Application of the Behaviour Change Wheel Framework to the development of interventions within the City4Age project

The probability of an intervention being effective is likely increased if it is designed following a behavioural analysis and with the aid of evidence-based intervention frameworks. For example, the Behaviour Change Wheel (BCW) framework and its associated COM-B model of behaviour have been used successfully as a starting point for designing behaviour change interventions. However, the BCW framework can also be applied at a later stage in the design process, such as when an intervention has been designed but before it is deployed. Here we describe the application of the BCW framework and COM-B model to evaluate and refine already designed interventions. We use a multidisciplinary multi-site project (‘City4Age’) as a case study. The project aims to promote independent living of older adults through the deployment of interventions using wearable and environment-based technology. We conducted face-to-face interviews with site representatives to identify the target behaviours, perceived barriers and facilitators, intervention functions, and modes of delivery for each planned intervention. Additionally, literature reviews were conducted to identify evidence-based facilitators and barriers for each targeted behaviour. Subsequently, we 1) compared the intervention functions proposed by the project-sites with those most likely to be effective according to the BCW; and 2) assessed the congruency of the barriers and facilitators identified by the pilot-sites with those identified in the literature. For five planned interventions across two project-sites (Birmingham and Singapore), two had intervention functions unlikely to be effective according to the BCW. The two planned interventions to promote social engagement did not address barriers or facilitators evident in the literature, indicating they required refinement. Applying the BCW framework allowed to identify which interventions needed refining. It also helped in providing specific guidance in our recommendations for improvements prior to deployment

Providing information on mental well-being during audiological consultations : exploring barriers and facilitators using the COM-B model

OBJECTIVE : To identify the barriers and facilitators of hearing healthcare clinicians (HHC) providing information to audiology consumers on (i) the mental health impacts of hearing loss, and (ii) management options for improving mental well-being. DESIGN : A qualitative study using semi-structured individual and group interviews. Both the interview guide and the deductive process of data analysis were based on the COM-B model (Capabilities, Opportunities and Motivations required for Behaviour change). STUDY SAMPLE : Fifteen HHCs with between 2 and 25 years of clinical experience (mean 9.3). RESULTS : Psychological Capability barriers included lack of knowledge relating to mental health signs and symptoms, management options available, referral processes, and resources/tools to assist discussion of options. Social opportunity barriers included clients’ lack of openness to receive mental health-related information from their HHC. Automatic motivation factors included feeling uncomfortable and helpless when discussing mental health. Reflective motivation factors included clinician’s limiting beliefs concerning their role and responsibilities regarding provision of mental health support, and doubts about whether mental health services are truly beneficial for clients with hearing loss. CONCLUSION : Application of the COM-B model for behaviour change identified factors that need to be addressed to increase the provision of mental health information in the audiology setting.The Raine Medical Research Foundation through a Raine Priming grant.https://www.tandfonline.com/loi/iija20hj2023Speech-Language Pathology and Audiolog

Connecting primary care patients to community-based physical activity:a qualitative study of health professional and patient views

Funding: NHS Fife Endowment Fund Grant which was awarded as part of a larger project (FIF142).Background Inconclusive evidence supporting referrals from health professionals to gym-based exercise programmes has raised concern for the roll-out of such schemes, and highlights the importance of developing links between healthcare settings and community-based opportunities to improve physical activity (PA) levels. Aim This study aimed to identify methods, and explore barriers and facilitators, of connecting primary care patients with PA opportunities from the perspectives of both health professionals (HPs) and patients, using the example of jogs cotland. Design & setting An exploratory study utilising semi-structured interviews with primary care patients (n = 14) and HPs (n = 14) from one UK NHS board was conducted. Method Patient and HP transcripts were analysed separately using thematic analysis. Potential methods of connection were identified. The Capability, Opportunity, Motivation, behavioural (COM-B) model and theoretical domains framework (TDF) were employed to facilitate identification of barriers and facilitators for connecting primary care to community jogscotland groups. Results Three methods of connecting patients to community-based groups were identified: informal passive signposting, informal active signposting, and formal referral or prescribing. Barriers and facilitators for patient connection fell into five TDF domains for HPs and two COM-B model components for patients. Conclusion For patients, HPs raising the topic of PA can help to justify, facilitate, and motivate action to change. The workload associated with connecting patients with community-based opportunities is central to implementation by HPs. Integrative resource solutions and social support for patients can provide a greater variety of PA options and the vital information and support for connecting with local opportunities, such as jogscotland.Publisher PDFPeer reviewe

