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practices listed by the Dutch College of General Practitioners by email. Purposive sampling of group practices was performed based on geographical spread , on rural or urban area and on the employment of a GP specialized in urogynaecology. To be able to gain information from different levels of experience, we aimed to include a specialized GP in multiple focus groups and to organize one focus group exclusively with GPs in training. We continued to organize focus groups until data saturation was achieved, which was defined as no additional information was gathered during subsequent focus groups, followed by one additional focus group for confirmation of data saturation. Of the approximately 5.000 GP practices in the Netherlands, 29 were invited to participate in the study, based on the earlier-mentioned criteria. Only groups of collaborating GPs were invited, and focus groups took place in their own medical office. No incentives were provided for participation. We expected that the interaction and sharing of experiences in focus groups would generate more relevant information compared to individual interviews. The semi-structured approach allowed the participants to talk freely with structured guidance from the moderator, using a topic guide (supplementary material). The topic guide was based on the literature and experience of the authors (all female), working in the fields of reproductive medicine, primary care, qualitative research, and implementation research. It was a dynamic document, on which topics were added when new items were identified during the focus groups. All focus groups were directed by one experienced moderator (W.N.) with a backup for taking notes and process monitoring (M.Z.). The moderators were not personally or professionally related to the participants. The GPs signed an informed consent form before participating. Anonymity and confidentiality were ensured.
The focus groups were audio recorded and fully transcribed. The qualitative research software package ATLAS-ti (v7.1) was used to assist in data analysis. Grounded theory methodology was applied for data analysis, which was performed in tandem with the focus groups 11,12. A summary of the analysis process is shown in figure 1. Study reporting was based on the COREQ criteria 13. We have provided a quantification to indicate whether the results have been obtained from few (1-3), some (4-10), many (11-21) or most (22 or more) participants.
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