Capability, Opportunity, Motivation, Behaviour Model Research Articles

Implementing Mental Health Screening for Adolescent Hematology and Oncology Patients: A Quality Improvement Initiative.

Purpose: Adolescents and young adults (AYA) with chronic illnesses experience an increase in mental health concerns. A mental health screening (MHS) process for hematology and oncology patients was implemented in a single institution. The quality improvement project was conducted to integrate a MHS process, educate providers about the importance of mental health in this patient population, and evaluate the process. Methods: The COM-B (capability, opportunity, motivation-behavior) model for behavior change was used to inform strategic planning and Plan-Do-Study-Act (PDSA) methodologies for process improvement. Retrospective chart reviews and surveys were conducted to determine missed screening rates and providers' perceptions, knowledge, attitudes, and skills of the MHS process. Results: Of 334 eligible patient encounters, the missed screening rate was 15.0%, the overall error rate of completing the screening was 3.8%, the error rate of completing the suicide or self-harm indicator was 2.6%, and the missed medical social worker touch point was 4.8%. Conclusion: The rising rates of mental health concerns in AYA hematology and oncology patients call for streamlined MHS processes to improve the identification of patients who may need intervention and services. Processes should be tailored to workflows and available resources. Future PDSA cycles will include providing dedicated nursing education and determining the cost needed to meet the rising mental health needs of the AYA hematology and oncology population.

Determinants of the optimal selection of vascular access devices: A systematic review underpinned by the COM-B behavioural model.

Optimal selection of vascular access devices is based on multiple factors and is the first strategy to reduce vascular access device-related complications. This process is dependent on behavioural and human factors. The COM-B (Capability, Opportunity, Motivation, Behaviour) model was used as a theoretical framework to organize the findings of this systematic review. To synthesize the evidence on determinants shaping the optimal selection of vascular access devices, using the COM-B behavioural model as the theoretical framework. Systematic review of studies which explore decision-making at the time of selecting vascular access devices. The Medline, Web of Science, Scopus and EbscoHost databases were interrogated to extract manuscripts published up to 31 December 2021, in English or Spanish. Among 16 studies included in the review, 8/16 (50%) focused on physical capability, 8/16 (50%) psychological capability, 15/16 (94%) physical opportunity, 12/16 (75%) social opportunity, 1/16 (6%) reflective motivation and 0/16 (0%) automatic motivation. This distribution represents a large gap in terms of interpersonal and motivational influences and cultural and social environments. Specialist teams (teams created for the insertion or maintenance of vascular access devices) are core for the optimal selection of vascular access devices (75% physical capability, 62% psychological capability, 80% physical opportunity and 100% social opportunity). Specialist teams predominantly lead all actions undertaken towards the optimal selection of vascular access devices. These actions primarily centre on assessing opportunity and capability, often overlooking motivational influences and social environments. A more implementation-focused professional approach could decrease inequity among patients and complications associated with vascular access devices. Optimal selection of vascular access devices is the primary strategy in mitigating complications associated with these devices. There is a significant disparity between interpersonal and motivational influences and the cultural and social environments. Furthermore, specialized teams play a pivotal role in facilitating the optimal selection of vascular access devices. The study can benefit institutions concerned about vascular access devices and their complications. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. No Patient or Public Contribution. WHAT DOES THIS ARTICLE CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Optimal selection of vascular devices remains a growing yet unresolved issue with costly clinical and patient experience impact. Interventions to improve the optimal selection of vascular devices have focused on training, education, algorithms and implementation of specialist vascular teams; alas, these approaches do not seem to have substantially addressed the problem. Specialist vascular teams should evolve and pivot towards leading the implementation of quality improvement interventions, optimizing resource use and enhancing their role.

