Capability, Opportunity, Motivation And Behaviour Research Articles

Barriers and enablers to a healthy lifestyle in people with infertility: a mixed-methods systematic review.

While there is a recognized role of optimizing lifestyle (diet and physical activity) behaviours in the management of infertility, the best practice remains unknown and factors influencing the lifestyle of people with infertility are not well understood. This systematic review evaluated barriers and enablers to a healthy lifestyle in people with infertility, from the perspectives of people with infertility and health professionals, in order to inform optimal behavioural change strategies. Ovid MEDLINE(R), PsycINFO, EMBASE, EBM Reviews, and CINAHL were searched from inception to 28 August 2023. Eligible studies were qualitative and quantitative primary studies that explored barriers and/or enablers to lifestyle for infertility management. Quality assessment was performed using the Centre for Evidence-Based Management Critical Appraisal of a Survey Tool and the Critical Appraisal Skills Programme Qualitative Checklist. Data were analysed by thematic analysis with themes mapped to the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domains Framework (TDF). After screening 12326 abstracts and 99 full-texts, 27 studies were included (12 quantitative, 6 qualitative and 9 mixed-methods) with 22 studies of women with infertility (n = 2524), 11 studies of men with infertility (n = 1407), and 6 studies of health professionals (n = 372). We identified barriers and enablers relating to capability (e.g. strategies for behaviour change), opportunity (e.g. limited time, resources, and money), and motivation (e.g. interplay between lifestyle and emotional state). Based on the identified themes, suggested intervention components to integrate into lifestyle management of infertility include facilitating development of self-management skills to support lifestyle change (e.g. self-monitoring, action planning, and goal setting) and incorporating mental health strategies (e.g. providing information about the benefits of healthy lifestyle behaviours for mental health and encouraging patients to reframe healthy lifestyle behaviours as self-care strategies). The findings have identified important factors that influence lifestyle management in people with infertility and have suggested relevant intervention components to consider when designing interventions. Given the paucity of qualitative studies identified, more research is needed to further understand the complex and interacting factors that shape lifestyle during the fertility journey.

Self-care ability and associated factors in community-dwelling older adults living with oral frailty using the COM-B model.

Self-care can improve overall oral health. However, few studies have investigated this in community-dwelling older adults with oral frailty. The Capability, Opportunity, Motivation and Behaviour (COM-B) model may be an appropriate framework to identify factors that affect self-care ability. The purpose of this study was to investigate the current status of and factors influencing self-care ability in community-dwelling older adults living with oral frailty, and to analyse the risk factors of low self-care ability. Two hundred seventy-five community-dwelling older adults with oral frailty participated in this cross-sectional study from October 2022 to March 2023. Participants underwent evaluations of oral health knowledge and behaviour, oral health literacy, nutritional condition, social support, oral health-related quality of life, self-efficacy and self-care ability using questionnaires. The self-care ability of older adults was assessed using the Chinese version of self-care ability scale for the elderly (SASE). The influencing factors were evaluated by single-factor analysis, correlation analysis and multi-factor analysis. Furthermore, we conducted additional analysis, wherein self-care ability was analysed as a categorical variable. Of the participants, the SASE score was 62.43 ± 7.33, and 73.09% were inadequate at self-care ability. There was a positive correlation between the level of self-care ability and each variable (p < .001). Multiple linear regression showed that health literacy (p < .001), age (p < .001), nutritional condition (p = .001), gender (p = .003), quality of life (p = .014) and self-efficacy (p = .040) were significantly associated with decreased self-care ability (R2 = 0.444, F = 19.241). Binomial logistic regression analysis showed that gender, educational level, nutritional condition, oral health literacy and quality of life (all P<0.05) were risk factors for developing low levels of self-care ability. This study suggests that health literacy, age, nutritional condition, quality of life, gender and self-efficacy are important factors that influence self-care ability in community-dwelling older adults living with oral frailty.

