Exploration of barriers and facilitators to engaging with healthcare innovation

Background:Osteoarthritis is the most common type of arthritis and is currently one of the leading and increasing causes of disability worldwide, representing a major public health issue. Exercise programmes appear...

BackgroundVirtual patient-to-provider messaging systems such as text messaging have the potential to improve healthcare access; however, little research has used theory to understand the barriers and facilitators impacting uptake of these systems by patients and healthcare providers. This review uses the Capability-Opportunity-Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to explore barriers and facilitators of patient-to-provider messaging.MethodsA rapid umbrella review method was followed. Medline and CINAHL were searched for review articles that examined patient-to-provider implementation barriers and facilitators by patients or healthcare providers. Two coders extracted implementation barriers and facilitators, and one coder mapped these barriers and facilitators on to the COM-B and TDF.ResultsFifty-nine unique barriers and facilitators were extracted. Regarding healthcare provider oriented barriers and facilitators, the most frequently identified COM-B components included Reflective Motivation (identified in 42% of provider barriers and facilitators), Psychological Capability (19%) and Physical Opportunity (19%) and TDF domains included Beliefs about Consequences (identified in 28% of provider barriers and facilitators), Environmental Context and Resources (19%), and Social Influences (17%). Regarding patient oriented barriers and facilitators, the most frequently identified COM-B components included Reflective Motivation (identified in 55% of patient barriers and facilitators), Psychological Capability (16%), and Physical Opportunity (16%) and TDF domains included Beliefs about Consequences (identified in 30% of patient barriers and facilitators), Environmental Context and Resources (16%), and Beliefs about Capabilities (11%).ConclusionsBoth patients and healthcare providers experience barriers to implementing patient-to-provider messaging systems. By conducting a COM-B and TDF-based analysis of the implementation barriers and facilitators, this review highlights several theoretical domains for researchers, healthcare systems, and policy-makers to focus on when designing interventions that can effectively target these issues and enhance the impact and reach of virtual messaging systems in the future.

Varenicline is the most efficacious approved smoking cessation medication, making it one of the most cost-effective clinical interventions for reducing tobacco-related morbidity and mortality. Adhering to varenicline is strongly associated with smoking cessation. Healthbots have the potential to help people adhere to their medications by scaling up evidence-based behavioral interventions. In this protocol, we outline how we will follow the UK's Medical Research Council's guidance to codesign a theory-informed, evidence-based, and patient-centered healthbot to help people adhere to varenicline. The study will utilize the Discover, Design and Build, and Test framework and will include three phases: (a) a rapid review and interviews with 20 patients and 20 healthcare providers to understand barriers and facilitators to varenicline adherence (Discover phase); (b) Wizard of Oz test to design the healthbot and get a sense of the questions that chatbot has to be able to answer (Design phase); and (c) building, training, and beta-testing the healthbot (Building and Testing phases) where the Nonadoption, Abandonment, Scale-up, Spread, and Sustainability framework will be used to develop the healthbot using the simplest sensible solution, and 20 participants will beta test the healthbot. We will use the Capability, Opportunity, Motivation-Behavior (COM-B) model of behavior change and its associated framework, the Theoretical Domains Framework, to organize the findings. The present approach will enable us to systematically identify the most appropriate features for the healthbot based on a well-established behavioral theory, the latest scientific evidence, and end users' and healthcare providers' knowledge.

ABSTRACTAthlete adherence to nutritional guidance is critical for optimal health and performance, yet little is known about the barriers and enablers to athletes’ dietary behaviours within high-performance sport. To advance understanding, we applied a theoretical lens derived from the Capability, Opportunity, Motivation – Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to explore the qualitative accounts of sports nutritionists. Five focus groups comprising sports nutritionists working in Olympic and Paralympic sport (n = 14), professional sport (n = 6), or both (n = 6) were undertaken. Thematic analysis was conducted and the interpretations of the findings were guided by COM-B and the TDF. To achieve nutritional adherence, the behavioural analysis identified the need to intervene across all three COM-B components and at least five associated TDF domains (e.g., decision-making processes, reinforcement, social influences, behavioural regulation and environmental context and resource). For the first time, the findings illustrate the complex interplay of the training setting with the capabilities, opportunities, and motivation of the practitioners, athletes and coaches. By applying established behavioural science theories to sports nutrition, the foundations for the development of targeted and multifaceted behavioural interventions addressing athlete dietary adherence in high-performance sport have been laid.

