COM-B Model Research Articles

Applying the COM-B Model to Understand the Drivers of Mistreatment During Childbirth: A Qualitative Enquiry Among Maternity Care Staff.

Respectful maternity care (RMC) during childbirth is an integral component of quality of care. However, women's experiences of mistreatment are prevalent in many low- and middle-income countries. This is a complex phenomenon that has not been well explored from a behavioral science perspective. We aimed to understand the behavioral drivers of mistreatment during childbirth among maternity care staff at public health facilities in the Sindh province of Pakistan. Applying the COM-B (capability-opportunity-motivation that leads to behavior change) model, we conducted semistructured in-depth interviews among clinical and nonclinical staff in public health facilities in Thatta and Sujawal, Sindh, Pakistan. Data were analyzed using thematic deductive analysis, and findings were synthesized using the COM-B model. We identified several behavioral drivers of mistreatment during childbirth: (1) institutional guidelines on RMC and training opportunities were absent, resulting in a lack of providers' knowledge and skills; (2) facilities lacked the infrastructure to maintain patient privacy and confidentiality and did not permit males as birth companions; (3) lack of provider performance monitoring system and patient feedback mechanism contributed to providers not feeling appreciated or recognized. Staff bias against patients from lower castes contributed to patient abuse and mistreatment. The perspectives of clinical and nonclinical staff overlapped regarding potential drivers of mistreatment during childbirth. Addressing mistreatment during childbirth requires improving the knowledge and capacity of maternity staff on RMC and psychosocial support to enhance their understanding of RMC. At the health facility level, governance and accountability mechanisms in routine supervision and monitoring of staff need to be improved. Patients' feedback should be incorporated for continuous improvement in providing maternity care services that meet patients' preferences and needs.

Why Do Employers (Fail to) Hire People with Disabilities? A Systematic Review of Capabilities, Opportunities and Motivations

PurposeTo increase the number of people with disabilities in employment, we need to understand what influences employers’ hiring decisions. In this systematic review, we map out factors affecting employers’ hiring decisions about people with disabilities.MethodsThis study is a systematic review that applies the COM-B model to identify factors that contribute to employers (not) hiring people with disabilities. The COM-B model proposes that employers will perform hiring behavior (B) if they have the capability (C), opportunity (O) and motivation (M) to do so. We also investigate if factors have a negative, positive or no effect. We report in accordance with the PRISMA guidelines.ResultsIn a review of 47 studies, we find 32 factors. Most of these factors are barriers. The most frequently mentioned barriers are employers’ (1) expectations that people with disabilities are unproductive, (2) expectations that people with disabilities cost a lot of money, and employers’ (3) lack of knowledge about disabilities. The most researched facilitators for employers to hire people with disabilities include (1) the motivation to help others, (2) working in a large organization, and (3) expecting a competitive advantage. The effect of factors can differ depending on contextual circumstances, including the type of organization, the type of disability and different policies.ConclusionsWe conclude that hiring decisions are influenced by an array of different barriers and facilitators. The effect of these factors can differ across organizations and disability types. Our study of factors affecting hiring can be used by scholars, policy makers, and organizations to create interventions to increase the hiring of people with disabilities.

Development of a tool to support general practitioners to help adolescents with knee pain: an analysis using the Theoretical Domains Framework.

Using the Theoretical Domains Framework (TDF) and COM-B model, this study aimed to determine the facilitators to a support tool for adolescent non-traumatic knee pain in general practice. Many children and adolescents with non-traumatic knee pain consult their general practice. Currently, there are no tools to support general practitioners in the diagnosis and management of this group. There is a need to identify behavioural targets that would facilitate further development and implementation of such a tool. This study was designed as a qualitative study using focus group interviews with 12 medical doctors working in general practice. The semi-structured focus group interviews conducted online and followed an interview guide based on the TDF and COM-B model. Data were analysed via thematic text analysis. One of the biggest challenges from the general practitioner's perspective was how to manage and guide adolescents with non-traumatic knee pain. The doctors had doubts in their capability to diagnose knee pain and saw opportunity to help structure the consultation. The doctors felt motivated to use a tool but considered access a potential barrier. Increasing opportunity and motivation by creating access in the community among general practitioners was considered important. We identified several barriers and facilitators for a support tool for the management of adolescent non-traumatic knee pain in general practice. To align with user needs, future tools should support diagnostic workup, structure the consultation and be easily available among doctors working in general practice.