Barriers and enablers to a healthy lifestyle in people with infertility: a mixed-methods systematic review

While there is a recognised role of optimising lifestyle behaviours such as diet and physical activity in the management of infertility, the best practice for lifestyle management of infertility remains unknown, and factors influencing the lifestyle behaviours of people with infertility are not well understood. The aim of this systematic review is to evaluate the barriers and enablers to a healthy lifestyle in people with infertility, from the perspectives of people with infertility and health professionals, in order to inform optimal behavioural change strategies for lifestyle management of infertility. Ovid MEDLINE(R), PsycINFO, EMBASE, EBM Reviews, and CINAHL Plus were searched from inception to 12th September 2022. Eligible studies were qualitative, quantitative or mixed-methods primary studies which explored barriers and/or enablers to lifestyle for infertility management, from the perspectives of people with infertility and/or health professionals. Two independent reviewers performed quality assessment, using the Centre for Evidence-Based Management Critical Appraisal of a Survey Tool (quantitative and mixed-methods studies) and the Critical Appraisal Skills Programme Qualitative Checklist (qualitative and mixed-methods studies). Data were analysed by inductive thematic analysis with themes mapped to the Capability, Opportunity, Motivation and Behaviour (COM-B) model(1) and Theoretical Domains Framework (TDF)(2). Relevant behaviour change techniques (BCTs)(3) to target the identified enablers and barriers were suggested. After screening 10703 citations and 82 full-texts, 22 studies were included (12 quantitative, 7 mixed-methods and 3 qualitative) with 18 studies including women with infertility (n = 2442), 10 including men with infertility (n = 1372) and 6 including health professionals (n = 261). From the perspectives of people with infertility, themes related to capability (e.g. strategies for behaviour change), opportunity (e.g. limited time, resources and money) and motivation (e.g. interplay between lifestyle and emotional state); themes mapped to 8 TDF domains. From the perspectives of health professionals, themes related to capability (e.g. identification of patients appropriate for lifestyle intervention), opportunity (e.g. mode of delivery) and motivation (e.g. professional responsibility); themes mapped to 6 TDF domains. 34 BCTs were identified across the suggested interventions. This systematic review found that several interacting factors influence lifestyle in people with infertility as well as health professional behaviour with regards to provision of lifestyle interventions for infertility. These factors can be targeted for optimisation of interventions. In light of the limited number of qualitative studies, there is a need for more qualitative research to gain deeper insights into the perspectives of people with infertility and health professionals for further exploration of the complex and interacting factors which shape lifestyle during the fertility journey.

Co-Design of a Reusable Learning Object (RLO) to Address Caregiver Responsive Infant Feeding Behaviours (CRIB) to Prevent Childhood Obesity: A Mixed-Method Protocol.

Responsive infant feeding is a key strategy for childhood obesity prevention. Responsive feeding involves caregivers responding to infant hunger and satiety cues in a timely and developmentally appropriate manner. There is a dearth of evidence-based information and guidance for caregivers on how to responsively feed their infants. The aim of this research is to co-design a Reusable Learning Object (RLO) and guidance infographic to improve caregiver awareness, understanding and use of responsive infant feeding behaviours. The Capability, Opportunity, Motivation and Behaviour (COM-B) model of behaviour change and the Aim, Storyboarding, Populate specification, Implement media, Review and release prototype, and Evaluate (ASPIRE) approach for digital intervention co-design will be utilised. Four co-design workshops with caregivers of infants and healthcare professionals (HCPs) will determine priority RLO content. Content analysis will enable RLO development and process reporting. Formative and summative surveys will be conducted to evaluate the usability of the RLO, its impact on caregivers and its potential implementation into NHS care pathways. The output will be a RLO on responsive feeding for caregivers and an infographic for HCPs/support workers which will contribute to a future obesity prevention intervention. The findings will be disseminated to stakeholders and submitted for publication in a peer-reviewed journal.

IMP2ART: development of a multi-level programme theory integrating the COM-B model and the iPARIHS framework, to enhance implementation of supported self-management of asthma in primary care