BackgroundAlthough the use of patient-reported outcome measures (PROMs) in practice is increasing, successful implementation is contingent on engaging healthcare providers (HCPs). Using Implementation Science (IS), we present the content of two workshops hosted at the International Society for Quality-of-Life annual conferences for individuals seeking to implement PROMs collection and use in their settings. Our goals were to provide workshop participants with knowledge, tools, and resources to prepare HCPs for PROM adoption and to demonstrate tailored strategies to meet context-specific needs.MethodsAn interdisciplinary team with diverse expertise in PROMs implementation delivered two workshops guided by the Capability, Opportunity, Motivation – Behavior (COM-B) model and the Theoretical Domains Framework (TDF). Using dotmocracy, participants were asked to consider, for their local context, the factors most important for changing HCPs’ behaviors to adopt PROMs in daily practice.ResultsThe workshops incorporated IS theories, models, and frameworks (TMFs) to identify barriers faced by HCPs, support behavior change, and apply tailored theory-informed implementation strategies to prepare HCPs for PROM integration and evaluate adoption success. The factors rated the most important by workshop participants (n = 53) were woven into the discussions to illustrate the most common barriers encountered by HCPs adopting PROMs. Presenters drew on real-world practice and research experiences to identify promising implementation strategies, including education, training, behavioral modeling, persuasion, environmental restructuring, enablement, and audit and feedback to increase the capability, opportunity, and motivation of HCPs.ConclusionsGiven the increasing evidence base supporting the role of PROMs in patient-centered care, it is imperative to understand the mechanisms and best practices for increasing provider adoption of PROMs. This work offers a roadmap for understanding determinants more important to HCPs and systematically selecting theory-informed implementation strategies that may increase the likelihood of HCP adoption of PROMs. Offering tailored HCP training/education programs and implementation strategies can prepare HCPs for timely and effective PROM implementation.

Background:The Canadian 24-hour Movement Guidelines provide people in Canada with a framework to support balancing time for physical activity, sedentary behaviour, and sleep in their 24-hour day. Achieving balance can...

BackgroundRecent advances in the psychological understanding of health‐related behaviour have focused on producing a comprehensive framework to model such behaviour. The Capability‐Opportunity‐Motivation‐Behaviour (COM‐B) and its associated Theoretical Domains Framework (TDF) allow researchers to classify psychological and behavioural constructs in a consistent and transferable manner across studies.AimTo identify oral and dental health‐related studies that have used the TDF and/or COM‐B as frameworks to guide research and examine the ways in which these concepts have been practically used in such research.MethodNarrative review of published literature. To be included, the paper had to (1) state that the TDF or COM‐B had been used and to have targeted at least one construct identified in either framework, (2) include primary empirical data, (3) focus on a behaviour directly related to oral or dental‐related health (eg brushing, applying fluoride varnish, flossing) and/or attitudes, intentions and beliefs related to the behaviour. Studies could include any research design, and participants of any age or gender and include patients, parents or dental health professionals.FindingsNine studies were identified that had drawn on the COM‐B and/or TDF as the framework for their research. Seven of the studies were based on the TDF only, with one employing both the COM‐B and Health Belief Model, and one using the TDF with COM‐B. The nine studies covered a broad range of oral health‐related behaviours including child tooth brushing, fluoride varnish application and non‐ or micro‐invasive management of proximal caries lesions. The populations in the studies included dentists, dental teams and parents of children. All studies adopted only a subset of the constructs within the TDF, often without justification.ConclusionsIt is encouraging that oral health researchers are adopting standardized psychological frameworks to develop their research and oral health interventions. Future work should build on the small number of studies identified in this review and consider using standardized tools to do so.

A qualitative study of physical activity drivers in autistic individuals using COM-B. Autistic and non-autistic perspectives

Research questionWhat is the feasibility of an anti-inflammatory diet in women diagnosed with endometriosis? DesignQualitative study using semi-structured focus groups and individual interviews among patients with endometriosis. Transcripts of the focus groups and interviews were thematically analysed using ATLAS.ti 9. To identify and structure the ideas and views from the focus groups and interviews, two behavioural change models were used. The Capability Opportunity Motivation Behaviour (COM-B) model and domains of the Theoretical Domains Framework (TDF) helped to identify factors that make adherence to an anti-inflammatory diet more or less feasible for women with endometriosis. ResultsThe study population consisted of 23 patients with endometriosis. Numerous perceived barriers and facilitators were identified from all COM-B components and 13 out of 15 TDF domains. Knowledge and social influences were the most prominent TDF domains. Key barriers were eating with others; disbelief in a patients’ own capability regarding specific dietary guidelines; concerns about taste; lack of knowledge on how to follow the diet; lack of noticeable beneficial effect; and lack of intention to follow the diet to full extent. Key facilitators were receiving social support; general confidence in a participant's own capabilities; knowing how and why to follow the diet; noticing beneficial effect; and belief that the diet would alleviate symptoms. ConclusionProvision of knowledge, stimulating social support and enhancing self-efficacy should be emphasized. Overall, an anti-inflammatory diet in endometriosis patients, especially when identified barriers and facilitators are addressed in an intervention, is feasible.