Using the COM-B model to identify barriers to and facilitators of evidence-based nurse urine-culture practices.

Our surveys of nurses modeled after the Capability, Opportunity, and Motivation Model of Behavior (COM-B model) revealed that opportunity and motivation factors heavily influence urine-culture practices (behavior), in addition to knowledge (capability). Understanding these barriers is a critical step towards implementing targeted interventions to improving urine-culture practices.

The correlation between physical inactivity and students' health based on data mining and related influencing factors.

The sedentary behavior among college students has become one of the most important factors affecting the development of physical and mental health. Chronic lack of physical activity may lead to health problems such as decreased physical fitness, and increased psychological disorders. In the post-epidemic era, it is necessary for college students to have a strong immune system, and a strong body cannot be achieved without regular leisure physical activity. Therefore, it is necessary to explore the relationship between relevant health factors and physical activity. This paper presents an optimized COM-B model. And the experimental results show that the optimized model is well applied in describing the current situation of physical activity participation among college students, analyzing the distribution characteristics of socio-demographic variables related to physical activity, and exploring the correlation between physical activity and the subhealth status of college students.

Systematic development and feasibility testing of a multibehavioural digital prehabilitation intervention for patients approaching major surgery (iPREPWELL): A study protocol.

Improving outcomes for people undergoing major surgery, specifically reducing perioperative morbidity and mortality remains a global health challenge. Prehabilitation involves the active preparation of patients prior to surgery, including support to tackle risk behaviours that mediate and undermine physical and mental health and wellbeing. The majority of prehabilitation interventions are delivered in person, however many patients express a preference for remotely-delivered interventions that provide them with tailored support and the flexibility. Digital prehabilitation interventions offer scalability and have the potential to benefit perioperative healthcare systems, however there is a lack of robustly developed and evaluated digital programmes for use in routine clinical care. We aim to systematically develop and test the feasibility of an evidence and theory-informed multibehavioural digital prehabilitation intervention 'iPREPWELL' designed to prepare patients for major surgery. The intervention will be developed with reference to the Behaviour Change Wheel, COM-B model, and the Theoretical Domains Framework. Codesign methodology will be used to develop a patient intervention and accompanying training intervention for healthcare professionals. Training will be designed to enable healthcare professionals to promote, support and facilitate delivery of the intervention as part of routine clinical care. Patients preparing for major surgery and healthcare professionals involved with their clinical care from two UK National Health Service centres will be recruited to stage 1 (systematic development) and stage 2 (feasibility testing of the intervention). Participants recruited at stage 1 will be asked to complete a COM-B questionnaire and to take part in a qualitative interview study and co-design workshops. Participants recruited at stage 2 (up to twenty healthcare professionals and forty participants) will be asked to take part in a single group intervention study where the primary outcomes will include feasibility, acceptability, and fidelity of intervention delivery, receipt, and enactment. Healthcare professionals will be trained to promote and support use of the intervention by patients, and the training intervention will be evaluated qualitatively and quantitatively. The multifaceted and systematically developed intervention will be the first of its kind and will provide a foundation for further refinement prior to formal efficacy testing.

Australasian Genetic Counselors' Perceptions of Their Role in Supporting Clients' Behavior Change.

Genetic testing does not always change health behavior. Effective behavior change requires a theory-driven coordinated set of activities (behavior change techniques). Genetic counselors are ideally positioned to facilitate behavior change. We aimed to explore genetic counselors' perceptions of their role in supporting clients' behavior change to inform the design of an intervention. Recruitment was via a professional organization and genetics services. Data were collected from 26 genetic counselors via qualitative focus groups/interview. Transcripts were analyzed using thematic analysis and mapped to the COM-B model. We identified three behaviors genetic counselors wanted clients to change: attend appointments, access information, and share information with family members. Strategies for changing clients' behavior included: assessing needs and capabilities, providing information and support, enabling and monitoring behavior change. Barriers included lack of behavior change skills and knowledge, lack of time, and beliefs about ownership of healthcare, directiveness of behavior change, and scope of practice. Equipping genetic counselors to deliver behavior change requires (i) education in behavior change theory and behavior change techniques, (ii) integration of capability, opportunity and motivation assessment into existing practice, and (iii) development of evidence-based strategies using behavior change tools to focus discussions and promote clients' agency to change their behavior.