Survey of the Barriers, Enablers, and Preferences to Swimming for People With Chronic Low Back Pain

Background and Purpose: It is common practice for health professionals to recommend swimming to people with chronic low back pain (CLBP) for rehabilitation and pain management and to improve levels of physical activity. Uptake and engagement in swimming involve a change in behavior, influenced by various factors including barriers, enablers, and preferences. The aim of this study was to identify the most common barriers, enablers, and preferences to swimming for people with CLBP and map them onto the Capability Opportunity Motivation-Behavior (COM-B) model. Methods: People with CLBP were invited to complete a survey collecting data regarding the barriers, enablers, and preferences in relation to swimming. The questions were scored on a 5-point Likert scale and mapped onto the COM-B model. Results: Eighty-two people completed the survey. More than 50% of participants agreed with the following barriers: I am not sure which swimming stroke is best for my back pain and I lack motivation to go swimming. These barriers mapped to the psychological capability and reflective motivation dimensions on the COM-B model. At least 50% of participants agreed with the following enablers: I would like to use swimming to improve my strength, flexibility, weight, fitness, health, mood, and well-being; setting goals and making an action plan could help me swim regularly, I am more likely to go swimming if a health professional advised me and I believe that swimming is good for my back. These enablers were also mapped to the reflective motivation and physical and social opportunity dimensions on the COM-B model. Discussion and Conclusions: The findings from this survey suggest that when recommending swimming, health professionals should discuss the wider health benefits of swimming, discuss specific swimming strokes and why swimming could be beneficial for back pain, and consider using motivational tools to encourage reflective motivation such as goal setting and action planning.

Hand hygiene perceptions, preferences, and practices among hospital staff in the Dominican Republic in the context of COVID-19: a qualitative study

Proper hand hygiene (HH), which includes sanitizing with alcohol-based hand rub (ABHR) (or handwashing with soap and water if ABHR is unavailable), is key for preventing healthcare-associated infections (HCAI), including COVID-19. Understanding drivers of HH is key to improving adherence. This study aims to explore drivers and barriers to HH practice at two hospitals in the Dominican Republic in the context of the COVID-19 pandemic to inform development of HH behaviour change interventions. We conducted in-depth interviews with 20 hospital staff during September 2021. We used the COM-B (capability, opportunity, motivation, behaviour) model to explore HH experiences and preferences. Interviews were recorded, transcribed, coded, and analysed using a thematic approach. A total of 11 parent codes and 27 sub-codes were identified, and 1145 coded segments were analysed. Use of handwashing with soap and water and/or sanitizing with ABHR was reported by all participants; handwashing was generally preferred. Participants expressed knowledge of proper HH methods (capability), but inconsistent supplies and lack of time presented HH challenges (opportunity). Interviewees described practicing HH to protect themselves and their families from COVID-19 and other infections (reflective motivation) or out of habit (automatic motivation). By understanding and addressing underlying factors affecting HH, hospitals can decrease the risk of HCAIs. Our findings suggest that interventions implemented to improve HH in these hospitals should target motivation and opportunity. These findings informed a multimodal intervention to increase ABHR access and implement message-tested communications campaigns; end-point assessments will provide insights into the intervention's impact.

A-I-D for Cascades: Designing a theory-informed intervention for addressing prescribing cascades in primary care

Abstract Introduction Prescribing cascades, which occur when a medication is used to treat the side effect of another medication, are important contributors to polypharmacy. There is an absence of studies that evaluate the implementation or impact of existing interventions to address prescribing cascades in practice. Aim To design theory-informed options for interventions to address prescribing cascades within interprofessional primary care teams. Methods The Behaviour Change Wheel (BCW) framework, and its eight steps, were applied to guide intervention development by the research team. Three target behaviours were drafted and prioritised for intervention development based on data collected as part of two qualitative studies exploring why and how cascades occur across practice settings.[1,2] A target behaviour was selected and the COM-B (capability, opportunity, motivation-behaviour) model was then applied to identify the relevant factors for interprofessional primary care teams. The BCW was used to determine the relevant intervention types and policy options for the behaviour. Next, corresponding behaviour change techniques (BCTs) were identified and intervention options drafted. Prioritisation of behaviours and intervention examples were guided by the APEASE criteria (Affordability, Practicability, Effectiveness/cost-effectiveness, Acceptability, Side-effects/safety, Equity). Results The three target behaviours involved supporting: 1) healthcare providers to ask about, investigate and manage cascades (often through deprescribing), 2) the public to ask about prescribing cascades, and 3) the public to share medication histories and experiences with healthcare providers. The team selected the healthcare provider behaviour, called A-I-D (ask, investigate, deprescribe), for intervention development. Psychological capability and physical opportunity were determined to be the most relevant COM-B components, corresponding to education, training, environmental restructuring, and enablement intervention types and the guidelines, communications and marketing, and service provision policy options within the BCW model. Ultimately, 10 intervention options comprised of BCTs were developed by the team, which are ready for further prioritisation by stakeholders. These can be grouped into three categories: provision of educational content or materials for use by clinicians, provision of consultation or training to support clinicians, and knowledge mobilisation strategies. Through the process, the team identified that development of a practice guidance tool, which assists healthcare providers to investigate and manage prescribing cascades, is needed to support further intervention development. Conclusion The BCW framework guided the design of intervention options that will support primary care clinicians practising in interprofessional teams to address prescribing cascades. A limitation of this work is that applying the BCW framework required several judgements by the team, comprised of scientists, pharmacists, and nurses but not a general practitioner physician. Many but not all have practised with primary care interprofessional teams. When identifying interventions for future consultation, it was determined that the development of a practice guidance tool (i.e., which assists with identifying, investigating, and managing prescribing cascades) underpinned all the proposed interventions for addressing prescribing cascades in practice. Further research is needed to determine what primary care clinicians will need in this practice guidance tool and how it will be used in practice, to support its development.

