Table 5 Barrier and facilitator themes linked to COM-B constructs and Behaviour Change Wheel intervention functions
COM-B construct | Â | Theme | Behaviour Change Wheel linked potential intervention functions |
|---|---|---|---|
Physical capability: physical skill, strength, or stamina | Â | None | None |
Psychological capability: knowledge or psychological skills, strength or stamina to engage in the necessary mental processes | Barriers | Knowledge gaps | Education Training Environmental restructuring Modelling Enablement |
Facilitators | Adequate knowledge and education | ||
Physical opportunity: opportunity afforded by the environment involving time, resources, locations, cues, physical affordance | Â | Time constraints and inadequate staffing | Training Restriction Environmental restructuring Enablement |
Barriers | Cost and lack of resources | ||
Resident complexity | |||
Compromised communication and information flow | |||
Staff turnover | |||
Competing priorities | |||
Guideline complexity and associated workload | |||
Healthcare system structure | |||
Limited physical environment | |||
Conflicting guidelines | |||
Impractical guideline | |||
Facilitators | Well-designed strategies, protocols, and resources | ||
Adequate services, resources, and time | |||
Innovative environmental modifications | |||
Social opportunity: opportunity afforded by the interpersonal influences, social cues and cultural norms that influence the way that we think about things | Barriers | Lack of teamwork | Restriction Environmental restructuring Modelling Enablement |
Lack of organizational support | |||
Inconsistent practices | |||
Reactive approach | |||
Facilitators | Leadership and champions | ||
Support and coordination among staff | |||
| Â | Involving residents and families | ||
| Â | Good communication and information flow | ||
Reflective motivation: reflective processes involving plans (self-conscious intentions) and evaluations (beliefs about what is good and bad) | Barriers | Conflict with clinical autonomy | Education Persuasion Modelling Enablement Incentivisation Coercion |
Belief against the guideline | |||
Moral distress Lack of noticeable outcomes from guideline implementation | |||
Facilitators | Noticeable outcomes from guideline implementation | ||
Conviction that the guideline is evidence-based and will demonstrate improvement | |||
Automatic motivation: automatic processes involving emotional reactions, desires (wants and needs), impulses, inhibitions, drive states and reflex responses | Barriers | Reluctance to change | Training Incentivisation Coercion Environmental restructuring Persuasion Modelling Enablement |
Emotional responses to work and confidence in skills | |||
Simultaneous changes or change fatigue | |||
Facilitators | Positive emotional responses to work and the intervention |