Table 4 Factors restricting participation in the e-learning program

Lack of time / time required

Poor match between the duration of the training and learners’ time constraints

“Time is the real sticker these days. It’s very difficult in today’s home support system. We’re overloaded, we have interviews with patients to conduct using CDSSs (computerized clinical decision support systems) that last hours, we’re under enormous pressure, and we don’t have time to stop.” (Occupational therapist #45, home support service #2)

Unfavorable period (note from author: training ran from February to May 2018)

“With the whirlwind of life, with the daily routine of my tasks as a family doctor, to do this in excess, at midnight or 1 am, it is not possible, at least not at that time, with all my tasks.” (Physician #55, Clinic #1)

No time slot dedicated to the training activities

“If you look at our work situation, of course it’s not always easy to take the time to stop and do it. The barriers we face are that we have many other tasks to do. I’m too busy to start wearing several hats at a time, so the barriers aren’t the training itself; it’s the fact it takes time, and that you have to make that time.” (Physician #73, Clinic #2)

Prioritization of clinical, family, or administrative activities limiting the time available for training

“I often work until midnight, and it’s not for additional training … So, training comes after all the other priorities.” (Physician #55, Clinic #1)

Time required to take ownership of the tool may be longer for those professionals lacking experience in the topic

“Of course, taking ownership of the tool also takes time.” (Physiotherapist #46, home support service #2)

Inconvenience of training components

Training fragmented into e-learning activity and evidence summaries makes it difficult to follow; multiple stages

“I think I would have preferred to do it all at once.” (Social worker #50, home support service #2)

DB content not well adapted to some professional fields of practice (e.g., dieticians)

“The Decision Boxes are certainly interesting, but they don’t apply to every situation. There weren’t any in my area of practice. So for me, it’s a bit less motivating. I don’t think I’ll be using any of the Decision Boxes that have been mentioned to date.” (Dietician #9, home support service #1)

Lack of information on how to use the DBs

“I gave all the information verbally. I didn’t know you could hand the DBs over to the patients. I only used the DBs designed for the clinicians and I didn’t have the reflex to use those designed for the patients.” (Nurse #26, Clinic #4)

Technical / logistical barriers

The audio can be a disturbance for co-workers in a shared office

“We share our offices. I don’t have headphones, so the training has to be done at precise times, so as not to disturb my colleagues. It could be harder to find the right time, but it’s really just a very minor point.” (Occupational therapist #29, home support service #3)

Issues finding where the learner left off in the event of pausing

“I thought that when we paused the training and came back to it later, we could just pick up where we left off. But that’s not what happened. Every time I came back to it, I had to enter the exact place I’d left off and keep clicking on “Forward” until I got back to the right spot. So that was a bit complicated, because sometimes I couldn’t remember where I’d got to.” (Dietician #9, home support service #1)

Issues with Internet

“As far as I’m concerned, I have a lot of trouble with things on the Internet. I’m the type to be more face-to-face.” (Dietician #9, home support service #1)

DB not optimized for viewing on smartphones

“I don’t have a computer at home, so I did it on my cellphone, and it wasn’t easy to do.” (Social worker #50, home support service #2)

Social barriers

No discussion to reflect on lessons with peers

“In my workplace, I was the only one doing it. It would have been good to have colleagues doing it at the same time so we could discuss it.” (Occupational therapist #29, home support service #3)

Negative influence of colleagues who did not complete the training program

“I suspect I’m not the only one at the clinic who didn’t have time to complete the online training because we have a lot of reading to do, forms to fill out, a family life when we can, so adding this on top.” (Physician #55, Clinic #1)

Lack of formal recognition of training by the employer

“It would have been good to receive more official recognition from the employer.” (Physiotherapist #46, home support service #2)

Evidence summaries unknown to/not popular with colleagues

“There is a lack of awareness that there are decision-making tools. They should be promoted even more.” (Physiotherapist #46, home support service #2)

Difficulty in using DBs

Costs associated with printing the DBs

“The printouts, especially the colour ones, which are more attractive, can generate costs, especially if you need them for the patients and their families as well.” (Physician #73, Clinic #2)

Preparation required before using them during consultation (access, printing, etc.)

“It takes a lot of steps to go find the link to access the tool, to go on the internet, to then be able to print it. It is a good tool, but it would be good to have it at your fingertips so it can be used. And since I didn’t have it at my fingertips ...” (Physician #73, Clinic #2)

Some figures in the DBs difficult to interpret and less relevant

“There are, for example, times when the percentages are not easy to interpret or apply. There are some that are relatively easy, like indoor gardening. As advantages, we see that agitation decreases for 64% of seniors: it is relatively easy. But for others, it is sometimes less obvious. We understand that the therapeutic touch decreases restlessness in 28–54% of cases. We understand that it can reduce agitation, but I don’t think I will use these figures, I will use the averages more.” (Social worker #20, home support service #1)

DBs not available for all patients

“When we’re at the clinic with patients, there are often a number of priorities to be addressed. It’s rare that there’s only one reason for consulting, and that that reason happens to be one of the ones addressed in the Decision Boxes.” (Physician #73, Clinic #2)

Other tools already handed out to patients; DBs not yet incorporated into regular practice and can be cumbersome

“We give out lots of advice and we hand out all kinds of stuff, plenty of documents. We haven’t gotten around to giving out additional tools. It just hasn’t been part of our practice so far.” (Occupational therapist #45, home support service#2)