BackgroundPressure ulcers are a major health concern. They have a significant impact on the healthcare system and individuals, reducing quality of life across several domains. In community settings, self-management behaviours are central to their prevention. However, adherence with pressure ulcer prevention guidelines remains low, with little evidence guiding the relationship between patients and healthcare professionals to establish a concordant partnership. ObjectiveTo synthesise evidence on factors contributing to community-based pressure ulcer prevention using the Theoretical Domains Framework and the Capability, Opportunity, Motivation, Behaviour (COM-B) model of behaviour. DesignMixed methods systematic review and narrative synthesis. MethodSystematic searches were conducted in the CINAHL, Cochrane, EMBASE, PsycINFO, PubMed, Scopus, and Web of Science databases on 14th December 2022. Studies were eligible if they contained data on the factors associated with adherence and concordance with pressure ulcer prevention guidelines in the community for patients, caregivers, and healthcare professionals. Methodological quality was assessed using the Hawker tool. Findings were synthesised using the Theoretical Domains Framework. The resulting themes were mapped onto the Capability, Opportunity, Motivation, Behaviour (COM-B) model. ResultsThirty studies were included in the review, including quantitative, qualitative, and mixed methods research. The synthesis identified 12 of the 14 Theoretical Domains Framework domains, with knowledge, social influences, beliefs about consequences, and beliefs about capabilities the most prevalent. Although knowledge appears to be an important contributor to adherence with prevention guidelines, knowledge alone does not appear sufficient to achieve concordance. A concordant relationship was facilitated by healthcare professionals' knowledge, motivation to work alongside patients and their priorities, and interpersonal skills to build rapport and trust, whilst barriers included lack of healthcare professional skills to navigate sensitive issues, paternalistic views of patient compliance and organisational processes that impact building rapport. ConclusionsSeveral psychosocial factors may affect the ability to achieve concordance between individuals, caregivers and healthcare professionals with pressure ulcer prevention guidelines in the community. However, data regarding the efficacy of behaviour change interventions targeting these constructs is limited, with further research required to guide intervention development in this area.

Eating disorders (EDs) are severe mental health conditions driven by psychological, social, and emotional factors and have the highest mortality rate of any psychiatric disorder. Although evidence-based, theory-driven behavior change interventions are the gold standard, access to treatment remains limited. Digital interventions, such as apps, may offer accessible support for individuals with mild to moderate EDs; however, their development has rarely been guided by systematic behavior change frameworks. Consequently, many interventions inadequately target the mechanisms underlying ED behaviors and commonly lack involvement of people with lived experience. This study aimed to identify priority behavioral change targets for ED apps by capturing lived experience perspectives on the psychological, behavioral, and contextual factors maintaining disordered eating and driving app engagement. Using the capability, opportunity, motivation-behavior (COM-B) and theoretical domains framework (TDF), we mapped these determinants to identify where and how apps can most effectively enhance capability, opportunity, and motivation. In total, 6 small focus groups (2-5 participants per group) were conducted with 13 female and 5 male adults, including minority ethnic backgrounds, living in the United Kingdom with lived experience of an ED. Discussions explored (1) the psychological, social, and environmental determinants underpinning participants' disordered eating behaviors and (2) the behavioral and contextual mechanisms influencing engagement with an ED app. A hybrid deductive-inductive thematic analysis was performed using the COM-B model and the TDF. Themes were mapped onto evidence-based behavior change techniques using the Theory and Techniques Tool. This study identified clear behavior change targets for digital ED interventions, identifying requirements in 5 of 6 (83%) COM-B domains and 13 of 14 (93%) associated TDF domains for changing maladaptive ED behaviors and 5 of 6 (83%) COM-B and 12 of 14 (86%) TDF domains for sustaining app engagement. Although social support and emotional regulation were key influences, less commonly targeted domains, such as social or professional role and identity and belief in capabilities, emerged as powerful drivers in this population. Crucially, it demonstrated that effectiveness depended not only on which behavior change techniques were included but also on how they were implemented, as poorly delivered techniques can undermine engagement and exacerbate symptoms. Sex and cultural background moderated almost every domain, highlighting the necessity of personalized, adaptive delivery and the inadequacy of one-size-fits-all approaches. As the first study to apply the COM-B and TDF frameworks to both disordered eating behaviors and app engagement, it identifies previously overlooked behavioral mechanisms and design pitfalls, including how poorly delivered techniques can undermine recovery. It provides a practical blueprint for developing safer, more personalized, and behaviorally effective ED apps. Significant work is needed to advance apps in line with these recommendations, supported by ongoing collaboration with diverse people with lived experience.