BackgroundSupported asthma self-management, incorporating an asthma action plan and annual clinical review, has been recommended by UK/global guidelines for over three decades. However, implementation remains poor, as only around a third of individuals receive basic asthma care, according to the UKs leading respiratory charity Asthma and Lung UK. A systematic review of implementation studies recommended that a whole systems approach targeting patients, healthcare professional education, and organisations is needed to improve implementation of supported asthma self-management in primary care. The IMPlementing IMProved Asthma self-management as RouTine (IMP2ART) is a national Hybrid-II implementation cluster randomised controlled trial that aims to evaluate such an approach. This paper describes the development of the implementation strategy for IMP2ART with particular focus on the integration of multiple level theories.MethodsThe Medical Research Council design and evaluation of complex interventions framework and the Person-Based Approach to intervention development were used as guidance for stages of strategy development. Specifically, we (i) set up a multidisciplinary team (including practicing and academic clinicians, health psychologists, public health and patient colleagues), (ii) reviewed and integrated evidence and theory, (iii) developed guiding principles, (iv) developed prototype materials, and (v) conducted a pre-pilot study before final refinement.ResultsThe implementation strategy included resources for patients, team-based and individual healthcare professional education, practice audit and feedback, and an asthma review template, as well as a facilitator role accessible to primary care practices for 12 months. The synthesis of the integrated Promoting Action on Research Implementation in Health Services (iPARIHS) and Capability, Opportunity, Motivation and Behaviour (COM-B) frameworks led to an evolved framework bringing together important implementation and behaviour change elements which will be used as a basis for the study process evaluation.ConclusionsA description of rigorous implementation strategy development for the IMP2ART study is provided along with newly theorised integration of implementation and behaviour change science which may be of benefit to others targeting implementation in primary care.Trial registrationISRCTN15448074. Registered on 2nd December 2019.

S9-4 Retirement as the starting point of active ageing? A mixed-methods study to identify barriers and facilitators of physical activity when retiring

Abstract Purpose The transition from work to retirement implies changes in daily activities and might constitute an opportunity to increase physical activity (PA). While qualitative studies reported that retirees mainly perceived increases in PA during this life transition, quantitative studies observed decreases in total PA. Moreover, changes in total PA seem to depend on socio-economic status, with mostly lower socio-economic groups decreasing their total PA. Therefore, the goal of this study is (1) to investigate subjective changes in PA during the retirement transition and the perceived determinants of these changes, including barriers and facilitators to increasing or maintaining PA; (2) to link this subjective information to device-based measurements of PA. Methods This study is part of a mixed-methods study with a parallel structure using quantitative and qualitative methods. In the quantitative, longitudinal part of this study (n = 93), PA is measured with accelerometers prior to retirement, and at three, six and twelve months post-retirement. In addition, one-on-one, semi-structured interviews are being conducted with a subsample six months after retirement (n = 30, stratified on gender and education, randomly selected from the total sample). Thematic analysis is used to analyse the interview data with an inductive approach. The emerged themes will be mapped on the COM-B (Capability, Opportunity, Motivation and Behaviour) and TDF (Theoretical Domains Framework) models. Results The data collection is ongoing and more than half of the interviews have been conducted. Based on preliminary analyses of the first 10 interviews, it seems that most participants perceive to have more PA post-retirement, and that time is a main facilitator. Those participants who report having become less physically active were never interested in PA and/or did not value it. Moreover, some participants report having other competing activities, including grandchild-care or sedentary leisure activities. Further analyses will provide more specific conclusions and link qualitative and quantitative results. Conclusions The experience of retiring is highly individual and interventions should be personalized to specific target groups. This study will provide useful information on potential keys to develop effective lifestyle interventions for adults during or near the retirement transition.

A qualitative study assessing the barriers and facilitators to physical activity in adults with hearing loss.

Growing epidemiological evidence has shown hearing loss is associated with physical inactivity. Currently, there is a dearth in evidence investigating why this occurs. This study aimed to investigate the barriers and facilitators to physical activity in middle-aged and older adults with hearing loss. Individual semi-structured qualitative interviews. A phenomenological approach was taken. Ten adults (≥40 years) were interviewed via videoconferencing. The interview schedule was underpinned by the capability, opportunity, motivation and behaviour (COM-B) model. Reflexive thematic analysis was used to generate themes, which were subsequently mapped onto the COM-B model and behaviour change wheel. Nine hearing loss specific themes were generated, which included the following barriers to physical activity: mental fatigue, interaction with the environment (acoustically challenging environments, difficulties with hearing aids when physically active) and social interactions (perceived stigma). Environmental modifications (digital capabilities of hearing aids), social support (hearing loss-only groups) and hearing loss self-efficacy were reported to facilitate physical activity. Middle-aged and older adults with hearing loss experience hearing-specific barriers to physical activity, which has a deleterious impact on their overall health and well-being. Interventions and public health programmes need to be tailored to account for these additional barriers. Further research is necessary to test potential behaviour change techniques.