Understanding wild dog reporting behaviour of rural landholders: identifying options for behaviour change

ABSTRACT Purpose As effective management of biosecurity risks such as wild dogs, relies on landholder reporting, we investigated how landholders can be encouraged to report wild dog presence or damage. Design/Methodology/Approach We identified potential drivers and barriers to wild dog reporting and organised these factors using the Behaviour change Wheel (BCW) framework and associated Capability, Opportunity, Motivation (COM) Behavioural model. We then surveyed 186 landholders to determine the importance of these factors, along with other demographic and situational variables, in predicting current reporting of wild dogs and their impacts. Findings Landholders’ willingness to report was found to be influenced primarily by their personal experience of wild dog problems and motivational factors. They were particularly dissuaded from reporting by perceived negative consequences and loss of autonomy. Segmentation using latent profile analysis highlighted that landholders were not a homogenous group, with each identified segment exhibiting their own unique COM barrier profile. Practical Implications: Use of the BCW framework and associated COM behaviour model allowed us to recommend the most appropriate type of interventions to improve the biosecurity reporting behaviour of rural landholders. Theoretical Implications We contribute to refining the use of psychological theory in the development of agricultural education strategies. Originality/Value Our study is the first to demonstrate the usefulness of the COM behaviour model and BCW framework to improve rural landholder reporting of biosecurity risks.

Strategies to implement evidence-informed decision making at the organizational level: a rapid systematic review

BackgroundAchievement of evidence-informed decision making (EIDM) requires the integration of evidence into all practice decisions by identifying and synthesizing evidence, then developing and executing plans to implement and evaluate changes to practice. This rapid systematic review synthesizes evidence for strategies for the implementation of EIDM across organizations, mapping facilitators and barriers to the COM-B (capability, opportunity, motivation, behaviour) model for behaviour change. The review was conducted to support leadership at organizations delivering public health services (health promotion, communicable disease prevention) to drive change toward evidence-informed public health.MethodsA systematic search was conducted in multiple databases and by reviewing publications of key authors. Articles that describe interventions to drive EIDM within teams, departments, or organizations were eligible for inclusion. For each included article, quality was assessed, and details of the intervention, setting, outcomes, facilitators and barriers were extracted. A convergent integrated approach was undertaken to analyze both quantitative and qualitative findings.ResultsThirty-seven articles are included. Studies were conducted in primary care, public health, social services, and occupational health settings. Strategies to implement EIDM included the establishment of Knowledge Broker-type roles, building the EIDM capacity of staff, and research or academic partnerships. Facilitators and barriers align with the COM-B model for behaviour change. Facilitators for capability include the development of staff knowledge and skill, establishing specialized roles, and knowledge sharing across the organization, though staff turnover and subsequent knowledge loss was a barrier to capability. For opportunity, facilitators include the development of processes or mechanisms to support new practices, forums for learning and skill development, and protected time, and barriers include competing priorities. Facilitators identified for motivation include supportive organizational culture, expectations for new practices to occur, recognition and positive reinforcement, and strong leadership support. Barriers include negative attitudes toward new practices, and lack of understanding and support from management.ConclusionThis review provides a comprehensive analysis of facilitators and barriers for the implementation of EIDM in organizations for public health, mapped to the COM-B model for behaviour change. The existing literature for strategies to support EIDM in public health illustrates several facilitators and barriers linked to realizing EIDM. Knowledge of these factors will help senior leadership develop and implement EIDM strategies tailored to their organization, leading to increased likelihood of implementation success.Review registrationPROSPERO CRD42022318994.