Can a mock medication-taking learning activity enable pharmacy students to experience the range of barriers and facilitators to medication adherence? An analysis informed by the Theoretical Domains Framework and COM-B model

Background: Pharmacy professionals are well-placed to provide medication adherence support to patients. The Capability, Opportunity, Motivation-Behaviour (COMsingle bondB) and Theoretical Domains Framework (TDF) are two complementary models previously applied to medication-taking behaviour. Understanding the patient-specific barriers and facilitators to adherence using psychological frameworks from the early stages of pharmacy education enables the design and delivery of effective interventions. Objectives: To examine whether a novel ‘mock medicine’ learning activity enabled students to experience the range of barriers and facilitators to medication adherence using the COM-B and TDF. Methods: A mock medicine activity was conducted with students at pharmacy schools in three universities in the UK, Norway, and Australia over one week. Percentage adherence was calculated for five dosing regimens; theoretical framework analysis was applied to map reflective statements from student logs to COM-B and TDF. Results: A total of 349 students (52.6%) returned completed logs, with high overall mean adherence (83.5%, range 0–100%). Analysis of the 277 (79.4%) students who provided reflective statements included barriers and facilitators that mapped onto one (9%), two (29%) or all three (62%) of the COM-B components and all fourteen TDF domains (overall mean = 4.04; Uni 1 = 3.72; Uni 2 = 4.50; Uni 3 = 4.38; range 1–8). Most frequently mapped domains were ‘Environmental context and resources’ (n = 199; 72%), ‘Skills’ (n = 186; 67%), ‘Memory, attention and decision-making’ (184; 66%) and ‘Beliefs about capabilities’ (n = 175; 63%). Conclusions: This is the first study to utilise both COM-B and TDF to analyse a proxy measure of medication adherence in pharmacy education. Data mapping demonstrated that students experienced similar issues to patients when prescribed a short course of medication. Importantly, all the factors influencing medication-taking reported by students were captured by these two psychological frameworks. Future educational strategies will involve students in the mapping exercise to gain hands-on experience of using these psychological constructs in practice

Barriers and Facilitators of midwives' physical activity behaviour in hospital and community contexts in Scotland

Aims To investigate barriers and facilitators of physical activity in midwives in hospital and community environments. Design A sequential mixed‐methods approach. Data Sources Focus groups and subsequent questionnaire survey. Methods Four focus groups were conducted in urban and rural areas with community and hospital‐based midwives in Scotland in 2015. Topics were based on the behaviour change theories via the Theoretical Domains Framework. Findings informed development of a questionnaire, sent to midwives in 2016 in Scottish health boards via managers, or online survey. Results Thirty‐three midwives participated in focus groups. Workplace environmental context and resources were both barriers and facilitators. Similarly, negative social influences were barriers, whereas positive social support facilitated physical activity. The questionnaire was completed by 345 midwives. Most (90%) were physically active with high levels of activity. Commonest activities included walking, swimming and housework. Physical activity facilitators included subsidized classes and protected breaks. Barriers included tiredness, stress, family responsibilities, unpredictable breaks and shift patterns. Conclusions Interventions should address midwives’ workplace context and resources and interpersonal factors such as stress and social support. Impact Midwives’ high levels of overweight/obesity and stress impact on their own health and delivery of patient care. More workplace physical activity could help. We found most were physically active but identified workplace barriers and facilitators, including resources, shift patterns and breaks. Findings could help midwifery managers to recognize and reduce barriers, thereby improving midwives’ physical activity in the workplace, supporting weight management and enhancing their health and well‐being

From benzos to berries: treatment offered at an Aboriginal youth solvent abuse treatment centre relays the importance of culture.

