction were strongly emphasized, these were frequently offset by barriers including time constraints, lack of systemic support, and competing economic priorities.\u003c/p\u003e\u003cp\u003eMapping COM-B Components to Proposed Interventions via the Behavior Change Wheel\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows how the COM-B components identified in the qualitative data were mapped to the Behavior Change Wheel (BHW) which informed targeted intervention strategies.\u003c/p\u003e\u003cp\u003eCapability-related factors (e.g., knowledge and skills gaps) were linked to interventions focused on education and training. Opportunity-related factors (e.g., time constraints, management support, peer encouragement) aligned with recommendations for environmental restructuring and social support. Motivation-related factors (e.g., ethical commitment, profit motives, personal satisfaction) mapped to recommended interventions including persuasion, incentivization, reinforcement, and modeling.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMapping of Themes and Codes to COM-B Components, and Proposed Behavior Change Wheel (BCW) Intervention Functions\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCOM-B Component\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention Function (BCW)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eKnowledge and Skills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCapability (physical/psychological)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEducation, Training\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime Constraints\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOpportunity (physical), Capability (psychological)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEnvironmental restructuring, Training\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient Engagement\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOpportunity (social), Capability (psychological), Motivation (automatic)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSocial support, Persuasion, Modeling\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSupport Systems\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOpportunity (social), Motivation (automatic)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEnvironmental restructuring, Social support, Incentivization\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProfessional Responsibility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMotivation (reflective)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePersuasion, Modeling\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEconomic considerations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOpportunity (social), Motivation (reflective)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIncentivization, Persuasion\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePersonal Satisfaction\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMotivation (reflective \u0026amp; automatic)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReinforcement, Modeling\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eSummary of key findings\u003c/p\u003e\u003cp\u003eThis study explored perceived behavioral determinants influencing HCPs ability to implement learning from an asthma CPD workshop into practice. Eleven participants (pharmacists and nurses) contributed perspectives across hospital, community, private, and primary care settings.\u003c/p\u003e\u003cp\u003eThe deductive analysis identified seven themes that reflected both facilitators and barriers to implementation. While CPD enhanced knowledge and skills, external pressures such as time constraints, lack of incentives, and unsupportive colleagues limited application. Conversely, professional responsibility, patient engagement, and personal satisfaction served as intrinsic motivators.\u003c/p\u003e\u003cp\u003eLinking these findings to COM-B revealed that capability was shaped by knowledge and skills as well as time management, opportunity was influenced by organizational and social contexts, and motivation was driven by intrinsic factors (ethical commitment, satisfaction) and extrinsic barriers (profit focus, limited incentives).\u003c/p\u003e\u003cp\u003eOverall, the findings illustrate that while CPD successfully builds capability, sustainable implementation requires supportive opportunities and reinforced motivation at both individual and organizational levels.\u003c/p\u003e\u003cp\u003eInterpretation of findings and implications\u003c/p\u003e\u003cp\u003eThis study demonstrates that implementing CPD learning is shaped by the interplay of capability, opportunity, and motivation, rather than knowledge alone. While participants reported that CPD enhanced their knowledge and confidence, the sustainability of practice change was influenced by contextual and motivational factors.\u003c/p\u003e\u003cp\u003eCapability was strengthened through knowledge acquisition and improved confidence in patient counseling. Similar findings have been reported in CPD research with midwives [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] and with dietetic counseling for cancer survivors[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. However, gaps in practical skills limited translation into practice, echoing calls for CPD programs to incorporate hands-on training to ensure that HCPs can apply knowledge in real-world settings[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This finding supports recommendations that CPD should go beyond information delivery and include interactive, skills-based components such as simulation, case-based learning, and supervised practice to strengthen physical capability[\u003cspan additionalcitationids=\"CR36 CR37\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eOpportunity, particularly time and workload, was a commonly cited barrier. This aligns with the \u003cem\u003eEnvironmental Context and Resources\u003c/em\u003e domain, where limited time and staffing consistently undermine implementation[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] Social opportunity also played a pivotal role: managerial and peer support enabled change, while disengaged colleagues and unsupportive leadership hindered it. These findings are consistent with prior research showing that organizational culture and leadership support are essential for embedding evidence-based practice[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].To maximize CPD impact, organizational leaders must address systemic barriers such as workload distribution, provide formal recognition or protected time for learning, and foster peer networks that normalize new practices.