Behavioural correlates of active transport among Canadian adults during the COVID-19 pandemic: The Canadian national active transportation Survey, 2021

IntroductionThis study examined the impact of COVID-19-related restrictions on the active transportation (AT) of Canadian adults and associated motivational determinants of such behaviour. Design and methods: A survey was conducted with 2,868 Canadian adults recruited as part of the Canadian National Active Transportation Survey, 2021 in November and December of 2021. Along with demographic information, questions assessed current physical activity (PA), changes in transportation modalities (i.e., AT, private vehicle, public transport, ride hailing) related to the pandemic, and beliefs about AT according to the capability, opportunity, motivation, behaviour (COM-B) model. A series of multinomial regressions were constructed to examine associations between shifts in AT and the COM-B components. ResultsA substantial proportion of Canadian adults reported engaging in less AT for work (32.4%), school (30.8%), and community activities (29.9%) than prior to the onset of the COVID-19 pandemic. This was slightly less than reductions reported for use of private vehicles (31.8% to 36.3%), ride hailing services (35.5% to 37.6%), and public transportation (38.4% to 38.6%). Similarly, 36.4% reported less engagement in overall PA. The components of the COM-B model were associated with shifts in AT for work and community activities. In particular, physical opportunity (odds ratios ranging from 1.14 to 1.20), reflective motivation (odds ratios ranging from 1.11 to 1.25), and physical capability (odds ratios ranging from 1.11 to 1.25) were the only predictors of behaviour. ConclusionsIf Canadian adults were motivated, felt physically capable, and believed their environment offered opportunities for AT they were less likely to reduce their AT during the COVID-19 period. Thus, future investments in infrastructure to support AT should be accompanied by promotion campaigns to foster motivation and inform on safe opportunities for AT.

Physical Activity in Individuals Newly Diagnosed With Multiple Sclerosis Through the Lens of the COM-B Model.

Physical activity (PA) is a promising intervention for disease modification and symptom management in multiple sclerosis (MS); however, there is a lack of research focusing on PA behavior change interventions for persons newly diagnosed with MS. Such PA behavior change interventions should be developed based on a strong empirical foundation of understanding the behavior and its determinants (ie, what to target for changes to occur). To that end, this qualitative study examined factors explaining PA in persons newly diagnosed with MS and identified potential targets for future behavior change intervention development based on the Capability-Opportunity-Motivation-Behavior (COM-B) model. Twenty individuals diagnosed with MS within the past 2 years underwent one-on-one semistructured interviews using questions developed based on the COM-B model. Data were analyzed using reflective thematic analysis, and the identified themes were then mapped with the COM-B model. Factors explaining PA in the study sample were identified across the COM-B components. The typical factors include knowledge and skills to sufficiently engage in PA with appropriate approaches, ability to adapt and navigate through new environmental and social difficulties after diagnosis, and motivation resulting from a combination of factors, such as outcome expectation, belief of capabilities, role/identity, reinforcement, and emotions. The COM-B model was applied successfully in this study to understand PA behavior and identify potential targets for behavior change in individuals newly diagnosed with MS. Future behavior change interventions should consider addressing these factors to generate effective PA behavior change in this population.

Understanding organisational and nursing behaviour changes associated with a therapeutic engagement improvement tool in acute mental health inpatient settings: A qualitative analysis