Initial insights into the impact and implementation of Creating Active Schools in Bradford, UK

BackgroundFew whole-school physical activity programmes integrate implementation science frameworks within the design, delivery, and evaluation. As a result, knowledge of the key factors that support implementation at scale is lacking. The Creating Active Schools (CAS) programme was co-designed and is underpinned by the Capability, Opportunity, Motivation and Behaviour (COM-B) model and the Consolidated Framework for Implementation Research (CFIR). The study aims to understand the initial impact and implementation of CAS in Bradford over 9 months using McKay’s et al.’s (2019) implementation evaluation roadmap.MethodsFocus groups and interviews were conducted with school staff (n = 30, schools = 25), CAS Champions (n = 9), and the CAS strategic lead (n = 1). Qualitative data were analysed both inductively and deductively. The deductive analysis involved coding data into a priori themes based on McKay et al’s implementation evaluation roadmap, using a codebook approach to thematic analysis. The inductive analysis included producing initial codes and reviewing themes before finalising.ResultsIdentified themes aligned into three categories: (i) key ingredients for successful adoption and implementation of CAS, (ii) CAS implementation: challenges and solutions, and (iv) the perceived effectiveness of CAS at the school level. This included the willingness of schools to adopt and implement whole-school approaches when they are perceived as high quality and aligned with current school values. The programme implementation processes were seen as supportive; schools identified and valued the step-change approach to implementing CAS long-term. Formal and informal communities of practice provided “safe spaces” for cross-school support. Conversely, challenges persisted with gaining broader reach within schools, school staff’s self-competence and shifting school culture around physical activity. This resulted in varied uptake between and within schools.ConclusionsThis study provides novel insights into the implementation of CAS, with outcomes aligning to the adoption, reach, and sustainability. Successful implementation of CAS was underpinned by determinants including acceptability, intervention complexity, school culture and school stakeholders’ perceived self-efficacy. The combination of McKay’s evaluation roadmap and CFIR establishes a rigorous approach for evaluating activity promotion programmes underpinned by behavioural and implementation science. Resultantly this study offers originality and progression in understanding the implementation and effectiveness of whole-school approaches to physical activity.

Barriers and enablers to implementing intranasal ketamine for Primary Care Paramedics in Canada – A parallel convergent mixed methods study

Introduction British Columbia Emergency Health Service trialled the use of intranasal (IN) ketamine given by Primary Care Paramedics (PCPs). Prior to this practice change, the PCPs had not performed weight-based drug calculations, given medications intranasally, nor been responsible for controlled and targeted substances. This study aimed to use the Capability, Opportunity, Motivation and Behaviour (COM-B) model and Theoretical Domain Framework (TDF) to identify enablers and barriers to implementing IN paramedic administered ketamine analgesia (iPAKA) for PCPs. Methods This was a parallel convergent mixed methods study with two phases. The quantitative phase consisted of longitudinal staff surveys to assess PCP knowledge and perceptions of ketamine and controlled and targeted substances policies. The qualitative phase involved staff focus groups on programme implementation. Descriptive statistics of survey results were integrated with coded focus group data and analysed using the COM-B model and TDF. Evidence-based behavioural change techniques were mapped to each TDF domain. Findings Our analysis revealed barriers and enablers across several TDF domains. Implementing ketamine was enabled by quality education, strong organisational support and the availability of cognitive aides. Trial success was attributed in part to participant's feelings of optimism and their increased job satisfaction. Key barriers included a knowledge gap involving drug dosage calculations, negative emotions associated with performance anxiety and a lack of field education and supervision to monitor paramedic practice. Conclusion The use of theoretical frameworks and models like COM-B/TDF serves to improve the sustainable implementation of behaviour and clinical practice change in paramedicine. When project teams use theory to guide design and implementation, they can systematically identify and target individual and organisational enablers and barriers to adopting routine practices. The iPAKA study reveals key barriers and facilitators in several TDF domains and presents theory-linked targeted behavioural techniques to support on-going implementation of PCP-administered IN ketamine for analgesia.

Sexual Rehabilitation After a Stroke: A Multi-site Qualitative Study About Influencing Factors and Strategies to Improve Services.

