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This study involved three sequential phases with primary care clinicians: a qualitative descriptive study, clinician consultation engagement workshops and a think-aloud interview study. Ethical approval was obtained for all three phases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixteen primary care clinicians participated in semistructured interviews to identify barriers and facilitators. An initial list of nine candidate components for the intervention, including design considerations, was developed. During phase 2 workshops with eight participants, four components were prioritised as \u2018Must have\u2019 or \u2018Should have\u2019: the clinical decision support system (CDSS); guidance on using the CDSS\/associated actions; evidence for the CDSS; patient education resources. A COBRA tool prototype incorporating these components was developed.<\/jats:p>\n                    <jats:p>Twelve participants tested the prototype during think-aloud interviews. Key perceived benefits of the COBRA tool included supporting clinicians\u2019 decision-making and reducing unnecessary anti-CCP testing. Over 40 changes were made to the COBRA tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our research included the views of clinicians and PPI representatives and was underpinned by a complex intervention research framework. This was critical to understanding barriers and facilitators to implementing the clinical prediction model in primary care and developing the COBRA tool.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-005957","type":"journal-article","created":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T19:25:15Z","timestamp":1771183515000},"page":"e005957","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Development of the \u2018COuld it Be RA\u2019 (COBRA) tool to facilitate early identification of people at risk of developing rheumatoid arthritis in primary care"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6015-332X","authenticated-orcid":false,"given":"Heidi J","family":"Siddle","sequence":"first","affiliation":[{"name":"Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK"},{"name":"Podiatry Department, Leeds Teaching 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