BackgroundEnhancing the quality of therapeutic engagement between nurse and service user is related to positive impact on care, safety, and recovery outcomes. Achieving improved therapeutic engagement remains challenging in the acute mental health inpatient setting, characterised by complex social processes and contextual features that constrain behaviour change. The Therapeutic Engagement Questionnaire is an evidence-based tool co-produced with service users and nurses to improve therapeutic engagement. ObjectivesThe objectives of this quality improvement project were to identify the organisational and nursing behaviour changes associated with the Therapeutic Engagement Questionnaire and to understand the active behaviour change ingredients of the improvement tool and how they exert their influence. DesignA qualitative multi-site case study design in which data were collected from study site field notes and document review. SettingFour acute mental health inpatient case study sites in England. MethodsData referencing Therapeutic Engagement Questionnaire-linked behaviour change in project meeting field notes and documents from each study site were analysed using an inductive and deductive approach with thematic analysis. The Capability Opportunity Motivation-Behaviour model was employed as a theoretical framework. FindingsThe therapeutic engagement tool had the capacity to prompt behaviour change across all three components of the behaviour change model: Capability – through nurses sharing good therapeutic engagement practice and use of statements in the questionnaire to build nurses’ knowledge and skills; Opportunity – through organisational barriers being addressed and ward-level practice and culture changes; Motivation – through nurses’ awareness of their influence on service user recovery, nurses’ alertness to their therapeutic work, and connections between the therapeutic engagement tool and nursing core values. However, the tool did not accord with the values of some nurses, reported to be unmotivated by the recognition it gave their profession for contribution to service user recovery. In sites evidencing more prominent behaviour change, senior leader and ward-level agents of change played a valuable facilitative role. ConclusionThe therapeutic engagement tool had the potential to prompt behaviour changes at organisation and ward level and to the ways individual nurses therapeutically engage with service users, helping strengthen therapeutic engagement practice. Leadership at senior organisational and ward level was important to address contextual barriers to change. The project resulted in a conceptual framework to explain and understand the behaviour change techniques and functions linked to the therapeutic engagement tool. Longevity of the behaviour changes and their impact on service user quality of care requires future evaluation. Tweetable abstractA therapeutic engagement tool can prompt organisational and nursing behaviour change in acute mental health inpatient settings.

A survey of preoperative surgical nutrition practices, opinions, and barriers across Canada.

Malnutrition is prevalent among surgical candidates and associated with adverse outcomes. Despite being potentially modifiable, malnutrition risk screening is not a standard preoperative practice. We conducted a cross-sectional survey to understand healthcare professionals' (HCPs) opinions and barriers regarding screening and treatment of malnutrition. HCPs working with adult surgical patients in Canada were invited to complete an online survey. Barriers to preoperative malnutrition screening were assessed using the Capability Opportunity Motivation-Behaviour model. Quantitative data were analyzed using descriptive statistics and qualitative data were analyzed using summative content analysis. Of the 225 HCPs surveyed (n=111 dietitians, n=72 physicians, n=42 allied HCPs), 96%-100% agreed that preoperative malnutrition is a modifiable risk factor associated with worse surgical outcomes and is a treatment priority. Yet, 65% (n=142/220; dietitians: 88%vs. physicians: 40%) reported screening for malnutrition, which mostly occured in the postoperative period (n=117) by dietitians (n=94). Just 42% (48/113) of non-dietitian respondents referred positively screened patients to a dietitian for further assessment and treatment. The most prevalent barriers for malnutrition screening were related to opportunity, including availability of resources (57%, n=121/212), time (40%, n=84/212) and support from others (38%, n=80/212). In conclusion, there is a gap between opinion and practice among surgical HCPs pertaining to malnutrition. Although HCPs agreed malnutrition is a surgical priority, the opportunity to screen for nutrition risk was a great barrier.

A qualitative study of facilitators of medication adherence in systemic lupus erythematosus: Perspectives from rheumatology providers/staff and patients.

Systemic lupus erythematosus (SLE) disproportionately affects patients from racial and ethnic minority groups. Medication adherence is lower among these patient populations, and nonadherence is associated with worse health outcomes. We aimed to identify factors that enable adherence to immunosuppressive medications among patients with SLE from racial and ethnic minority groups. Using a qualitative descriptive study design, we conducted in-depth interviews with purposefully selected (1) patients with SLE from racial and ethnic minority groups who were taking immunosuppressants and (2) lupus providers and staff. We focused on adherence facilitators, asking patients to describe approaches supporting adherence and for overcoming common adherence challenges and providers and staff to describe actions they can take to foster patient adherence. We used applied thematic analysis and categorized themes using the Capability, Opportunity, Motivation, Behavior (COM-B) model. We interviewed 12 patients (4 adherent and 8 nonadherent based on medication possession ratio) and 12 providers and staff. Although each patient described a unique set of facilitators, patients most often described social support, physical well-being, reminders, and ability to acquire medications as facilitators. Providers also commonly mentioned reminders and easy medication access as facilitators as well as patient education/communication and empowerment. Using an established behavioral change model, we categorized a breadth of adherence facilitators within each domain of the COM-B model while highlighting patients' individual approaches. Our findings suggest that an optimal adherence intervention may require a multi-modal and individually tailored approach including components from each behavioral domain-ensuring medication access (Capability) and utilizing reminders and social support (Opportunity), while coupled with internal motivation through improved communication and empowerment (Motivation).