First Nations and Inuit youth who abuse solvents are one of the most highly stigmatized substance-abusing groups in Canada. Drawing on a residential treatment response that is grounded in a culture-based model of resiliency, this article discusses the cultural implications for psychiatry's individualized approach to treating mental disorders. A systematic review of articles published in The Canadian Journal of Psychiatry during the past decade, augmented with a review of Canadian and international literature, revealed a gap in understanding and practice between Western psychiatric disorder-based and Aboriginal culture-based approaches to treatment and healing from substance abuse and mental disorders. Differing conceptualizations of mental health and substance abuse are discussed from Western psychiatric and Aboriginal worldviews, with a focus on connection to self, community, and political context. Applying an Aboriginal method of knowledge translation-storytelling-experiences from front-line workers in a youth solvent abuse treatment centre relay the difficulties with applying Western responses to Aboriginal healing. This lends to a discussion of how psychiatry can capitalize on the growing debate regarding the role of culture in the treatment of Aboriginal youth who abuse solvents. There is significant need for culturally competent psychiatric research specific to diagnosing and treating First Nations and Inuit youth who abuse substances, including solvents. Such understanding for front-line psychiatrists is necessary to improve practice. A health promotion perspective may be a valuable beginning point for attaining this understanding, as it situates psychiatry's approach to treating mental disorders within the etiology for Aboriginal Peoples

Perceived barriers and facilitators to breaking up sitting time among desk-based office workers: a qualitative investigation using the TDF and COM-B

High amounts of sedentary behaviour, such as sitting, can lead to adverse health consequences. Interventions to break up prolonged sitting in the workplace have used active workstations, although few studies have used behaviour change theory. This study aimed to combine the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation to Behaviour system (COM-B) to investigate perceived barriers and facilitators to breaking up sitting in desk-based office workers. Semi-structured interviews with 25 desk-based employees investigated barriers and facilitators to breaking up sitting in the workplace. Seven core inductive themes were identified: ‘Knowledge-deficit sitting behaviour’, ‘Willingness to change’, ‘Tied to the desk’, ‘Organisational support and interpersonal influences’, ‘Competing motivations’, ‘Emotional influences’, and ‘Inadequate cognitive resources for action’. These themes were then deductively mapped to 11 of the 14 TDF domains and five of the six COM-B constructs. Participants believed that high amounts of sitting had adverse consequences but lacked knowledge regarding recommendations and were at times unmotivated to change. Physical and social opportunities were identified as key influences, including organisational support and height-adjustable desks. Future research should identify intervention functions, policy categories and behaviour change techniques to inform tailored interventions to change sitting behaviour of office workers

Activating waitlists: identifying barriers and facilitators to pain self-management while waiting

Objectives Waitlists for pain management services are often extensive, risking psychological and physical decline and patient non-engagement in treatment once accessed. Currently, for outpatient pain management, no standardised waiting list interventions exist, resulting in passive waiting. To arrest prospective wait-related decline(s), this study aimed to identify the barriers and facilitators to pain self-management while waiting, forming the foundation for a waitlist intervention development. Design An inductive qualitative approach was utilised to explore the barriers and drivers of pain self-management while waiting for chronic pain management. Method Semi-structured interviews, underpinned by the Theoretical Domains Framework and COM-B model, were conducted with people waiting for pain management services ( N = 38). Interviews were audio-recorded, transcribed verbatim, and analysed via reflexive thematic analysis. Results The analysis demonstrated four thematised barriers and one facilitator: (1) Shunted Around the System (barrier); (2) The Information Gap (barrier); (3) Resisting Adaptation ( barrier); (4) Losing Hope ( barrier); and (5) Help Yourself or Lose Yourself (facilitator). Conclusion This study demonstrates the severe emotional and motivational impact of waiting, increasing treatment disengagement. The waitlist represents a prime opportunity for prehabilitation to protect wellbeing and optimise self-management engagement. Infrastructural and interpersonal barriers of poor communication and healthcare professional pain invalidation must be addressed to improve emotional wellbeing and motivation to engage with planned treatment. Enhancing self-efficacy, pain acceptance, self-compassion, and internal HLOC are fundamental to increasing pain self-management. These can all be met within a prehabilitation framework. This study is foundational for the development of psychological prehabilitation in outpatient chronic pain management

Barriers and Facilitators to Implementing the CURE Stop Smoking Project: A Qualitative Study.