This study aimed to better understand the factors influencing the provision of sexuality-related post-stroke rehabilitation services by clinicians on different sites and to explore strategies to improve post-stroke rehabilitation services with stakeholders. A qualitative study with co-design methods was conducted with 20 clinicians from five post-stroke rehabilitation centers in Canada, 1 manager and 1 patient-partner. Participants either took part in a focus group or in sessions of an adapted version of the LEGO Serious Play method to explore influencing factors and strategies of improvement in relation to post-stroke sexual rehabilitation services. Thematic analysis was conducted semi-deductively using the Theoretical Domains Framework (TDF), the Capability, Opportunity, Motivation and Behaviour (COM-B) system and the Behaviour Change Wheel (BCW). A total of twenty factors pertaining either to the categories of Capability (n = 8; e.g., Sexual rehabilitation procedural knowledge), Motivation (n = 4; e.g., Professional boundaries) or Opportunity (n = 8; e.g., Workload) were perceived as influencing provision of sexual rehabilitation services by participants. A theoretical model was conceptualized. Strategies (n = 10) were categorized in concordance with the BCW as Training (n = 1), Enablement (n = 5) or Environmental restructuring (n = 4). This study showed that factors influencing provision of post-stroke rehabilitation services were numerous and interrelated, and that various strategies aiming either clinicians or the rehabilitation environment would be relevant to improve services. This study will help guide the design and implementation of future interventions studies aiming at improving post-stroke sexual rehabilitation services.

The promotion of homebased physical activity for people with lung cancer and cachexia, a qualitative study of healthcare professionals, patients and carers

PurposeThere is some evidence of the benefits of physical activity (PA) in patients with lung cancer; however, there is a lack of understanding of acceptable PA for patients with established cachexia and how to facilitate sustainable behaviour change to promote PA. Therefore, this study explored the views of healthcare professionals (HP), patients with lung cancer and cachexia, and their carers on preferences for, barriers and facilitators of homebased PA.MethodsThis qualitative study involved ten telephone interviews with HPs and face-to-face interviews with seven patients with lung cancer and cachexia and their carers. Interviews were transcribed and analysed thematically. The Capability, Opportunity, Motivation and Behaviour (COM-B) model was used as a framework for the thematic cross-group analysis.ResultsThe types of homebased PA suggested by patients with lung cancer and cachexia (n = 7), their carers (n = 7) and HPs (n = 10) were functional, flexible, individualised and initially of short duration and low intensity. PA was influenced by themes within physical and psychological Capability, physical and social Opportunities as well as automatic and reflective Motivation.ConclusionBased on a behaviour change theory, principles to promote homebased PA were developed. These principles need to be integrated into tools to promote PA in people with lung cancer and weight loss.Implications for Cancer SurvivorsThe application of the proposed principles by clinicians will promote physical activity, enhancing the function and wellbeing of patients with lung cancer and reducing burden on carers.

Identification of factors influencing core competence promotion among professional nurses and midwives: A qualitative study using the COM-B model

AimTo identify factors influencing a behaviour of improving core competencies among nurses and midwives in the Maternity and Child Health Care Hospital using the capability, opportunity, motivation and behaviour (COM-B) model. BackgroundWith the increasing number of women with pregnancy complications and the COVID-19 pandemic, nurses and midwives are being challenged and enhancing their core competencies is imperative to ensure high-quality care. To develop effective intervention strategies, it is essential to systematically explore what influences nurses and midwives to improve their core competencies. To this end, this study applied the COM-B model of behavioural change. DesignQualitative study using the COM-B model. MethodsThis qualitative descriptive study was conducted in 2022 using face-to-face interviews, including 49 nurses and midwives. Topic guides for the interviews were developed based on the COM-B model. Transcribed verbatim interviews were analysed using deductive thematic analysis. ResultsThe COM-B model captures several factors. Capability factors included clinical knowledge and self-directed learning abilities. Opportunity factors included professional education covering necessary clinical skills, adequate clinical practice, personalised training, available time, insufficient clinical learning resources, absence of scientific research resources and support from leadership. Motivational factors were access to long-term work, incentive policies based on individuals’ work values and responses to upward social comparison. ConclusionsThe findings of this study suggested that prior to developing intervention strategies to enhance the core competencies of nurses and midwives, processing barriers to nurses’ and midwives’ capabilities, opportunities and motivation can facilitate the implementation of interventions.