Comparing factors influencing seasonal influenza vaccine acceptance and intentions among Chinese university students residing in China and UK: A cross-sectional study

ABSTRACT University students, who face an elevated risk of influenza due to close living quarters and frequent social interactions, often exhibit low vaccine uptake rates. This issue is particularly pronounced among Chinese students, who encounter unique barriers related to awareness and access, emphasizing the need for heightened attention to this problem within this demographic. This cross-sectional study conducted in May-June 2022 involved 1,006 participants (404 in the UK, 602 in Mainland China) and aimed to explore and compare the factors influencing influenza vaccine acceptance and intentions between Chinese university students residing in the UK (C-UK) and Mainland China (C-M). The study employed a self-administered questionnaire based on the Theoretical Domains Framework and Capability Opportunity Motivation-Behavior model. Results revealed that approximately 46.8% of C-UK students received the influenza vaccine in the past year, compared to 32.9% of C-M students. More than half in both groups (C-UK: 54.5%, C-M: 58.1%) had no plans for vaccination in the upcoming year. Knowledge, belief about consequences, and reinforcement significantly influenced previous vaccine acceptance and intention in both student groups. Barriers to vaccination behavior included insufficient knowledge about the influenza vaccine and its accessibility and the distance to the vaccine center. Enablers included the vaccination behavior of individuals within their social circles, motivation to protect others, and concerns regarding difficulties in accessing medical resources during the COVID-19 pandemic. The findings of this study offer valuable insights for evidence-based intervention design, providing evidence for healthcare professionals, policymakers, and educators working to enhance vaccination rates within this specific demographic.

Barriers and Facilitators to Exercise in Older Adults Awaiting Kidney Transplantation and Their Care Partners

Despite guidelines calling to improve physical activity in older adults, and evidence suggesting that prekidney transplant physical function is highly associated with posttransplant outcomes, only a small percentage of older patients treated with dialysis are engaged in structured exercise. We sought to elucidate barriers and facilitators of exercise among older adults treated with dialysis awaiting transplant and their care partners. Individual, in-depth, cognitive interviews were conducted separately for patients and care partners through secure web-conferencing. Twenty-three patients (≥50 years of age, treated with dialysis from the University of San Francisco kidney transplantation clinic, with a short physical performance battery of≤10) and their care partners. All audio interviews were transcribed verbatim. Three investigators independently coded data and performed qualitative thematic content. The interview guide was updated iteratively based on the Capability Opportunity Motivation Behavior model. Patients' median age was 60 years (57 ± 63.5) and care partners' median ages was 57 years (49.5 ± 65.5). Thirty-nine percent of patients and 78% of care partners were female, 39% of patients and 30% of care partners self-identified as African American, and 47% of dyads were spouse or partner relationships. Major themes for barriers to pretransplant exercise included lack of understanding of an appropriate regimen, physical impairments, dialysis schedules, and safety concerns. Major facilitators included having individualized or structured exercise programs, increasing social support for patients and care partners, and motivation to regain independence or functionality or to promote successful transplantation. Participants geographically limited to Northern California. Although patients and care partners report numerous barriers to pretransplant exercise and activity, they also reported many facilitators. An individualized, structured, home-based exercise program could circumvent many of the reported barriers and allow older patients to improve pretransplant physical function.

A COM-B analysis of facilitators of and barriers to smoking cessation among Chinese smokers: A qualitative study.

