Capability, Opportunity, Motivation, Behaviour Model Research Articles

Development of an Interactive Lifestyle Programme for Adolescents at Risk of Developing Type 2 Diabetes: PRE-STARt.

Background: Type 2 diabetes (T2D) is increasing in young people. Reporting on the processes used when developing prevention interventions is needed. We present the development of a family-based interactive lifestyle intervention for adolescents with risk factors for T2D in the future. Method: A multidisciplinary team in the UK site led the intervention development process with sites in Portugal, Greece, Germany and Spain. Potential programme topics and underpinning theory were gathered from literature and stakeholders. A theoretical framework based on self-efficacy theory and the COM-B (capability, opportunity, motivation, behaviour) model was developed. Sessions and supporting resources were developed and refined via two iterative cycles of session and resource piloting, feedback, reflection and refinement. Decision on delivery and content were made by stakeholders (young people, teachers, parents, paediatricians) and all sites. Materials were translated to local languages. Site-specific adaptations to the language, content and supporting resources were made. Results: The “PRE-STARt” programme is eight 90-min interactive sessions with supporting curriculum and resources. Iterative development work provided valuable feedback on programme content and delivery. Conclusion: Reporting on the intervention development process, which includes stakeholder input, could yield a flexible approach for use in this emerging ‘at risk’ groups and their families.

Obesity prevention in the early years: A mapping study of national policies in England from a behavioural science perspective.

Evidence indicates that early life is critical for determining future obesity risk. A sharper policy focus on pregnancy and early childhood could help improve obesity prevention efforts. This study aimed to systematically identify and categorise policy levers used in England with potential to influence early life course (pregnancy, 0-5 years) and identify how these interface with energy balance behaviours. The objective is to identify gaps and where further policy actions could most effectively focus. A behavioural science approach was taken using the Capability-Opportunity-Motivation-Behaviour (COM-B) model and Behaviour Change Wheel (BCW) framework. The key determinants of energy balance in the early years were identified from the Foresight Systems Map. Policy actions were scoped systematically from available literature, including any health or non-health policies which could impact on energy balance behaviours. Foresight variables and policy actions were considered in terms of COM-B and the BCW to determine approaches likely to be effective for obesity prevention and treatment. Existing policies were overlaid across the map of key risk factors to identify gaps in obesity prevention and treatment provision. A wide range of policy actions were identified (n = 115) to address obesity-relevant risk factors. These were most commonly educational or guidelines relating to environmental restructuring (i.e. changing the physical or social context). Scope for strengthening policies relating to the food system (e.g. the market price of food) and psychological factors contributing to obesity were identified. Policies acted via all aspects of the COM-B model, but there was scope for improving policies to increase capability through skills acquisition and both reflective and automatic motivation. There is substantial policy activity to address early years obesity but much is focused on education. Scope exists to strengthen actions relating to upstream policies which act on food systems and those targeting psychological factors contributing to obesity risk.

The perceived impact of Covid-19 on periodontal practice in the United Kingdom: A questionnaire study

IntroductionCOVID-19 has impacted dentistry in unprecedented ways. ObjectiveThe following research aimed to investigate the impact of the COVID-19 pandemic on periodontal practice in the United Kingdom using the COM-B (Capability Opportunity Motivation-Behaviour) model as the basis for a questionnaire. Basic research designAn online survey link was sent to all members of the British Society of Periodontology and Implant Dentistry. A total of 358 responses were received and analysed. ResultsThe great majority of participants thought that the pandemic had an impact on their profession, while only 4.7 % had no concerns. The main worries related to financial concerns and ability to provide appropriate levels of care. More than 80 % of respondents agreed that their establishment was compliant with infection control procedures. Some participants felt benefits mainly in terms of more time for CPD activities. It was felt that some of the changes needed will need to be sustained long-term. ConclusionsRespondents were generally worried. However, they perceived they had the physical and psychological ability to effect changes to their practice, higher than the physical and social opportunities that they were afforded. Although the COVID-19 pandemic is causing profound changes and worries for the profession of Periodontology, clinicians are clear about their capability to control the situation and feel they have the motivation to make the required changes. Clinical significanceCOVID-19 has presented clinicians with novel challenges. Investigating the professional response to change and expected impact is of interest in the current climate as we navigate the ‘new normal’. Assessing the results could be useful in informing support strategies moving forward.