\u003c/p\u003e\u003cp\u003eAutomatic motivation was often undermined by emotional pressures, including stress and patient demands, reflecting the \u003cem\u003eEmotion\u003c/em\u003e domain[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] Yet reflective motivation, tied to professional responsibility and ethical duty, was also a facilitator, consistent with evidence that professional identity and beliefs about consequences are critical for sustained behavior change[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e] Patient feedback provided reinforcement that strengthened motivation, but patient resistance or language barriers acted as deterrents, highlighting the complexity of interpersonal dynamics[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These findings suggest that CPD should explicitly address motivational factors by incorporating strategies to build resilience, enhance communication skills, and reinforce professional identity. At the organizational level, systems of feedback, recognition, and incentivization can help sustain motivation and counteract emotional fatigue.\u003c/p\u003e\u003cp\u003eEconomic considerations had a dual influence. In some settings, financial incentives reinforced implementation. However, when profit motives conflicted with patient care, they undermined intrinsic motivators such as professional responsibility[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. To address this, policymakers and healthcare organizations should carefully balance the use of financial incentives with measures that support professional values, ensuring that commercial priorities do not erode patient-centered care.\u003c/p\u003e\u003cp\u003eOverall, these findings reinforce that CPD can effectively build capability, but lasting impact depends on addressing opportunity and motivation through multilevel interventions. CPD design should therefore adopt a systems perspective, integrating educational content with organizational and policy-level strategies that tackle barriers and reinforce facilitators.\u003c/p\u003e\u003cp\u003eStrengths and limitations\u003c/p\u003e\u003cp\u003eA notable strength is the theoretical grounding of the study. The use of the COM-B model provided a systematic framework for data collection, analysis, and interpretation, ensuring that findings were not only descriptive but also mapped to established behavior change theory. This enhanced the credibility of the findings and strengthened their potential to inform targeted interventions via the BCW. The study also benefited from qualitative depth, capturing barriers and facilitators across diverse healthcare settings, which supports confirmability by grounding interpretations in rich participant accounts.\u003c/p\u003e\u003cp\u003eLimitations include the small sample size, which may not reflect the perspectives of all healthcare professionals and therefore constrains transferability beyond similar contexts. Self-selection bias is possible, as those more motivated or engaged with CPD may have been more likely to participate, potentially under-representing less engaged individuals. The gender imbalance in the sample, with fewer male participants, may also have limited the diversity of perspectives. Finally, as a local study based on a single CPD activity, the findings may not generalize to other professional groups, specialties, or national settings. These factors should be considered when interpreting the results. Nonetheless, by applying theory and drawing on diverse practice settings, the study offers insights with practical relevance and contributes to the trustworthiness of evidence on CPD implementation.\u003c/p\u003e\u003cp\u003eRecommendations for future studies\u003c/p\u003e\u003cp\u003eFuture research should extend beyond individual healthcare professionals to include the perspectives of administrators, managers, and policymakers. Understanding how organizational culture, leadership, and resource allocation influence CPD implementation could help identify structural changes needed to address barriers such as workload, time pressure, and lack of support.\u003c/p\u003e\u003cp\u003eBuilding on this study, there is also a need to design and test tailored interventions that target specific determinants of behavior using the COM-B model. Potential strategies include time-management tools, stress-reduction initiatives, workload adjustments, and peer-support mechanisms to strengthen both opportunity and motivation for applying CPD learning.\u003c/p\u003e\u003cp\u003eFinally, to enhance generalizability, future studies should adopt mixed-methods approaches. Large-scale surveys could establish the prevalence of identified barriers and facilitators across different settings, while qualitative interviews or focus groups would add depth and contextual understanding. Such approaches would validate these findings and support the development of scalable, evidence-informed strategies for CPD implementation in diverse healthcare environments.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study contributes new evidence on the behavioral determinants influencing the implementation of CPD learning, highlighting that its success depends not only on enhanced knowledge and skills but also on addressing motivational and organizational factors. Motivation\u0026mdash;through professional responsibility, patient engagement, and personal satisfaction\u0026mdash;was a strong facilitator, while opportunity-related barriers such as time constraints, workload, and limited management support hindered change. These findings emphasize that CPD initiatives must move beyond knowledge delivery to incorporate strategies that strengthen opportunity and reinforce motivation.\u003c/p\u003e\u003cp\u003eBy applying the COM-B model, this research provides a theory-driven framework to guide the design of targeted interventions, with the BCW offering practical solutions for addressing barriers and enhancing facilitators. For healthcare organizations, aligning CPD with supportive structures and incentives can promote sustained behavior change, leading to improved patient care and the advancement of healthcare practice.\u003c/p\u003e\u003cp\u003eStatements \u0026amp; Declarations\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eContinuing Professional Development (CPD), COM-B model Capability, Opportunity, Motivation\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u0026nbsp; The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHAO, ZN contributed to the study conception and design. Material preparation, data collection and analysis were performed by HAO, DS, AS, ZN. The first draft of the manuscript was written by HAO, ZN and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u0026nbsp;\u003c/strong\u003eAll data supporting the findings of this study are provided in the results section of the article. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: Ethical approval was obtained from the Institutional Review Board (IRB) at Qatar University [QU-IRB 1985-EA/23].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u0026nbsp;\u003c/strong\u003eInformed consent was obtained from all individual participants included in the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish:\u0026nbsp;\u003c/strong\u003eNot applicable\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e Not applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSargeant J, Wong BM, Campbell CM. 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Public Health. 2019. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003eorg/10.1016/j.puhe.2019.01.012\u003c/span\u003e\u003cspan address=\"10.1016/j.puhe.2019.01.012\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/https://doi.\u003c/span\u003e\u003cspan address=\"https://doi.org/https://doi.\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. 169:101\u0026thinsp;\u0026ndash;\u0026thinsp;13.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-clinical-pharmacy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcp","sideBox":"Learn more about [International Journal of Clinical Pharmacy](https://www.springer.com/journal/11096)","snPcode":"11096","submissionUrl":"https://submission.nature.com/new-submission/11096/3","title":"International Journal of Clinical Pharmacy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Continuing Education, Professional Practice, Health Personnel, Behavior Change, Implementation.","lastPublishedDoi":"10.21203/rs.3.rs-7638468/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7638468/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIntroduction: The integration of learning from continuing professional development (CPD) activities into practice is shaped by behavioral, organizational, and broader system-level factors. However, there is scarce research utilizing theory to provide a comprehensive understanding of prevalent behavioral determinants.\u003c/p\u003e\u003cp\u003eAim: To investigate key behavioral determinants that influence CPD participants\u0026rsquo; implementation of learning into their practice following participation in CPD activities.\u003c/p\u003e\u003cp\u003e Method: Eleven semi-structured interviews were conducted with healthcare professionals 4\u0026ndash;6 weeks after they participated in a live, interactive CPD workshop. Interview questions were guided by the COM-B model to elucidate behavioral determinants; emerging themes were subsequently mapped to the COM-B domains. Recommended interventions were derived to optimize CPD outcomes using the Behavior Change Wheel (BCW).\u003c/p\u003e\u003cp\u003eResults: Most participants reported applying their CPD learning in practice. Analysis revealed that while \u003cem\u003eCapability, Opportunity\u003c/em\u003e, and \u003cem\u003eMotivation\u003c/em\u003e were all perceived to influence implementation, \u003cem\u003eMotivation\u003c/em\u003e was an important driver, with professional responsibility and satisfaction from positive patient outcomes were also perceived to influence behavior. \u003cem\u003eOpportunity\u003c/em\u003e was particularly challenging in community pharmacy settings due to time constraints, workload, and organizational factors. These findings informed targeted recommendations to optimize CPD implementation.\u003c/p\u003e\u003cp\u003eConclusion: This study highlights the complex interplay of behavioral determinants that are perceived to influence the translation of CPD learning into routine clinical practice. Effective CPD programs should incorporate strategies to address setting-specific barriers\u0026mdash;such as time constraints, emotional pressures, and organizational support to foster motivation and facilitate sustained practice change. Tailoring CPD design to these behavioral determinants can improve the integration of learning into practice and ultimately enhance patient care.\u003c/p\u003e","manuscriptTitle":"A Qualitative Study of Behavioral Determinants Influencing CPD Implementation in Healthcare Practice","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-06 15:45:35","doi":"10.21203/rs.3.rs-7638468/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-02T16:20:36+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-28T08:10:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"41153893880230940332285984229954492604","date":"2025-10-22T09:47:11+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-15T08:45:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"179447973517859629192280550556501581558","date":"2025-10-02T14:16:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"281798321881604436619169008069169824450","date":"2025-09-30T04:52:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-23T12:08:32+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-18T06:48:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-18T06:47:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal of Clinical Pharmacy","date":"2025-09-17T09:28:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-of-clinical-pharmacy","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijcp","sideBox":"Learn more about [International Journal of Clinical Pharmacy](https://www.springer.com/journal/11096)","snPcode":"11096","submissionUrl":"https://submission.nature.com/new-submission/11096/3","title":"International Journal of Clinical Pharmacy","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"943a2f7f-df3e-4fac-aac7-393fed628345","owner":[],"postedDate":"October 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T16:48:31+00:00","versionOfRecord":{"articleIdentity":"rs-7638468","link":"https://doi.org/10.1007/s11096-025-02079-8","journal":{"identity":"international-journal-of-clinical-pharmacy","isVorOnly":false,"title":"International Journal of Clinical Pharmacy"},"publishedOn":"2026-01-16 16:30:03","publishedOnDateReadable":"January 16th, 2026"},"versionCreatedAt":"2025-10-06 15:45:35","video":"","vorDoi":"10.1007/s11096-025-02079-8","vorDoiUrl":"https://doi.org/10.1007/s11096-025-02079-8","workflowStages":[]},"version":"v1","identity":"rs-7638468","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7638468","identity":"rs-7638468","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}