Identifying barriers and facilitators to deprescribing benzodiazepines and sedative hypnotics in the hospital setting using the Theoretical Domains Framework and the Capability, Opportunity, Motivation and Behaviour (COM-B) Model: a qualitative study

ObjectivesGeriatric guidelines strongly recommend avoiding benzodiazepines and non-benzodiazepine sedative hypnotics in older adults. Hospitalisation may provide an important opportunity to begin the process of deprescribing these medications, particularly as new...

Barriers and enablers of weight management after breast cancer: a thematic analysis of free text survey responses using the COM-B model

BackgroundWeight gain is common after breast cancer. The aim of this study was to identify and describe the barriers to and enablers of successful weight management for women with breast cancer.MethodsThis was a combined inductive and deductive framework analysis of free text responses to an anonymous cross-sectional survey on weight after breast cancer. Women were recruited mainly through the Breast Cancer Network Australia Review and Survey Group. We applied deductive thematic analysis to free text responses to questions on barriers, enablers, research priorities, and one open-ended question at the end of the survey using the Capability, Opportunity, Motivation and Behaviour (COM-B) model as a framework. Subthemes that arose from the inductive analysis were mapped onto the COM-B model framework. Findings were used to identify behaviour change intervention functions.ResultsOne hundred thirty-three women provided free text responses. Most women were of Caucasian origin and had been diagnosed with non-metastatic breast cancer, with a mean age of 59.1 years. Women's physical capability to adopt and sustain healthy lifestyle habits was significantly affected by treatment effects and physical illness, and some lacked psychological capability to self-regulate the face of stress and other triggers. Limited time and finances, and the social impact of undergoing cancer treatment affected the ability to control their diet. Frustration and futility around weight management were prominent. However, some women were confident in their abilities to self-regulate and self-monitor lifestyle behaviours, described support from friends and health professionals as enablers, and welcomed the physical and psychological benefits of being active in the context of embracing transformation and self-care after cancer.ConclusionWomen need specific advice and support from peers, friends and families and health professionals. There is a substantial gap in provision of supportive care to enable women to adopt and sustain healthy lifestyles. Environmental restructuring (including financial support), incentivization (creating an expectation of looking and feeling better), persuasion and coercion (aiming to prevent recurrence), and equipping women with specific knowledge and skills, would also facilitate optimal lifestyle behaviours and weight management.

Impact of COVID-19 on digital practice in UK paediatric speech and language therapy and implications for the future: A national survey.

BackgroundThe COVID‐19 pandemic and subsequent measures to reduce transmission risk has led to unprecedented digital transformation across health, education and social care services. This includes UK paediatric speech and language therapy (SLT), which sits at the crossroads of these services. Given the rapid onset of this pandemic‐induced digital transition, there is now a need to capture, reflect and learn from the SLT profession so that benefits can be sustained, and barriers addressed.AimsTo survey the impact of COVID‐19 remote working on UK paediatric SLTs’ digital views and experiences using the Capability, Opportunity, Motivation and Behaviour (COM‐B) model.Methods & ProceduresAn online survey was conducted from May to October 2020. Respondents were asked to rate their use of technology in service delivery before and during the pandemic, to select factors facilitating digital practice, and to provide open‐response aspirations for the future role of technology in paediatric SLT which were analysed thematically using the COM‐B behaviour change model.Outcomes & ResultsA total of 424 UK paediatric SLTs responded to the survey. Findings indicate a marked increase in clinicians’ perception of their frequency, convenience and confidence with digital practice during COVID‐19 compared with before the pandemic. Respondents identified that specialist training (27%), funding for workplace devices (22%) and supportive leadership (19%) were most likely to facilitate sustained digital practice. Clinicians hoped for a blended approach going forward with technology enhancing existing best practice. Further prominent themes included digital accessibility for all and maintaining the increased opportunity for multidisciplinary working that videoconferencing has afforded. More service‐specific aspirations were bespoke technological solutions as well as parents/carers being able to engage remotely with school‐based provisions.Conclusions & ImplicationsDuring COVID‐19, paediatric SLTs’ recognition and acceptance of how technology can augment practice has accelerated, with particular value being placed on inclusivity, choice, training, resources, leadership and indication of effectiveness. These are important considerations to help guide the profession towards the long‐term digital enhancement of SLT services.WHAT THIS PAPER ADDSWhat is already known on the subject The COVID‐19 pandemic led to an unprecedented interest in the use of technology across SLT practice. Studies are emerging nationally and internationally to identify the digital priorities of the SLT workforce, the areas of digital SLT provision that are thriving or lacking, and the evidence to guide clinical practice and service development. What this study adds to existing knowledge This is the first UK‐wide COVID‐19 survey solely focusing on the digital practice of paediatric SLTs. The findings provide critical insights into SLT perception of how practice has been impacted in the early stages of the COVID‐19 pandemic, including digital trends that are service, condition and demographic specific. Tools and channels required to support sustained beneficial change are also discussed. What are the potential or actual clinical implications of this work? This paper demonstrates the potential for digital solutions to enhance SLT practice, as long as implementation is guided by clinicians’ experiences and perspectives. The findings lay groundwork for service development work, such as the creation of training packages, updating of clinical guidelines and care pathways, and development of processes to ensure equitable allocation of evidence‐based resources.