Barriers and facilitators to infection prevention and control in a neonatal unit in Zimbabwe – a theory-driven qualitative study to inform design of a behaviour change intervention

Hospital-acquired infection (HAI) is an increasing cause of neonatal morbidity/mortality in low-income settings. Hospital staff behaviours (e.g., hand hygiene) are key contributors to HAI. Understanding the drivers of these can inform interventions to improve infection prevention and control (IPC). To explore barriers/facilitators to IPC in a neonatal unit in Harare, Zimbabwe. Interviews were conducted with 15 staff members of neonatal and maternity units alongside ethnographic observations. The interview guide and data analysis were informed by the COM-B (Capability, Opportunity, Motivation-Behaviour) model and explored individual, socio-cultural, and organizational barriers/facilitators to IPC. Potential interventions were identified using the Behaviour-Change Wheel. Enablers within Capability included awareness of IPC, and within Motivation beliefs that IPC was crucial to one's role, and concerns about consequences of poor IPC. Staff were optimistic that IPC could improve, contingent upon resource availability (Opportunity). Barriers included: limited knowledge of guidelines, no formal feedback on performance (Capability), lack of resources (Opportunity), often leading to improvization and poor habit formation. Further barriers included the unit's hierarchy, e.g., low engagement of cleaners and mothers in IPC, and staff witnessing implementation of poor practices by other team members (Opportunity). Potential interventions could include role-modelling, engaging mothers and staff across cadres, audit and feedback and flexible protocols (adaptable to water/handrub availability). Most barriers to IPC fell within Opportunity, whilst most enablers fell under Capability and Motivation. Theory-based investigation provides the basis for systematically identifying and developing interventions to address barriers and enablers to IPC in low-income settings.

Integrated Knowledge Translation To Inform Implementation Of Exercise Counselling And Referral Of Cancer Survivors

There is limited evidence supporting successful implementation of exercise-programming for cancer survivors into cancer clinical care pathways. We designed and launched a five-year hybrid effectiveness and implementation study to evaluate the relative benefit from an Alberta wide clinic-to-community based cancer and exercise model of care - the Alberta Cancer Exercise (ACE) program, and to evaluate the implementation of ACE into clinical cancer care. PURPOSE: To determine Health Care Provider (HCP) preferences, barriers and facilitators towards exercise counselling and referral of survivors to ACE at the Cross Cancer Institute (CCI), Edmonton, Alberta, and to test the feasibility of in-clinic, HCP-informed implementation tools. METHODS: Stage I: A theory-informed electronic questionnaire was distributed to HCPs at the CCI, of which N=47 responded (Aug-Oct 2017). A subsequent focus group N= 7 (May 2018) of CCI HCPs was held to probe into questionnaire findings and to determine actionable strategies. Stage II: Responses were mapped to the Capability Opportunity Motivation Behavior model. Tools were developed to specifically target the needs of HCPs in the head and neck cancer (HNC) tumor group. Tool packages were distributed to HCPs (N=9) for in-clinic use for 4 weeks, corresponding to ACE recruitment for Spring programming (March-April 2019). Referral of HNC survivors to ACE programming was tracked. RESULTS: Stage I: Across all disciplines, only 17% of HCPs reported performing exercise counselling with survivors. The most common HCP identified barrier to exercise counselling was time, followed by a lack of knowledge regarding appropriate exercise. The most common facilitator was the ‘interdisciplinary team’, including access to physical therapy services. Stage II: Tool-based implementation strategies were developed and involved an educational package and exercise screening algorithm that was distributed to HCPs. A total of N=14 HNC survivors were referred, representing more than double the average number of previous HNC referrals (N=6) per session. HCPs reported the implementation tools to be ‘somewhat’ to ‘very helpful’. CONCLUSIONS: HCP-identified implementation tools can enhance exercise-counselling and referral practices, and improve referral to community-based exercise programming.

Barriers and Facilitators to Involvement in Children's Diabetes Management Among Minority Parents.

