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Table 1 Potential analytic directions considered

From: The role of analytic direction in qualitative research

Potential analytic directions Notes about analytic direction
Strategies used by a “good” patient vs. a “patient advocate” appeared to differa • Participants talk about “doing as they are told”, following orders, being a good patient, even if they are experiencing side effects of the prescribed medication
• Participants talk about doing what their doctor tells them but also trying to understand it and why, even if it means going to other health care providers for more information and for answers
• Who are the participants who follow recommendations vs. those who do not – could this be influenced by patient characteristics and/or system characteristics?
• What is the progression from being a “good” patient to being a patient advocate?
• Some participants reported advocating for themselves until they found someone they trusted
• Being a patient advocate is limited by the health care system (e.g. difficult to get a second opinion from health care provider)
Different motivations and routes to becoming a member of the patient group • Some participants did not appear to join the patient group because they felt strongly about being a patient advocate
• Some participants found the group on the internet while looking for information on bone health
• Some participants were actively enrolled in the patient group through a fracture clinic or an osteoporosis program or through involvement in an Osteoporosis Chapter in their region
• Being a member of a patient group may be just another source of information for individuals
• Did the manner in which an individual became a member of the patient group reflect their experiences with bone health and recommendations for bone health?
There are many barriers in the health care system • Some participants described challenges with getting a bone mineral density test (e.g. general practitioner as a potential barrier)
• Health care system can be a barrier to accessing care (e.g. restricted access to specialists, the general practitioner not wanting to make a referral, limited specialists in participant’s geographic area)
• How are participants able to get what they want/need (e.g. change in medications, referral to a specialist, information) despite system constraints?
Perceived messages by general practitioner and specialists to bone health as a health condition appear to varya • Perceived lack of seriousness of the condition or interest in the condition – participants not happy with their general practitioner either accepted this or sought care elsewhere (e.g. osteoporosis clinic, specialist)
• Not feeling heard
• Some participants requested a bone mineral density test and were denied getting the test or had to push for the test – in several cases, participants who pushed for the test reported compromised bone health on test results
• Some participants requested a referral to a specialist but were not given a referral
• Receiving bone health care sometimes attributed to luck (e.g. a medical student prompted the further investigation)
• Care related to bone health by a general practitioner vs. a specialist not always the same
• Both general practitioners and specialists did not appear to recommend non-pharmacological strategies to manage bone health, including supplements and exercise
Patients talk differently about compromised bone health vs. being at risk for future fracture • Health care providers need to articulate the importance of bone health as well as the importance of reducing one’s fracture risk
• Discussions about bone health differed from discussions about fracture risk
• Sometimes difficult to understand whether participants connected their previous fractures with bone health
• Some participants reported that the term “osteoporosis” was more frightening than being “high risk” for future fracture
• Participants reported that they should hear about bone health from within the medical system and not outside it (e.g. from Osteoporosis Canada)
Several factors appeared to influence participants’ perceptions of bone active medication • Some questioned whether the medication was working or not
• Reported belief that doing something is better than doing nothing
• Some participants expressed a desire or hope that they might be able to stop taking the medication in future
• A few participants refused to “do as told” because they did not like taking medication in general – this was not specific to bone active medication
• Age and the presence or absence of other health conditions appeared to influence one’s attitude to starting, or continuing to take, bone active medications
Participants appeared to have a favourable view of bone active medication • Most participants did not have an issue or complaint about the idea of starting, and/or taking, bone active medication prescribed
• There appeared to be a lot of participants who had switched bone active medications several times
• Participants were willing and interested in trying new medications as they became available
• Participants appeared to be very aware of new bone active medications on the market
• Participants switched medications due to experiencing side effects
• Participants appeared to be pro-medication to the point where their idea of “good” care was getting a prescription for the best medications on the market. This attitude seemed to persist despite individuals re-fracturing and/or experiencing side effects while taking the medication
Choice to take medication appeared to influence participants’ engagement in non-pharmacological strategies • How does taking medication influence participants’ perceptions of what else they can do with respect to managing bone health?
• Some participants perceived they had more of a role in their bone health if they chose not to take bone active medication prescribed
What is the relationship between the Theory of Planned Behaviour and pharmacological and non-pharmacological treatment?a • Initially, the Theory of Planned Behaviour did not appear to be very useful in explaining medication initiation and/or use
• Participants do not speak in the language of behaviour change models – the domains are difficult to match to participants’ language
• Difficult to separate non-pharmacological strategies for an in-depth analysis of the Theory of Planned Behaviour domains
• Difficult to code intentions retrospectively
What is the relationship between the Theory of Planned Behaviour and bone mineral density testing? • The domains of the Theory of Planned Behaviour do not appear to factor into participants’ decision to go for a bone mineral density test.
• Participants do not appear to have issues with going for a bone mineral density test – they do not appear to need to be convinced to go for the test
• Difficult to code intentions retrospectively
  1. aAnalytic direction pursued for further analysis and selected