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Table 4 Overview of results: Summary of barriers and facilitators across levels (patient, provider, and service) and theoretical component

From: Application of the COM-B model to barriers and facilitators to chlamydia testing in general practice for young people and primary care practitioners: a systematic review

COM-B Subcomponent Patient Level Provider Level Service Level
Barrier Source Facilitator Source Barrier Source Facilitator Source Barrier Source Facilitator Source
Physical capability      Lack of training and skills [55, 57, 60, 63, 64, 66, 69, 73] Skills-based training [56, 59, 60, 62, 64, 65, 67, 70, 73,74,75] Receptionist involvement [38, 40, 41, 44, 48, 66, 67, 69, 70, 74, 75] Receptionist involvement [38, 40, 41, 44, 48, 66, 67, 69, 70, 74, 75]
         Practice nurse involvement [58,59,60, 71] Practice nurse involvement [55, 58, 59, 63, 66, 69, 71]
Psychological capability Lack of patient education, knowledge, and awareness [51, 55, 60, 73] Increase knowledge, education, and awareness [37, 41, 43, 48, 49, 51, 54, 55, 61, 62, 64, 67, 68, 73] Lack of provider knowledge and awareness [55, 60, 63,64,65,66, 71, 75] Increasing knowledge, awareness, and education [54,55,56, 59, 62, 64, 65, 67, 70, 73, 75] Lack of testing guidance [64] Prompts and reminders [55, 66, 67, 70, 75]
Forgetfulness [41, 48, 75]    Forgetfulness [51, 52, 55, 60, 66, 68, 70, 75]    Lack of knowledge, education, and general awareness [55, 60, 63,64,65,66, 71] Testing guidelines [55, 60]
Reflective motivation Beliefs regarding perceived risk [37, 41, 42, 44,45,46] Beliefs that testing is responsible, mature, and healthy [37, 38] Assumptions and perceptions of patients [53,54,55, 61, 66, 69, 70, 74, 75] Increase confidence [59, 62, 70] Targets set too high [70, 74]   
     Beliefs about consequences of offering [54, 66, 69, 70, 73, 74]    Testing policy: new patients’ health checks [64]   
Automatic motivation Embarrassment and shame [37, 40,41,42,43, 48, 49, 55, 69, 70, 73] and [37, 38, 40, 42, 43] Asymptomatic infection worries [37, 44, 45] Difficult to discuss [52, 60,61,62, 64, 66, 68,69,70, 73, 75]    Testing policy: based on behaviour [41, 48] Reward and incentive programmes [51, 55, 61, 62, 66,67,68,69, 74, 75]
Fear [38, 41,42,43, 48, 50]           
           Feedback on efforts [70, 74, 75]
Physical opportunity Time constraints [40, 41, 48] PCP offering testing [41, 47] Time constraints [51, 52, 55, 57,58,59,60,61,62,63,64, 66, 68,69,70,71,72,73,74,75] Mode of testing [55, 62, 64, 73, 75] Time constraints [40, 41, 48] and [51, 52, 55, 57,58,59,60,61,62,63,64, 66, 68,69,70,71,72,73,74,75] Promotional materials [54, 63, 70, 74, 75]
Receptionist involvement [38, 40, 41, 44, 48, 66, 67, 69, 70, 74, 75] Mode of testing [39,40,41, 44, 48]    Receptionist involvement [38, 40, 41, 44, 48, 66, 67, 69, 70, 74, 75] Reception area [38, 40, 41, 44, 48, 70] and [74, 75] Testing policy: inclusion in other consultations [48, 66, 67]
         Written invitations [61, 67] System to record offers [66]
         Service cost to patient [37, 39, 47, 60] Simplified laboratory systems [59, 62, 66, 68]
         Absence of systems to record test offers [66, 69] Support for partner notification [62, 64, 69]
         Lack of support for partner notification [55, 60, 62,63,64, 73]   
Social opportunity Stigma [37, 38, 40,41,42,43, 55, 61, 71] Normalisation [38, 41,42,43, 61] Practice social norms [66, 73] Normalisation [54, 61, 66, 67, 70, 74] Testing policy: women only [37, 38, 69] Normalisation [52, 54, 55, 61, 63, 66, 67, 70]
     Provider-patient relationship [48, 55, 58, 59, 66, 74] Consultation social context [45, 55, 56, 61, 64, 67, 70, 73] Cultural norms [66, 73] Testing policy: blanket testing [38, 48]
  1. COM-B capability, opportunity, motivation, behaviour