This study aimed to describe parents' perceptions of the factors that facilitate or are barriers to their involvement in children's type 1 diabetes (T1D) management among African American and Latino parents. African American and Latino parents (N = 28) of 5- to 9-year-old children with T1D completed audio-recorded, semi-structured interviews that were transcribed and analyzed using thematic analysis. Themes were identified that aligned with the theoretically-derived Capability-Opportunity-Motivation-Behavior (COM-B) framework. Parents described Capability-based facilitators of parent involvement, including positive stress management, religious/spiritual coping, organizational/planning skills, and diabetes knowledge. Capability-based barriers included child and parent distress. Interpersonal relationships, degree of flexibility in work environments, and access to diabetes technologies were both Opportunity-based facilitators and barriers; and Opportunity-based barriers consisted of food insecurity/low financial resources. Parents' desire for their child to have a "normal" life was described as both a Motivation-based facilitator and barrier. African American and Latino families described helpful and unhelpful factors that spanned all aspects of the COM-B model. Reinforcing or targeting families' unique psychological, interpersonal, and environmental strengths and challenges in multilevel interventions has potential to maximize parental involvement in children's diabetes management.

Pro-Environmental Energy Behavior in the Military: Assessing Behavior Change Factors at a Selected Military Unit

The purpose of this study is to explore how pro-environmental energy behavior is manifested at a military unit and what behavioral change factors can enhance such behavior. The military unit represents an organization dominated by an exceptionally strong sense of community and belonging where individual pro-environmental energy behavior goes in line with a collective one. The application of Capability-Opportunity-Motivation-Behavior (COM-B) approach led to a better understanding of energy-saving behavior in the military as an organization where personnel are trained to increase their awareness of their peers’ behavior. Methods: The results were obtained using data collected from two independent samples of both professional soldiers and conscripts at a military unit of Lithuanian defense forces located in a fixed installation in the time frame of 2018–2019. The total sample of respondents (professional soldiers and conscripts) was N = 454. A series of statistical tests were performed at the 0.05 level of confidence. Results: An extended COM-B model for the analysis of pro-environmental energy behavior in the military was proposed and applied. The results show that the three behavioral change factors—capability, opportunity, and motivation—are first of all positively linked with the collective energy behavior at the military unit and only then with the individual soldier’s pro-environmental energy behavior. This is a new insight into the COM-B model as collective and individual behavior are identified as separate indicators and then combined into a single measurable construct. In addition, the results indicate that in the military unit, communality plays an important role in sustaining pro-environmental energy behavior, even if an individual behavior indicates low-involvement.

Using the theoretical domains framework to explore reasons for missed opportunities for vaccination among children in Kano, Nigeria: a qualitative study in the pre-implementation phase of a collaborative quality improvement project

ABSTRACTBackground: Missed opportunities for vaccination (MOV) have been identified as an important contributor to low childhood immunization coverage. In this study, we explore the reasons for MOV from the perspective of caregivers of children aged 0–23 months attending primary health care (PHC) facilities in Nassarawa Local Government Area (LGA) of Kano State, Nigeria. This was to inform the implementation of a quality improvement program to reduce MOV.Methodology: An exploratory qualitative research was conducted using focus group discussions (FGD) with caregivers of children aged 0–23 months that visited PHC facilities. The study was conducted in three purposively selected PHC facilities in Nassarawa, Kano. The caregivers were purposively selected from the three PHC facilities and were homogenous in terms of their place of residence. Each FGD was conducted face-to-face in a private room within the health facility. During the discussion, participants maintained a circular sitting arrangement. The FGD were audio-recorded, transcribed verbatim, and analyzed using template analysis approach through the lens of the theoretical domains framework (TDF) and the capability, opportunity, motivation – behavior (COM-B) model. The researchers that conducted this study are epidemiologists and implementation scientists with experience in immunization programs. They are multilingual, and some are fluent in both English and Hausa language. Although four of them are medical doctors, however, they do not have any affiliations or provide health services in any of the PHC facilities where this study was conducted.Result: Five FGD with 30 caregivers was conducted. The caregivers were aged between 19 and 32 years and lived within the LGA. Based on their lived experiences, several factors that are responsible for MOV were identified and categorized into three constructs based on the COM-B model. Capability encompassed caregiver’s inadequate knowledge of the vaccines that children need. The opportunity included contextual factors such as non-screening of home-based records, health worker’s refusal to offer immunization services, and husband’s refusal due to socio-cultural beliefs. Finally, motivation included fear of the side effects of vaccination.Conclusion: This study identified a useful framework that aided deeper insights into caregiver-related factors responsible for MOV in Nassarawa, Kano. Some of the findings from this study can be used to inform change ideas in a quality improvement program and should be explored.