Psychologically informed oral health interventions in pregnancy and type 2 diabetes: A scoping review.

Oral health is a critical aspect of gestational diabetes management. Gestational diabetes is high blood glucose levels during pregnancy and is managed like type 2 diabetes with diet and physical activity interventions. This scoping review sets out to discuss why oral health support should also become part of gestational diabetes management. The primary objective was to synthesise the existing psychologically informed oral health interventions for pregnant women and individuals with type 2 diabetes, and the extent to which these interventions map on to the COM-B Model. No literature exists on oral health interventions in gestational diabetes, why studies with type 2 diabetes populations were selected instead. The secondary objective was to identify the precise outcomes targeted in the interventions. The Joanna Briggs Institute's Methodology for Scoping Reviews was used to conduct this review. The populations of interest were pregnant women and individuals with type 2 diabetes, and eligible concepts were psychologically informed oral health interventions. Quasi-experimental and experimental designs were considered. The Ovid Interface including Embase, Medline, Global Health, APA PsychInfo, Health Management Information, Maternity, Infant Care Database, the Cochrane Library, and CINAHL was used as information sources. The study selection followed the PRISMA guidelines. The first search was conducted on the week commencing the 25th of July 2022, with a follow-up search conducted on the 10th of October 2022. 28 records were included for synthesis. The most frequently assessed psychological outcome was oral health knowledge and the most frequently assessed oral clinical outcome was Plaque Index. All studies used an educational intervention approach, while psychological capability in the COM-B Model was targeted in all interventions by increasing oral health knowledge among the participants. The Health Belief Model was the most frequently used theory in the interventions. The results demonstrate that oral health is a recognised aspect of pregnancy and type 2 diabetes. The findings from this review and a qualitative interview study which is under development will inform the first oral health intervention for women with gestational diabetes in the United Kingdom.

Assessing the Impacts of Creating Active Schools on Organisational Culture for Physical Activity.

National and international guidance recommends whole-school approaches to physical activity, but there are few studies assessing their effectiveness, especially at an organisational level. This study assesses the impact of the Creating Active School's (CAS) programme on organisational changes to physical activity provision. In-school CAS leads completed a 77-item questionnaire assessing school-level organisational change. The questionnaire comprised 19 domains aligned with the CAS framework and COM-B model of behaviour change. Wilcoxon Signed Rank Tests assessed the pre-to-nine-month change. >70% of schools (n = 53) pre-CAS had inadequate whole-school physical activity provision. After nine months (n = 32), CAS had a significant positive effect on organisational physical activity. The positive change was observed for: whole-school culture and ethos, teachers and wider school staff, academic lessons, physical education (PE) lessons, commute to/from school and stakeholder behaviour. This study provides preliminary evidence that CAS is a viable model to facilitate system-level change for physical activity in schools located within deprived areas of a multi-ethnic city. To confirm the results, future studies are required which adopt controlled designs combined with a holistic understanding of implementation determinants and underlying mechanisms.

1178. Opportunities and Challenges to Emergency Department-Based HIV Testing Services and Self-Testing Programs: A Qualitative Study of Healthcare Providers and Patients in Kenya

