Table 2 Behavioral diagnosis and intervention functions to address change in the COM-B categories among providers and staff
COM-B component | Theoretical domains and constructs | What needs to happen for the target behavior to occur? | Potential candidate intervention functions | Potential behavioral targets (responsible staff) |
|---|---|---|---|---|
Physical capability | Skills | Physical skills to prepare lab slips | Not applicable | None: psychiatrists have physical skills to prepare and distribute lab slips. |
Physical skills to distribute lab slips | ||||
Environmental context and resources | Lab slips need to be readily available | Environmental restructuring | Make sure lab slips are fully stocked in all treatments rooms (clinic staff). | |
Psychiatrists must have access to all relevant laboratory data from the different systems in which they are served | Creation of a registry with laboratory data from several electronic records (clinic staff). | |||
Psychological capability | Knowledge | Psychiatrists need to know and can easily learn what specific metabolic labs to order | Education | Education about metabolic screening guidelines (primary care consultant). |
Education about medications (and side effects) to treat potential metabolic abnormalities (primary care consultant). | ||||
Persuasion | Using colorful and readable visual charts to motivate learning the cutoffs for different normal cardiometabolic levels (primary care consultant creates; clinic staff distributes). | |||
Psychiatrists need to know how to initiate treatment when metabolic abnormalities are identified | Training | Receive instruction on how to read and use the decision charts with algorithms in making treatment decisions (primary care consultant). | ||
Memory | Psychiatrists need to remember the algorithms for treatment | Enablement | Making algorithm decision charts readily available by distributing copies to all psychiatrists, posting copies in all treatment rooms, and making it accessible electronically (primary care consultant creates; clinic staff distributes). | |
Attention and decision processes | Psychiatrists need to have support for treatment decisions | Environmental restructuring | Providing access to a primary care consultant for clinical decision support through the electronic medical record (EMR) system (IT administrator). | |
Social role and identity | Psychiatrists need to believe that it is their role to screen and treat metabolic abnormalities. | Modeling | Medical director participates in trainings and uses algorithms and primary care consultant via EMR system for decision support around managing cardiometabolic lab results (clinic medical director). | |
Physical opportunity | Intentions and goals | Patients need to receive filled out lab slips from psychiatrists. | Enablement | Provide psychiatrists with completed lab slips monthly for patients with labs due and samples of completed lab slips in examination rooms; ensure that examination rooms are fully stocked with lab slips (clinic staff). |
Utilize phlebotomy services that are located near clinic. | Persuasion | Distribute map of identified lab screening locations and transportation route to all patients with labs due to increase motivation to follow through on obtaining labs (clinic staff). | ||
Patients who are disorganized or have physical disabilities should receive assistance to obtain phlebotomy services | Environmental restructuring | Ensure the availability of a peer navigator as a physical resource for assistance with patients that require assistance in obtaining labs (peer navigator). | ||
Social opportunity | Social influences | Staff psychiatrists observe senior health providers ordering and managing metabolic labs. | Modeling | Local clinic medical director participates in and helps with designing the intervention (clinic medical director). |
Psychiatrists need support to manage abnormalities and access to primary care services | Enablement | The intervention has the support of local champions and leadershipin the form of additional resources that aid psychiatrists in managing cardiometabolic labs (clinic medical director). | ||
Reflective motivation | Optimism | Psychiatrists need to believe that regular metabolic lab screening and treatment will lead to better care | Education | Provide education about improved health outcomes after screening and treatment, and give examples from prior studies to show that it is possible for patients with SMI to have metabolic labs managed in community mental health settings (primary care provider). |
Beliefs about consequences | Psychiatrists need to believe that their work will decrease mortality rates among this population | Persuasion | ||
Automatic motivation | Reinforcement | Need an established routine for reminding psychiatrists about labs and providing feedback for following through on labs. | Enablement | Automated system for reminding psychiatrists which patients have labs due (IT administrator). |
Incentivization | Provide regular performance monitoring to show proportion of patients for each provider that receive lab draws over time and reward providers in their efforts to order lab draws in their patients (IT administrator) | |||
Education | Provide information regarding improved health outcomes for patient population (primary care consultant). |