Sports nutritionists’ perspectives on enablers and barriers to nutritional adherence in high performance sport: A qualitative analysis informed by the COM-B model and theoretical domains framework

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.

Applying the COM-B Model to Assess the Usability of Smartphone-Connected Listening Devices in Adults with Hearing Loss.

Unlike conventional hearing aids, smartphone-connected listening devices may require limited or no input from a trained audiologist in terms of device programming and adjustment. However, there is a lack of peer-reviewed evidence assessing the real-world perspectives of people living with hearing loss toward such technological innovations. This study assessed the everyday experiences of adults living with hearing loss toward a range of smartphone-connected listening devices using the Capability, Opportunity, Motivation, Behaviour (COM-B) model as a theoretical framework. A qualitative study where participants trialed one of the following smartphone-connected listening devices for two weeks in their everyday lives: made-for-smartphone hearing aid, personal sound amplification product, and smartphone "hearing aid" app with wired earphones or wireless hearable. Individual semistructured interviews were conducted. Twenty adults (13 male and 7 female; mean age = 62.25 years, SD = 11.59) with mild-to-moderate hearing loss (mean better ear pure-tone average = 30.49 dB HL, SD = 17.51) were recruited using a convenience sampling strategy. All participants owned conventional hearing aids. The data were analyzed using an established deductive thematic analysis procedure within the context of the COM-B model. The model stipulates that for individuals to engage in a particular behavior (B), they must have sufficient capability (C), opportunity (O), and motivation (M). Capability: One of the key advantages facilitating use and adherence of smartphone-connected listening devices was the ability for participants to make fine-tune adjustments in any listening situation. Opportunity: Participants commented that these devices could address issues surrounding stigma as smartphones are ubiquitous in everyday life. Motivation: Participants consistently reported that the ability to make adjustments via a smartphone provided them with a greater sense of autonomy and empowerment. As a result, they felt more in control of their hearing loss. This study lays the foundation for further high-quality research to explore whether smartphone-connected technologies have the potential to yield optimum benefits for people living with hearing loss.

Understanding health behaviour in pregnancy and infant feeding intentions in low-income women from the UK through qualitative visual methods and application to the COM-B (Capability, Opportunity, Motivation-Behaviour) model

BackgroundHealth behaviours during pregnancy and the early years of life have been proven to affect long term health, resulting in investment in interventions. However, interventions often have low levels of completion and limited effectiveness. Consequently, it is increasingly important for interventions to be based on both behaviour change theories and techniques, and the accounts of pregnant women. This study engaged with pregnant women from deprived communities, to understand their subjective experiences of health in pregnancy.MethodsThe study adopted a women-centred ethos and recruited a purposive sample of ten pregnant women, who lived in deprived areas and were on low incomes. Participants engaged with three creative techniques of visual data production (timelines, collaging and dyad sandboxing), followed by elicitation interviews. One participant only engaged in the initial activity and interview, resulting in a total of 28 elicitation interviews. This in-depth qualitative approach was designed to enable a nuanced account of the participants’ thoughts, everyday experiences and social relationships. Data were deductively coded for alcohol, smoking and infant feeding and then mapped to the COM-B model (Capability, Opportunity, Motivation – Behaviour).ResultsFive participants had experience of smoking during pregnancy, four had consumed alcohol during pregnancy, and all participants, except one who had exclusively formula fed her child, disclosed a range of infant feeding experiences and intentions for their current pregnancies. Considerable variation was identified between the drivers of behaviour around infant feeding and that related to abstinence from tobacco and alcohol during pregnancy. Overall, knowledge and confidence (psychological capability), the role of partners (social opportunity) and support from services to overcome physical challenges (environmental opportunity) were reported to impact on (reflective) motivation, and thus women’s behaviour. The role of the public in creating and reinforcing stigma (social opportunity) was also noted in relation to all three behaviours.ConclusionsWhen designing new interventions to improve maternal health behaviours it is important to consider the accounts of pregnant women. Acknowledging pregnant women’s subjective experiences and the challenges they face in negotiating acceptable forms of motherhood, can contribute to informed policy and practice, which can engage rather than isolate potential user groups.

