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Table 5 Barrier and facilitator themes linked to COM-B constructs and Behaviour Change Wheel intervention functions

From: Barriers and facilitators to implementing evidence-based guidelines in long-term care: a qualitative evidence synthesis

COM-B construct   Theme Behaviour Change Wheel linked potential intervention functions
Physical capability: physical skill, strength, or stamina   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   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
  Involving residents and families
  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