Abstract Background Young people in Sub-Saharan Africa, especially males, have been insufficiently engaged through HIV Testing Services (HTS). In Kenya, younger persons are often treated in emergency departments (EDs) for injuries, an interaction where HTS and HIV self-testing (HIVST) can be leveraged. Data from stakeholders on ED-HTS and HIVST is lacking and needed to understand opportunities and barriers for HIV testing and care, and inform program implementation. Methods Between December 2021 and March 2022, 32 in-depth interviews (IDIs) were conducted with 16 male and 16 female patients who had been treated in the Kenyatta National Hospital (KNH) ED, half of whom had been HIV-tested. Six focus-group discussions (FGDs) were also conducted with 50 nurses, doctors, HIV testing counselors, and administrators working in the ED. All transcripts were double-coded and thematically analyzed using Dedoose software and a parallel inductive and deductive coding approach which allowed for capture of both a priori and emergent themes. Results Patients and providers agreed that ED-HTS are facilitated by friendly staff, patient education, high perceived HIV risk, and confidentiality. However, ED-HTS is limited by burdens on staff, resources, time, and space, as well as severity of patient injuries limiting ability to consent to or prioritize HIV testing. These limitations provide opportunities for ED-HIVST: particularly the ability to test at a comfortable time and place, especially when provided alongside sufficient HIV and testing education, contact with healthcare providers, and psychosocial support. Barriers for ED-HIVST where identified and as patients’ concerns about HIVST accuracy and mental health impacts of a positive test, as well providers’ identified barriers on their concerns for loss to follow up and inability to complete confirmatory testing. COM-B Model Application of the COM-B Model of Behavior Change to ED-HIVST Acceptability in Kenya Conclusion ED stakeholders are receptive to HTS and HIVST, and patients desire the opportunity to use HIVST. Potential challenges—such as psychological effects of testing positive, worries about access to follow-up care, and confusion about how to self-administer testing, may be addressed through programming designed to promote education, access and ensure follow-up mechanisms. Disclosures All Authors: No reported disclosures.

Digital Engagement of Older Adults: Scoping Review

Digital technologies facilitate everyday life, social connectedness, aging at home, well-being, and dignified care. However, older adults are disproportionately excluded from these benefits. Equal digital opportunities, access, and meaningful engagement require an understanding of older adults' experience across different stages of the technological engagement life cycle from nonuse and initial adoption to sustained use, factors influencing their decisions, and how the experience changes over time. Our objectives were to identify the extent and breadth of existing literature on older adults' perspective on digital engagement and summarize the barriers to and facilitators for technological nonuse, initial adoption, and sustained digital technology engagement. We used the Arksey and O'Malley framework for the scoping review process. We searched MEDLINE, PsycINFO, CINAHL, Web of Science, and ACM digital library for primary studies published between 2005 and 2021. The inclusion and exclusion criteria were developed based on the Joanna Briggs Institute (participants, content, and context) framework. Studies that investigated the digital engagement experience as well as barriers to and facilitators of older adults' digital technology engagement were included. The characteristics of the study, types of digital technology, and digital engagement levels were analyzed descriptively. Content analysis was used to generate tentative elements using a congruent theme, and barriers and facilitators were mapped over the capability, opportunity, and motivation behavior change model (COM-B) and the theoretical domain framework. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). In total, 96 publications were eligible for the final charting and synthesis. Most of the studies were published over the past 5 years, investigated the initial adoption stage of digital engagement, and focused on everyday technologies. The most cited barriers and facilitators across the engagement stages from each COM-B component were capability (eg, physical and psychological changes and lack of skill), opportunity (eg, technological features, environmental context, and resources), and motivation (eg, optimism from perceived usefulness and beliefs about capability). The COM-B model and theoretical domain framework provide a guide for identifying multiple and intertwined barriers and facilitators at each stage of digital engagement. There are limited studies looking into the whole spectrum of older adults' digital technology experience; in particular, studies on technological nonuse and sustained use stages are rare. Future research and practice should focus on tailored interventions accounting for the barriers to older adults' digital engagement and addressing capabilities, motivation, and opportunities; affordable, usable, and useful digital technologies, which address the changes and capability requirements of older adults and are cocreated with a value framework; and lifelong learning and empowerment to develop older adults' knowledge and skills to cope with digital technology development. RR2-10.2196/25616.