Exploring mental health professionals\u2019 practice in relation to smoke-free policy within a mental health trust: a qualitative study using the COM-B model of behaviour

BackgroundSmoking has played a significant role in the historical culture of mental healthcare settings. Mental health professionals (MHPs) often hold dismissive attitudes regarding the importance of smoking cessation in the context of mental healthcare. In 2007, English mental health inpatient buildings were required by law to become smoke-free, and healthcare trusts have more recently begun to implement comprehensive policies (i.e. smoke-free grounds and buildings) and staff training in response to national guidance. It is therefore important to explore MHPs practice around smoking, smoking cessation, and smoke-free policy adherence. This study aimed to explore these issues by using the COM-B (capability, opportunity, motivation, behaviour) model to systematically identify barriers to, and facilitators for, MHPs addressing smoking with their patients.MethodsFive focus groups with a total of 36 MHPs were conducted between March and August 2017. MHPs were recruited from one of the largest mental health trusts in Europe. Discussions were guided by a semi-structured guide. Responses were audio recorded, transcribed and coded using thematic analysis and the COM-B framework.ResultsAddressing smoking with patients was undermined by MHPs’ 1) psychological capability to recall training content, misunderstand the potential benefits of addressing patient smoking and harm reduction approaches; 2) physical opportunity in terms of time constraints, and easy accessibility of tobacco in the community; 3) social opportunity in terms of increased cultural value of tobacco following inpatient smoke-free policy implementation, and lack of support from colleagues to enforce the smoke-free policy; 4) automatic motivation, including intrinsic biases regarding patients abilities and motivations to quit, and 5) reflective motivation, including perceived job role and decision making processes related to addressing behaviours deemed more important than smoking. The main facilitating factors identified were MHPs’ having opportunity in the form of patients asking directly for support, and MHPs having access to resources such as stop smoking services and spirometers.ConclusionMultiple barriers were identified across all key domains of the COM-B framework that undermine MHPs’ practice regarding smoking cessation. Few facilitators were identified which may have implications for future smoke-free policy and clinical practice.

Developing a theory-driven contextually relevant mHealth intervention

ABSTRACTBackground: mHealth interventions have huge potential to reach large numbers of people in resource poor settings but have been criticised for lacking theory-driven design and rigorous evaluation. This paper shares the process we developed when developing an awareness raising and behaviour change focused mHealth intervention, through applying behavioural theory to in-depth qualitative research. It addresses an important gap in research regarding the use of theory and formative research to develop an mHealth intervention.Objectives: To develop a theory-driven contextually relevant mHealth intervention aimed at preventing and managing diabetes among the general population in rural Bangladesh.Methods: In-depth formative qualitative research (interviews and focus group discussions) were conducted in rural Faridpur. The data were analysed thematically and enablers and barriers to behaviour change related to lifestyle and the prevention of and management of diabetes were identified. In addition to the COM-B (Capability, Opportunity, Motivation-Behaviour) model of behaviour change we selected the Transtheoretical Domains Framework (TDF) to be applied to the formative research in order to guide the development of the intervention.Results: A six step-process was developed to outline the content of voice messages drawing on in-depth qualitative research and COM-B and TDF models. A table to inform voice messages was developed and acted as a guide to scriptwriters in the production of the messages.Conclusions: In order to respond to the local needs of a community in Bangladesh, a process of formative research, drawing on behavioural theory helped in the development of awareness-raising and behaviour change mHealth messages through helping us to conceptualise and understand behaviour (for example by categorising behaviour into specific domains) and subsequently identify specific behavioural strategies to target the behaviour.

Barriers to and enablers of the implementation of an ICF-based intake tool in clinical otology and audiology practice-A qualitative pre-implementation study.

The authors are developing an intake tool based on the Brief International Classification of Functioning Disability and Health Core Set for Hearing Loss, by operationalizing its categories into a Patient Reported Outcome Measure. This study was aimed at identifying enablers and barriers to using this tool as perceived by hearing health professionals (HHPs) and patients. Focus groups and interviews were held with HHPs (ENT surgeons, N = 14; audiologists, N = 8) and patients (N = 18). Interview questions were based on the Capability-Opportunity-Motivation-Behavior (COM-B) model. Using the COM-B model and the Theoretical Domains Framework (TDF), transcript fragments were divided into meaning units, which were then categorized into capability-, opportunity- and motivation-related barriers and enablers. These were further specified into TDF domains. HHP barriers included: lack of time to use the tool (O); and fear of being made responsible for addressing any emerging problems, which may be outside the expertise of the HHP (M). Enablers included integration of the tool in the electronic patient record (O); opportunity for the patient to be better prepared for the intake visit (M); and provision of a complete picture of the patient’s functioning via the tool (M). Patient’ barriers included fear of losing personal contact with the HHP (M); and fear that use of the tool might negatively affect conversations with the HHP (M). Enablers included knowledge on the aim and relevance of the tool (C); expected better self-preparation (M); and a more focused intake (M). These findings suggest that an intervention is needed to enhance HHPs’ knowledge, skills and motivation regarding the relevance and the clinical usefulness of the tool. Providing clear and specific information on the purpose of the tool can also enhance patient motivation. For both HHPs and patients, opportunities relating to the (digital) administration and the design of the tool provide additional targets for successful implementation.

