The use of the Capability-Opportunity- Motivation Behavior (COM-B) model to identify barriers to medication adherence and the application of mobile health technology in adults with coronary heart disease: A qualitative study

Abstract

ObjectiveAmong patients with coronary heart disease, we sought to address the research questions of: 1) What is the acceptability of applying a technology-enabled approach to support medication adherence?; and 2) What are barriers to medication adherence using the Capability-Opportunity-Motivation Behavior (COM-B) model as a guiding framework? MethodsApplying qualitative research methods, we employed a series of 3 focus groups per individual (total 9 sessions). Coded data from thematic analysis were mapped to the COM-B model components for meaningful associations. ResultsFourteen participants were recruited (median age 69.5 ± 11, 50% female). Barriers to medication adherence were organized along these COM-B domains: psychological capability (forgetfulness, distractions, fear of side effects), physical opportunity (inaccessible medications, inability to renew prescriptions), reflective (burdening family members), and automatic motivation (medication fatigue, health decline). ConclusionsTailored text messaging and mobile phone apps were perceived as helpful tools for medication adherence. The COM-B model was useful to provide a comprehensive, theory-driven evaluation of patients' beliefs and motivations on whether to engage in medication adherence. InnovationTo date, text messaging and mobile applications have not been widely implemented in the clinical setting and provide a major opportunity to innovate on approaches to address medication adherence.