Patient engagement as a core element of translating clinical evidence into practice- application of the COM-B model behaviour change model

Background The results of rehabilitation trials are often not fully attained when the intervention is implemented beyond the initial trial. One of the key reasons is that a patients’ ability and/or capacity to take part in their own healthcare is not considered in the trial design yet has significant impact on the outcomes during the implementation phase. Body of text We propose a shift from a therapist-focus to patient-focus in trial design, through addressing patient engagement as a core consideration in trials. We argue that engaging patients in any rehabilitation program is a process of behavioural change. Exercise prescription is used as an example to illustrate how the Behaviour Change Wheel can be applied to analyse barriers and facilitators associated with patients’ capabilities, opportunities and motivations in integrating trial interventions into their daily life. We propose a framework to assist in this shift. Conclusion A core part of implementing rehabilitation interventions at the primary care level requires patient engagement. Related aspects of interventions should be identified and assessed using the COM-B model at the outset of trial design to ensure that the results are realistic, meaningful and transferable, so as to enable real impact.

Understanding the real-time interaction between middle-aged consumers and online experts based on the COM-B model

This paper presents a study of middle-aged online consumers’ specific shopping behaviour on live streaming platforms and analyses the distinct marketing strategy provided by online experts. Influenced by unique social and cultural backgrounds, middle-aged online consumers lack related shopping experience and keep counterfeiting concerns to live streaming shopping, making them prefer to interact with online experts before making final decisions. Based on the COM-B Behaviour Changing theory and the Emotional attachment theory, the research model has been established in this study, and it divides influencing factors into the Emotion unit, Opportunity unit and Capability unit. To test the relationships between influencing factors and middle-aged online consumers’ interactive motivation, the partial least-squares path modelling and variance-based structural equation modelling (PLS-SEM) have been applied on the SmartPLS. By analysing 450 samples, the study shows that the counterfeiting concern and ease of use factors positively impact online consumers’ motivation to interact with online experts, and self-efficacy plays a negative role.

Combination of Radiomics Features and Functional Radiosensitivity Enhances Prediction of Acute Pulmonary Toxicity in a Prospective Validation Cohort of Patients with a Locally Advanced Lung Cancer Treated with VMAT-Radiotherapy.

The standard of care for people with locally advanced lung cancer (LALC) who cannot be operated on is (chemo)-radiation. Despite the application of dose constraints, acute pulmonary toxicity (APT) still often occurs. Prediction of APT is of paramount importance for the development of innovative therapeutic combinations. The two models were previously individually created. With success, the Rad-model incorporated six radiomics functions. After additional validation in prospective cohorts, a Pmap-model was created by identifying a specific region of the right posterior lung and incorporating several clinical and dosimetric parameters. To create and test a novel model to forecast the risk of APT in two cohorts receiving volumetric arctherapy radiotherapy (VMAT), we aimed to include all the variables in this study. In the training cohort, we retrospectively included all patients treated by VMAT for LALC at one institution between 2015 and 2018. APT was assessed according to the CTCAE v4.0 scale. Usual clinical and dosimetric features, as well as the mean dose to the pre-defined Pmap zone (DMeanPmap), were processed using a neural network approach and subsequently validated on an observational prospective cohort. The model was evaluated using the area under the curve (AUC) and balanced accuracy (Bacc). 165 and 42 patients were enrolled in the training and test cohorts, with APT rates of 22.4 and 19.1%, respectively. The AUCs for the Rad and Pmap models in the validation cohort were 0.83 and 0.81, respectively, whereas the AUC for the combined model (Comb-model) was 0.90. The Bacc for the Rad, Pmap, and Comb models in the validation cohort were respectively 78.7, 82.4, and 89.7%. The accuracy of prediction models were increased by combining radiomics, DMeanPmap, and common clinical and dosimetric features. The use of this model may improve the evaluation of APT risk and provide access to novel therapeutic alternatives, such as dose escalation or creative therapy combinations.

Ethical preparedness in health research and care: the role of behavioural approaches