Background The Conversation, Understand, Replace, Experts and evidence-based treatment (CURE) project aims to provide a comprehensive offer of both pharmacotherapy and specialist support for tobacco dependence to all smokers admitted to hospital and after discharge. CURE was recently piloted within a single trust in Greater Manchester, with preliminary evidence suggesting this intervention may be successful in improving patient outcomes. Plans are currently underway to pilot a model based upon CURE in other sites across England. To inform implementation, we conducted a qualitative study, which aimed to identify factors influencing healthcare professionals’ implementation behaviour within the pilot site. Methods Individual, semi-structured telephone interviews were conducted with 10 purposively sampled health professionals involved in the delivery and implementation of the CURE project pilot. Topic guides were informed by the Theoretical Domains Framework (TDF). Transcripts were analysed in line with the framework method, with data coded to TDF domains to highlight important areas of influence and then mapped to the COM-B to support future intervention development. Results Eight TDF domains were identified as important areas influencing CURE implementation; ‘environmental context and resources’ (physical opportunity), ‘social influence’ (social opportunity), ‘goals’, ‘professional role and identity’ and ‘beliefs about consequences’ (reflective motivation), ‘reinforcement’ (automatic motivation), ‘skills’ and ‘knowledge’ (psychological capability). Most domains had the potential to both hinder and/or facilitate implementation, with the exception of ‘beliefs about consequences’ and ‘knowledge’, which were highlighted as facilitators of CURE. Participants suggested that ‘environmental context and resources’ was the most important factor influencing implementation; with barriers most often related to challenges integrating into the wider healthcare context. Conclusions This qualitative study identified multi-level barriers and facilitators to CURE implementation. The use of theoretical frameworks allowed for the identification of domains known to influence behaviour change, and thus can be taken forward to develop targeted interventions to support future service implementation. Future work should focus on discussing these findings with a broad range of stakeholders, to ensure resultant intervention strategies are feasible and practicable within a healthcare context. These findings complement wider evaluative work to support nationwide roll out of NHS funded tobacco dependence treatment services in acute care trusts

The barriers and facilitators to stopping inappropriate medicines ('deprescribing') for older people living in care homes

Background: UK care home residents are prescribed an average of 8-10 medicines daily with evidence that inappropriate prescribing is prevalent leading to problematic polypharmacy. This increases the risk of adverse drug events that negatively affect resident outcomes, quality-of-life and have financial costs to the NHS. Deprescribing (the cessation of inappropriate medicines) can reduce inappropriate prescribing, however, there are significant barriers to its implementation in this setting. Identifying and understanding barriers and facilitators of stopping inappropriate medicines is necessary to improve the implementation of deprescribing in care homes. Methods: A literature review was conducted to synthesise existing evidence. Semi-structured interviews were conducted with residents, relatives, care home staff, GPs and pharmacists. Themes and explanations were developed using Framework Analysis. Theoretical models of behaviour change were applied to identify candidate components for a novel intervention for deprescribing in care homes. Findings: The literature review highlighted a lack of evidence regarding residents’ and relatives’ attitudes to deprescribing, and a lack of depth regarding barriers and facilitators to deprescribing. Three themes were identified from the empirical data: 1) individuals involved in the deprescribing process; 2) social barriers; 3) logistical barriers. Theme 1 highlighted the complexity of the deprescribing process and themes 2&3 identified and explained systematic barriers and facilitators to deprescribing. Social barriers included a reluctance to discuss life expectancy and healthcare professionals’ perceptions of residents and relatives. Logistical barriers included the unavailability of key stakeholders and navigating health and social care systems. Potential intervention components included; demonstrating the behaviour of deprescribing, providing feedback on its outcomes plus provision of prompts. Conclusions: This thesis has provided novel, in-depth explanation and insight of the barriers and facilitators to deprescribing from the perspective of key stakeholders. This was utilised to identify potential components of a deprescribing behaviour change intervention for implementation and evaluation in care homes