Smoking prevalence remains high in China with a low cessation motivation level, despite the government's tobacco control efforts. There is a lack of research specifically examining perceptions, attitudes, and behaviors related to smoking cessation in this region, particularly from a theory-based deductive perspective. Utilizing the COM-B (Capability, Opportunity, Motivation-Behavior) model as a theoretical framework, this study aimed to identify facilitators and barriers to smoking cessation among Chinese smokers. The study employed semi-structured individual interviews with 40 participants. Each interview spanned approximately 30 minutes. The participants, constituting both current and former smokers, were all aged ≥18 years (n=40). Interview data were then examined using a directed content analysis approach. Analysis revealed three interrelated themes. Capability: Smokers face challenges when resisting peer pressure and dealing with life after quitting. They also lack knowledge about smoking, quitting techniques, and withdrawal symptoms. Opportunity: Changing societal attitudes towards smoking create opportunities for quitting, but these are hindered by inadequate cessation services and a lack of family support. Motivation: Smokers' motivation to quit is mainly driven by health concerns. Resistance to quitting often stems from the belief that smoking is a personal choice or just a habit. Excessive emphasis on willpower may hinder motivation to quit. To enhance smoking cessation efforts in China, three key aspects should be considered: capability, opportunity, and motivation. Publicity and educational campaigns should target common misconceptions about smoking as a personal freedom, correct the overemphasis on willpower, and widely promote available cessation services. A crucial aspect is shifting societal norms to foster anti-smoking sentiments. Effective strategies may involve using real-life stories to illustrate smoking's health consequences, disseminating information about cessation services in maternity centers, enhancing services through mobile health initiatives, and empowering families to support smokers in their quit attempts.

Barriers and facilitators experienced in delivering alcohol screening and brief interventions in community pharmacy: a qualitative evidence synthesis.

Following increases in deaths due to alcohol during the COVID-19 pandemic, there have been renewed calls to increase resources in alcohol screening and brief intervention (SBI). Research has shown that community pharmacy could be a promising setting for SBI. This review aimed to investigate the barriers and facilitators to SBI delivery in community pharmacy to inform its further development. A systematic search of four databases (MEDLINE, EMBASE, CINAHL, and PsycINFO) was conducted in October 2021 to identify relevant published qualitative or mixed-method studies. Relevant qualitative data were extracted from the included studies and a framework synthesis was performed using the Capability-Opportunity-Motivation-Behaviour (COM-B) model. Two thousand two hundred and ten articles were screened and nine studies were included in the review (seven in the United Kingdom and two in Australia). Identified barriers and facilitators to delivering SBI corresponded to all components of the COM-B model. Facilitators included non-confrontational communication skills, aligning SBI with existing pharmacy services and pharmacist role legitimacy. Barriers included multiple demands on staff time, a lack of staff experience with screening tools, and staff concerns of causing offence. Using the Behaviour Change Wheel (BCW), we propose five elements of a pharmacy SBI to address identified barriers. Research into SBI in community pharmacy is limited in comparison to other healthcare settings and this review provides an understanding of the barriers and facilitators to the delivery of SBI in community pharmacy from a behavioural perspective. Through the use of COM-B and BCW, our findings could inform the development of future pharmacy-based SBI.

Characterising the interventions designed to affect the reporting of musculoskeletal imaging: a scoping review protocol using the COM-B model

IntroductionAttributing musculoskeletal (MSK) pain to normal and commonly occurring imaging findings, such as tendon, cartilage and spinal disc degeneration, has been shown to increase people’s fear of movement, reduce their...

Personal protective equipment and medical students in times of COVID-19: experiences and perspectives from the final clerkship year

BackgroundThe availability and correct use of personal protective equipment (PPE) to prevent and control infections plays a critical role in the safety of medical students in clinical placements. This study explored their experiences and perspectives in their final clerkship year with PPE during the COVID-19 pandemic.MethodsThis qualitative study was based on social constructivism and was conducted in 2021 at the Charité - Universitätsmedizin Berlin. In three online focus group discussions, 15 medical students in their final clerkship year reported their experiences with PPE training and use during the COVID-19 pandemic. Data were recorded, transcribed and analysed based on Kuckartz’s approach to content analysis. We drew upon the a priori dimensions of the capability, opportunity, motivation - behaviour (COM-B) model as main categories as well as emergent issues raised by the study participants (subcategories).ResultsIn addition to the three main categories of the COM-B model, eleven subcategories were identified through inductive analysis. The study participants reported several factors that hindered the correct use of PPE. In the area of capabilities, these factors were related to learning experience with PPE in terms of both theoretical and practical learning together with later supervision in practice. In the area of opportunities, these factors included the limited availability of some PPE components, a lack of time for PPE instruction and supervision and inappropriate role modelling due to the inconsistent use of PPE by physicians and nursing staff. The area of motivation to use PPE was characterized by an ambivalent fear of infection by the SARS-CoV-2 virus and the prioritization of patient safety, i.e., the need to prevent the transmission of the virus to patients.ConclusionsOur study revealed several limitations pertaining to the enabling factors associated with the trainable behaviour “correct use of PPE”. The concept of shared responsibility for student safety was used to derive recommendations for future improvement specifically for the medical school as an organization, the teachers and supervisors, and students themselves. This study may guide and stimulate other medical schools and faculties to explore and analyse components of student safety in clinical settings in times of infectious pandemics.