BackgroundPublic health scholars have long called for preparedness to help better negotiate ethical issues that emerge during public health emergencies. In this paper we argue that the concept of ethical preparedness has much to offer other areas of health beyond pandemic emergencies, particularly in areas where rapid technological developments have the potential to transform aspects of health research and care, as well as the relationship between them. We do this by viewing the ethical decision-making process as a behaviour, and conceptualising ethical preparedness as providing a health research/care setting that can facilitate the promotion of this behaviour. We draw on an implementation science and behaviour change model, COM-B, to demonstrate that to be ethically prepared requires having the capability (ability), opportunity, and motivation (willingness) to work in an ethically prepared way.MethodsWe use two case examples from our empirical research—one pandemic and one non-pandemic related—to illustrate how our conceptualisation of ethical preparedness can be applied in practice. The first case study was of the UK NHSX COVID-19 contact tracing application case study involved eight in-depth interviews with people involved with the development/governance of this application. The second case involved a complex case regarding familial communication discussed at the UK Genethics Forum. We used deductive qualitative analysis based on the COM-B model categories to analyse the transcripbed data from each case study.ResultsOur analysis highlighted that being ethically prepared needs to go beyond merely equipping health professionals with skills and knowledge, or providing research governance actors with ethical principles and/or frameworks. To allow or support these different actors to utilise their skills and knowledge (or principles and frameworks), a focus on the physical and social opportunity is important, as is a better understanding the role of motivation.ConclusionsTo understand ethical preparedness, we need to view the process of ethical decision-making as a behaviour. We have provided insight into the specific factors that are needed to promote this behaviour—using examples from both in the pandemic context as well as in areas of health research and medicine where there have been rapid technological developments. This offers a useful starting point for further conceptual work around the notion of being ethically prepared.

Implementing best practice occupational therapist-led environmental assessment and modification to prevent falls: A qualitative study of two regional and rural public health services in Australia.

Occupational therapist-led environmental assessment and modification (EAM) is effective in reducing falls for populations at high risk. Two regional and rural public health services in Queensland devised an implementation strategy to embed best practice occupational therapist-led EAM. A qualitative study was conducted to compare the determinants of implementation success across the different health services, using the COM-B model of behaviour change. Six semi-structured interviews were completed with occupational therapists involved at each site, following 12 months of implementation. Interview data were triangulated with minutes from three combined site steering committee meetings, eight local steering committee meetings, and field notes. Thematic analysis was completed to compare barriers and facilitators to best practice uptake of EAM and differences in outcomes between the two sites. Both sites commenced implementation with similar states of capability and motivation. After 12 months, one site considered that practice change had been embedded as noted in steering committee minutes and comments; however, the other site observed limited progress. According to the COM-B analysis, opportunity (the factors that lie outside the individual's control) had a significant influence on how both sites were able to respond to the practice change and navigate some of the unexpected challenges that emerged, including the COVID-19 pandemic. Existing team structure, multiple responsibilities of key stakeholders, differences in access to resources, and lack of connection between complementary services meant that COVID-19 disruptions were only a catalyst for unveiling other systemic issues. This study highlights the power of external factors on influencing behaviour change for best practice implementation. Learnings from the study will provide deeper understanding of completing implementation projects in regional and rural contexts and support the future implementation of EAM in occupational therapy clinical settings.

Exploring human behavior change in equine welfare: Insights from a COM-B analysis of the UK's equine obesity epidemic.

While equine obesity is understood by equine professionals to be a serious and widespread welfare problem, thus far approaches to reducing the prevalence of obesity in the UK's leisure horses have mainly been limited to educating owners about the dangers of obesity in their horses. In human health, approaches to behavior change encourage holistic thinking around human behavior, recognizing the importance of the connection between the individuals' knowledge, attitudes, habits, and the social and physical environments. This study used qualitative data from interviews with horse owners and professionals, open-access discussion fora and focus groups in order to collate extensive information about the factors shaping the UK's equine obesity crisis. The data were initially analyzed using a grounded theory method to determine the common themes, and were then analyzed using the COM-B model of behavior change, in order to identify areas where human behavior change might be better supported. The analysis highlighted the importance of a holistic approach to behavior change, since all areas of the COM-B were important in limiting owners' recognition of, and response to, equine obesity. For example, environments and social norms limited the likelihood of owners proactively managing horse weight, and owners also found it difficult to identify overweight horses, and evaluate the risks of long-term health issues as a result of weight, with short-term negative impacts of weight management. While interventions often aim to educate owners into changing their behavior, this analysis highlights the importance of creative and holistic approaches which work alongside the owners' motivations, while shaping the social and physical environments.

Exploring the challenges to safer prescribing and medication monitoring in prisons: A qualitative study with health care staff.