ObjectivesThis study aimed to establish a consensus on key factors that influence medication choices for Parkinson’s disease and to identify the behavioural determinants of these factors using behavioural change theory...

Perspectives of primary care providers on multidisciplinary collaboration to prevent medication-related falls

BackgroundRecurrences of low back pain (LBP) are frequent and associated with high levels of disability and medical costs. Regular exercise practice may be an effective strategy to prevent recurrences of LBP, however, the promotion of this behaviour by physiotherapists seems to be challenging. This study aims to explore physiotherapists’ perceived barriers and facilitators to the implementation of a behaviour change-informed exercise intervention to promote the adoption of regular exercise practice by patients at risk of recurrence of low back pain.MethodsTwo focus groups with primary healthcare physiotherapists were conducted, based on a semi-structured interview schedule informed by the Behaviour Change Wheel, including the Capability, Opportunity, Motivation–Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). All focus groups were held through videoconference, audio and video recorded and transcribed verbatim. A deductive content analysis, using a coding matrix based on the COM-B and TDF, was performed by two independent researchers. A third researcher was approached to settle disagreements.ResultsIn total, 14 physiotherapists participated in the focus groups. The analysis revealed a total of 13 barriers (4 COM-B components and 7 TDF domains) and 23 facilitators (5 COM-B and 13 TDF) to physiotherapists’ implementation of a behaviour change-informed exercise intervention. The most common barriers were the lack of skills and confidence to implement the proposed intervention. These were explained by the fact that it differs from the usual practice of most participants and requires the learning of new skills applied to their contexts. However, for those who had already implemented other similar interventions or whose rationale is aligned with the new intervention, there seemed to exist more positive determinants, such as potential benefits for physiotherapists and the profession, improvement of quality of care and willingness to change clinical practice. For others who did not previously succeed in implementing these types of interventions, more context-related barriers were mentioned, such as lack of time to implement the intervention, schedule incompatibilities and lack of material and human resources.ConclusionsThis study identified modifiable barriers and facilitators to physiotherapists’ implementation of a behaviour change-informed exercise intervention for patients at risk of recurrence of LBP in primary healthcare. The findings of this study will allow the systematic and theory-based development of a behaviour change-informed training programme, aimed at physiotherapists and supporting the successful implementation of the exercise intervention.

Background While goal setting with children and their families is considered best practice during rehabilitation following acquired brain injury, its successful implementation in an interdisciplinary team is not straightforward. This paper describes the application of a theoretical framework to understand factors influencing goal setting with children and their families in a large interdisciplinary rehabilitation team. Methods A semi-structured focus group was conducted with rehabilitation clinicians and those with lived experience of paediatric acquired brain injury (ABI). The 90-min focus group was audio-recorded and transcribed verbatim. Data were thematically coded and mapped against the Theoretical Domains Framework (TDF) to understand influencing factors, which were then linked to the Capability, Opportunity, Motivation - Behaviour (COM-B) model. Results A total of 11 participants (nine paediatric rehabilitation clinicians, one parent and one young person with lived experience of paediatric ABI) participated in the focus group. Factors influencing collaborative goal setting mapped to the COM-B and six domains of the TDF: Capabilities (Skills, Knowledge, Beliefs about capabilities, and Behavioural regulation), Opportunities (Environmental context and resources), and Motivation (Social/professional role and identity). Results suggest that a multifaceted intervention is needed to enhance rehabilitation clinicians' and families' skills and knowledge of goal setting, restructure the goal communication processes, and clarify the roles clinicians play in goal setting within the interdisciplinary team. Conclusion The use of the TDF and COM-B enabled a systematic approach to understanding the factors influencing goal setting for children with acquired brain injury in a large interdisciplinary rehabilitation team, and develop a targeted, multifaceted intervention for clinical use. These represent important considerations for the improvement of collaborative goal setting in paediatric rehabilitation services to ensure that best practice approaches to goal setting are implemented effectively in clinical practice.