Abstract Background and Study Aims Multicomponent audit and feedback (A participation rates were tracked. Subsequently, endoscopists were invited to an interview to share their experience with the A&F initiative. Interviews were transcribed. Data were analyzed using directed and conventional content analyses. Results We identified 121 potentially lower-performing endoscopists among the 885 practicing in Ontario in 2015. Only 25 endoscopists (20.7%) participated in the A&F initiative. Eleven of 121 endoscopists completed the interview. Interviewees discussed 18 facilitators and 11 barriers to participation in the A&F initiative. Some interviewees took steps to improve their colonoscopy quality, changed documentation practices to improve the accuracy of future A&F reports, or adopted potentially inappropriate documentation or patient care practices to look better on future A&F reports. Conclusions The low participation rate, the range of drivers of endoscopist participation, and the intended and unintended effects identified suggest that A&F initiatives are complex interventions requiring careful design and evaluation.
Llovet et al. (2026) studied this question.