Research suggests that patients who are prisoners experience greater morbidity, increased health inequalities and frequent preventable harm, compared to the general population. Little is known about the process and influencing factors for safe prescribing in the unique prison environment, which may limit the development efforts to improve the quality of care in prisons. This study aimed to understand the process and challenges associated with prescribing in prisons, explore the causes and impact of these challenges, and explore approaches to improve prescribing safety in prisons. Grounded theory informed data collection and analysis of a nominal group discussion by seven participants and semi-structured telephone interviews with twenty prison healthcare staff, including GPs, pharmacists, psychiatrists and nurses. The underlying complexity of prescribing in prison settings increased the level of challenge and influenced the safety of this process. Multiple contributors to the challenges of safe prescribing were identified (comprising governance and policy; the prison structure; staff retention, training and skill mix; IT systems and interface; polypharmacy and co-morbidity; tradability and patient behaviour) with overarching constructs of variations in practice/policy and the influence of prison culture. Participants identified measures to address these challenges through multi-disciplinary collaborative working, increased consistency in processes, and the need for more innovation and education/training. Our study highlighted that healthcare provision in prisons is unique and needs to tailor the care provided to patients without enforcing a model focused on primary, secondary or tertiary care. Participants emphasised a necessary shift in workplace culture and behaviour change to support improvements. The COM-B model of behaviour change may be effectively applied to develop interventions in organisations that have in-depth understanding of their own unique challenges.

Mobile phone-based lifestyle support for families with young children in primary health care (MINISTOP 2.0): Exploring behavioral change determinants for implementation using the COM-B model.

Obesity in childhood is a public health concern worldwide and mobile phone-based interventions (mHealth) has shown to facilitate obesity prevention. However, more research is needed on the implementation of digital tools in routine primary care. This study explored behavior change determinants for implementing a health promotion mHealth intervention (MINISTOP 2.0 app) targeting parents of 4-year-olds. Secondary data from telephone interviews (n = 15) with child health care nurses working within primary child healthcare in Sweden was analyzed using directed content analysis and the COM-B model. Barriers for implementation included: limited knowledge about using technology and reservations about how and to what extent parents would use mHealth. Potential facilitators included nurses' openness to learn and try new tools, confidence in their role and engagement in reaching parents as well as beliefs that the app could improve practice by prompting dialogue and being a shared platform. Nurses expressed a strong professional identity and shared understanding of their practice, mechanisms that could potentially inhibit or facilitate implementation. Findings suggest cautious optimism regarding implementing mobile phone-based tools in child primary healthcare in terms of capability, opportunity and motivation among stakeholders. Implementation strategies such as educational outreach visits and making the intervention testable among stakeholders could further facilitate implementation in this clinical context. However, more research is needed on behavior change determinants in different stages of real-world implementation.

Applying the COM-B model to understand wearable activity tracker use in children and adolescents

AimWearable activity trackers (wearables) are increasingly popular intervention tools for increasing child and adolescent physical activity (PA) levels. However, the large-scale habitual use of wearables in children and adolescents is unknown. This study investigated the prevalence of wearable use in children and adolescents, and what factors impact their use.Subjects and methodsThis study utilised a cross-sectional survey and the ‘Capability, Opportunity, Motivation and Behaviour’ (COM-B) model was applied to explore what child/adolescent and parental characteristics impact wearable use. Parents/guardians of 5- to 17-year-olds were invited to complete the survey. The survey was open internationally, and consisted of between 19 and 23 questions, depending on child/adolescent wearable use. Multinomial logistic regression analyses were conducted to explore variables impacting wearable use, in children (5 to 9 years) and adolescents (10 to 17 years).ResultsThe survey was completed by 652 parents, representing 831 children/adolescents. Most children/adolescents had never used a wearable (n = 429; 51.6%), and 252 (30.3%) and 150 (18.1%) currently or had previously used a wearable, respectively. Child age and sex, capability, opportunity and motivation for PA were associated with wearable use, and differences were present between child (5 to 9 years) and adolescent (10 to 17 years) wearable use.ConclusionsThis study offers a novel contribution to the understanding of child and adolescent habitual wearable use, and what impacts wearable use in these age groups.