'Pushing the change': barriers, facilitators, and implementation plan for integrating individually tailored physical activity guidance in rheumatology practice.

Objectives: The objective of this paper was to identify determinants to implementing individually tailored physical activity (PA) counselling in rheumatology outpatient care, and secondarily, to develop a context-specific implementation plan. Together, these activities constituted the initial phase of a larger implementation research project guided by the Quality Implementation Framework (QIF). Methods: This qualitative study was conducted in 4 rheumatology outpatient clinics in the Capital Region of Denmark. Data were collected through nonparticipant observations of clinical consultations and semistructured interviews with nurses, physicians, and managers. Data were analysed using a 2-step approach: a deductive thematic analysis guided by the Theoretical Domains Framework (TDF), followed by an inductive content analysis of all TDF-coded data. Identified determinants were mapped to implementation strategies in collaboration with local working groups. Results: Twelve health professionals and managers were interviewed (mean age of 44 years and an average of 11 years of experience in rheumatology care). The most prominent TDF domains were Conclusions: Integrating PA counselling into rheumatology care requires addressing determinants at individual, professional, and organisational levels. Combining the QIF and TDF enabled a systematic and context-specific approach to early-phase implementation planning.