Factors influencing adults who participate in a physical activity coaching intervention: a theoretically informed qualitative study

ObjectiveBehaviour change interventions targeting changes in physical activity (PA) can benefit by examining the underlying mechanisms that promote change. This study explored the use of the Capability, Opportunity, Motivation and...

Experiences of pelvic floor dysfunction and treatment in women with breast cancer: a qualitative study.

PurposeTo explore the experiences of women with breast cancer and pelvic floor (PF) dysfunction and the perceived enablers and barriers to uptake of treatment for PF dysfunction during their recovery.MethodPurposive sampling was used to recruit 30 women with a past diagnosis of breast cancer and PF dysfunction. Semi-structured interviews were conducted, and data were analysed inductively to identify new concepts in the experiences of PF dysfunction in women with breast cancer and deductively according to the capability, opportunity, motivation and behaviour (COM-B) framework to identify the enablers and barriers to the uptake of treatment for PF dysfunction in women with breast cancer.ResultsParticipants were aged between 31 and 88 years, diagnosed with stages I–IV breast cancer and experienced either urinary incontinence (n = 24/30, 80%), faecal incontinence (n = 6/30, 20%) or sexual dysfunction (n = 20/30, 67%). They were either resigned to or bothered by their PF dysfunction; bother was exacerbated by embarrassment from experiencing PF symptoms in public. Barriers to accessing treatment for PF dysfunction included a lack of awareness about PF dysfunction following breast cancer treatments and health care professionals not focussing on the management of PF symptoms during cancer treatment. An enabler was their motivation to resume their normal pre-cancer lives.ConclusionParticipants in this study reported that there needs to be more awareness about PF dysfunction in women undergoing treatment for breast cancer. They would like to receive information about PF dysfunction prior to starting cancer treatment, be screened for PF dysfunction during cancer treatment and be offered therapies for their PF dysfunction after primary cancer treatment. Therefore, a greater focus on managing PF symptoms by clinicians may be warranted in women with breast cancer.

Does a school-based intervention to engage parents change opportunity for handwashing with soap at home? Practical experience from the Mikono Safi trial in Northwestern Tanzania.

BackgroundSchool-based de-worming is advocated as a strategy for reducing the burden of soil-transmitted helminth (STH) infections among children. However, re-infection tends to occur rapidly, suggesting that comprehensive water, sanitation, and hygiene (WASH) improvements may be needed to prevent this. We qualitatively assessed the influence of parental engagement activities on parents’ motivation to improve WASH infrastructure and hygiene practices at home in the context of a school-based de-worming programme.MethodologyWe conducted a longitudinal qualitative study nested within the Mikono Safi trial, designed to assess the effect of a WASH intervention on STH infection prevalence in children. Meetings were organized for parents/guardians at schools where they were given information about STH infection, the role of WASH in STH infection prevention, and actionable steps they could take at home. During the meetings, parents/guardians received information about their own child’s STH infection status. Twenty purposively selected households were visited and interviewed 3 times over a period of about 8-months. We employed thematic analysis; findings are reported following the Capability-Opportunity-Motivation and Behaviour (COM-B) framework.Principal findingsThe engagement strategy improved parents’/guardians’ knowledge and skills about handwashing with soap and its benefits. Parents/guardians reported that the sessions had motivated them to improve WASH infrastructure at home. Of 20 households included in this study, 17 renovated or built new latrines and 18 installed handwashing facilities. However, only 8 households established and maintained handwashing stations with both soap and water at 8 months.ConclusionsThe engagement of parents/guardians in a school-based WASH education intervention as part of the Mikono Safi trial resulted in increased knowledge and motivation about handwashing and sanitation. This led to improvements in sanitation facilities and handwashing opportunities at home. However, long-term success in provision of water and soap was limited, indicating that sustained engagement may be required to encourage households to ensure these materials are consistently available at home.

