Table 3 Focus group examples of applying COM-B classifications to barriers and enablers affecting adoption of diabetes prevention behaviors

An individual’s physical and psychological capacity to engage in the behavior. Includes physical capability (strength, skills, stamina) and psychological capability (knowledge, psychological skills, stamina).

Processes that affect being able to do the behavior at the relevant time and not engage in a competing behavior. Motivation is reflective (self-conscious planning) and evaluation (beliefs about what is good or bad, what will be consequences) and automatic (processes related to wants and needs, desires, reflexes and impulses).

Factors that affect the behavior in the context of the environment both physically and socially. Includes physical opportunity (time, triggers, resources, physical barriers) or social (interpersonal influences, social cues, cultural norms).

Psychological capability

 Knowledge: Women do not know about family friendly low sugar foods they can prepare or how to incrementally lower total sugars.

 Skills: Women lack navigational skills for getting physical activity in their postpartum and post-migration lives- given barriers such as unsafe neighborhoods, isolation, lack of familiarity.

Reflective motivation

 Beliefs: Women do not feel they are ‘supposed’ to focus on exercise for themselves in their roles as mothers (also relates to Social Opportunity, and cultural norms about what mothers can do for ‘themselves’).

 Outcome expectations: Women do not think their family, especially husband or partner, will go along with reductions in meat consumption, so they do not want to try and have conflict about it.

  Beliefs: Women believe that they are the cultural custodians of their family’s traditions about food, and have many ideas about how to eat healthier.

Physical opportunity

 Time: Women feel exhausted and have limited time when they are not caring for others to develop new approaches to preventive behaviors.

 Resources: Women are often food insecure and feel frustrated at the lack of options for healthy foods.

  Resources: Women are often eligible for local programs to access fresh produce that align with their desires for naturalness and healthy foods.

 Access: Women often do not feel they can walk or exercise near their homes which are on crowded streets or in bad neighborhoods.

Physical capability

(none identified)

Automatic motivation

 Reactions to stress: Women often feel stressed about their lives and turn to food to comfort them, often making impulse purchases or eating large portions.

Social opportunity

 Social norms: Women feel pressured by other women who are experienced mothers to introduce solids and reduce breastfeeding if their babies are fussy.

 Cues to action: Women do not have the regular reminders they had during pregnancy to help them with diet and exercise. For most of the women, they had nutritionists or other clinic staff, such as health educators, routinely checking in and prompting women to maintain healthy behaviors.

  Social support: Women often had good experiences with the nutritionist and provider care they received in pregnancy and enjoy discussing healthy eating with others.