Feasibility and usability of an ontology-based mobile intervention for patients with hypertension

BackgroundLifestyle changes and the adoption of healthy behaviours are well established recommendations for the management of hypertension—a risk factor for cardiovascular and kidney disease. Mobile health interventions offer unique advantages and novel approaches to helping individuals make and maintain such behaviour changes; however, current interventions often lack theoretical and scientific grounding. ObjectiveThe goal of this study is to effectively model the knowledge, concepts and relationships relevant to the management of a chronic illness like hypertension, and to implement this knowledge model within a mobile self-management application that can be used by patients. MethodsA behaviour modification approach based on COM-B (capability, opportunity, motivation, behaviour) Model and the associated Behaviour Change Wheel was developed. An ontology-based knowledge model was implemented to formally conceptualise relevant knowledge in hypertension clinical practice guidelines, behaviour change models and associated behaviour change strategies. A hypertension management decision support framework was designed and implemented as a proof-of-concept mobile phone application (EmpowerBP) using the aforementioned model. The usability of this pilot application was tested using think-aloud protocol by eight individuals with hypertension while performing predefined tasks. Thematic analysis with inductive thematic coding was performed to identify specific feedback and areas for improvement. ResultsThe most common positive feedback included participants finding application resources interesting or helpful and liking the user interface. The most common negative feedback was finding the included salt calculator confusing or laborious to use and finding the profile creation questionnaire too long. The derived themes were: features, profile creation, resources, scenario, usability, user interface. ConclusionsThe ontology knowledge model formalises variables, properties, and relationships such that they can be used for problem solving. By integrating and computerising complex knowledge from clinical practice guidelines, behaviour change theories, and associated behaviour change strategies, it is possible to model existing information about the management of hypertension as an ontology. This proof-of-concept application creates clinical and behavioural profiles of a user to provide them with personalised management strategies, rooted in established behaviour change theory, that will engage and empower them to manage their condition. Given the nature of ontological models, this approach can be easily modified to address a variety of chronic illnesses.

\u201cIf I\u2019d Known \u2026\u201d\u2014a Theory-Informed Systematic Analysis of Missed Opportunities in Optimising Use of Nicotine Replacement Therapy and Accessing Relevant Support: a Qualitative Study

PurposeNicotine replacement therapy (NRT) is often used suboptimally by smokers. Previous research has focused on cognitions and attitudes as potential reasons. This study drew on theoretical frameworks of behaviour to comprehensively explore smokers’ NRT use to identify new intervention targets.MethodsSemi-structured face-to-face interviews were conducted with 16 adult UK-based smokers and ex-smokers who used NRT in recent quit attempts (mean (SD) age = 34.9(10.3); 82.3% women). The COM-B (capability, opportunity, motivation, behaviour) model and the theoretical domains framework informed the interviews and analyses. Data were analysed in NVivo 11.ResultsTwo related behaviours were identified relevant to NRT use: use of NRT per se and engaging with information and support with NRT use. A meta-theme of “missed opportunity” identified instances when smokers did not or could not engage in these behaviours. For use of NRT per se, these included limited knowledge, poor technique of use, low motivation to optimise use, and lack of role models. For engaging with information and support, they included low awareness of optimal use techniques, selective information-seeking, low expectations, limited exposure to guidelines, deficient advice from healthcare professionals, and suboptimal product display. Prior suboptimal experience tended to negatively affect subsequent use and views. Participants were interested in accessible and comprehensive guidelines on NRT and its use.ConclusionsThere appear to be important missed opportunities for optimal use of NRT both in terms of use itself and engagement with information on optimal use. These missed opportunities arise from a range of capability, motivational, and opportunity-related factors.