ACCESS TO ORAL MEDICINE: PERCEPTIONS OF WASHINGTON STATE DENTAL PROVIDERS ON USING TELEHEALTH TO DELIVER ORAL MEDICINE SPECIALTY TREATMENT TO THEIR PATIENTS

<h3>Objectives</h3> Telehealth has provided increased specialty access to patients and health care providers; however, it is currently being underutilized to deliver oral medicine. In this study, we aim to assess the telehealth-related perspectives of licensed oral health providers in the state of Washington and their likelihood to utilize telehealth for oral medicine services. <h3>Study Design</h3> A cross-sectional, confidential, online survey study was performed with data collected via REDCap. Emails were distributed to 8427 licensed dentists and dental hygienists provided by the Washington State Department of Health public records. Analyses included descriptive statistics, means and standard deviations, as well as a hierarchical multiple regression modeled by the Capability, Opportunity, Motivation and Behaviour (COM-B) system of the theoretical domains framework. <h3>Results</h3> Among the 927 participants who initiated the survey (11% response rate), 563 (57%) were included in the analysis based on level of completeness. Dental providers indicated a significant lack of adequate access to oral medicine services (mean [M]= 2.16, standard deviation [SD] = 1.70 on a scale from 1 to 5, with 5 indicating <i>strong agreement</i>) and a significant likelihood to use telehealth to deliver oral medicine (adjusted: M = 71.30, SD = 25.38 on a 100-mm VAS scale, with 100 being <i>very likely</i>). Within the capabilities, opportunity and motivation domains, motivation was the domain most strongly associated with higher likelihood to use telehealth to deliver oral medicine <h3>Conclusions</h3> We identified oral health providers' lack of access to oral medicine in Washington State and their willingness to use a telehealth program to deliver oral medicine. Benefits and barriers indicated by providers in this survey may inform the development of a telehealth program where a multidisciplinary team can support other dental providers in the integrated delivery of oral medicine to their patients across Washington State.

Using storytelling methodology to identify barriers and facilitators of sustained physical activity in patients with a chronic disease: a qualitative study.

ObjectivesTo identify implicit and more profound barriers and facilitators and involving context elements to accomplish sustained physical activity (PA) in patients with a chronic disease. Understanding these barriers and facilitators may help develop future strategies to be used by healthcare professionals in primary care to support patients with a chronic disease to reach sustained PA.Design and methodsThe qualitative, narrative research method storytelling was applied. Perspectives of both patients with a chronic disease (n=12) and involved healthcare professionals (n=11) were collected. Stories were audiotaped and retrieved from the transcriptions. Analysis involved a cyclic process of constant comparison. Main themes were arranged in the theoretical framework of the Capability, Opportunity, Motivation and Behaviour (COM-B) model.ParticipantsPatients were adults with a chronic disease or at high risk of developing a chronic disease who participated in a PA promoting programme. Eligible healthcare professionals were those involved in these PA promoting programmes in primary care, such as physiotherapists, nurse practitioners or sports consultants.ResultsFrom 176 stories, 62 relevant and unique stories were selected for further analysis. Eleven main themes were identified and afterwards linked to the COM-B model. Trust in one’s own capabilities and in the healthcare professional were relevant themes. Also, health literacy and coping with temporary interruption were important capabilities. Important motivators were customised PA, increasing awareness, meaningful activities, exercising in a group and success experiences. Aversion to sports was seen as a barrier. Interprofessional collaboration and prerequisites can be a facilitator or a barrier.ConclusionsThis study provides insight into deeper motivations, barriers and facilitators of sustained PA from both the patients’ and healthcare professionals’ perspective. Comparing these perspectives revealed different views and beliefs on some themes. Attention for temporary interruptions, aversion to sports and health literacy were identified to be important for sustained PA.