Structural equation modeling for associated factors with patient safety behaviors among nursing interns: A cross-sectional study based on the capability opportunity motivation-behavior model

BackgroundNursing interns are one of the most crucial providers of nursing services. Their safety behaviors are closely associated with adverse events. Therefore, it is vital to explore the factors influencing nursing intern safety behavior to improve patient safety. ObjectiveTo evaluate patient safety behavior among nursing interns and explore latent influencing mechanisms based on the capability opportunity motivation-behavior (COMB) model. DesignA cross-sectional study Settings and participantsThe participants were 422 nursing interns recruited through convenience sampling from a comprehensive teaching hospital. MethodsData on general information, nursing interns' patient safety behavior, metacognitive ability, clinical internship environment, and moral sensitivity were collected. Nursing interns' patient safety behavior was described with means and standard deviations. The independent sample t-test, ANOVA, Pearson's correlation, and SEM were used to determine contributing factors to nursing interns' patient safety behavior. ResultsThe mean total score for patient safety behavior was 53.08 ± 6.22. The results indicated that metacognitive ability not only directly affects the patient safety behavior of nursing interns (β = 0.554, P < 0.001, 95 % CI = [0.446, 0.637]) but indirectly affects interns' safety behavior through professional identity (β = 0.009, P = 0.031, 95 % CI = [0.001, 0.019]). The clinical internship environment also has both direct (β = 0.258, P = 0.001, 95 % CI = [0.166, 0.349]) and indirect (β = 0.007, P = 0.029, 95 % CI = [0.001, 0.015]) effects on the patient safety behavior of nursing interns. ConclusionThere are some specific areas where nursing interns' safety behaviors need to be improved. This study reveals that strong metacognitive ability and a clinical internship environment with rich opportunities might be essential for the development of patient safety behaviors. To promote nursing interns' patient safety behaviors, clinical teachers could use reflective teaching methods and provide a supportive clinical environment to nurture nursing interns' professional identities and patient safety behaviors.

Application of the COM-B model to explore barriers and facilitators to participation in research by hospital pharmacists and pharmacy technicians: A cross-sectional mixed-methods survey

BackgroundCombining research and clinical practice is crucial for advancing evidence-based healthcare and improving pharmacy service delivery. While hospital pharmacists report significant interest in research, this does not translate to high levels of research engagement. Furthermore, little is known regarding barriers and motivators for pharmacy technician involvement in research. ObjectiveTo characterise the barriers and enablers to engaging in practice-based research reported by hospital pharmacy staff using the Capability, Opportunity, Motivation - Behaviour (COM-B) framework. MethodsAn online cross-sectional survey, using the validated Research Capacity in Context tool, was sent to all employees of a statewide hospital pharmacy service. Respondent characteristics and quantitatively reported barriers and motivators were analysed using descriptive statistics. Qualitative data from open text responses were analysed through inductive thematic analysis. Results were mapped to the components of the COM-B framework at individual, team and organisation levels. Results278 responses were received (response rate 43.3%) from pharmacists (68.0%) and pharmacy assistants/technicians (28.4%) across 19 hospitals. Research behaviour was influenced by factors linked to five of six COM-B subdomains. Reflective motivation, linked to a desire to improve practice and patient care, self-development, and recognition, indicates pharmacy staff would like to engage in research. However, barriers related to physical opportunity (lack of time for research, other work roles that take priority) and psychological capability (lack of skills and mentorship) hindered involvement. Social opportunity and automatic motivation, tied to managerial support, role perceptions and departmental research culture were also reported facilitators. Subtle differences in the factors that motivate hospital pharmacists and pharmacy technicians were identified. ConclusionsMapping factors associated with research participation by hospital pharmacy staff to the COM-B model is an important step towards identifying evidence-based intervention types that could form the basis of strategies to optimise hospital pharmacy staff engagement with practice-based research, using the behaviour change wheel.