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The public health impact of health and well-being digital interventions is dependent upon sufficient real-world uptake and engagement. Uptake is currently largely dependent on popularity indicators (eg, ranking and user ratings on app stores), which may not correspond with effectiveness, and rapid disengagement is common. Therefore, there is an urgent need to identify factors that influence uptake and engagement with health and well-being apps to inform new approaches that promote the effective use of such tools. This review aimed to understand what is known about influences on the uptake of and engagement with health and well-being smartphone apps among adults. We conducted a systematic review of quantitative, qualitative, and mixed methods studies. Studies conducted on adults were included if they focused on health and well-being smartphone apps reporting on uptake and engagement behavior. Studies identified through a systematic search in Medical Literature Analysis and Retrieval System Online, or MEDLARS Online (MEDLINE), EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Scopus, Cochrane library databases, DataBase systems and Logic Programming (DBLP), and Association for Computing Machinery (ACM) Digital library were screened, with a proportion screened independently by 2 authors. Data synthesis and interpretation were undertaken using a deductive iterative process. External validity checking was undertaken by an independent researcher. A narrative synthesis of the findings was structured around the components of the capability, opportunity, motivation, behavior change model and the theoretical domains framework (TDF). Of the 7640 identified studies, 41 were included in the review. Factors related to uptake (U), engagement (E), or both (B) were identified. Under capability, the main factors identified were app literacy skills (B), app awareness (U), available user guidance (B), health information (E), statistical information on progress (E), well-designed reminders (E), features to reduce cognitive load (E), and self-monitoring features (E). Availability at low cost (U), positive tone, and personalization (E) were identified as physical opportunity factors, whereas recommendations for health and well-being apps (U), embedded health professional support (E), and social networking (E) possibilities were social opportunity factors. Finally, the motivation factors included positive feedback (E), available rewards (E), goal setting (E), and the perceived utility of the app (E). Across a wide range of populations and behaviors, 26 factors relating to capability, opportunity, and motivation appear to influence the uptake of and engagement with health and well-being smartphone apps. Our recommendations may help app developers, health app portal developers, and policy makers in the optimization of health and well-being apps.

Background Physical activity is important for all aspects of health, yet most university students are not active enough to reap these benefits. Understanding the factors that influence physical activity in the context of behaviour change theory is valuable to inform the development of effective evidence-based interventions to increase university students’ physical activity. The current systematic review a) identified barriers and facilitators to university students’ physical activity, b) mapped these factors to the Theoretical Domains Framework (TDF) and COM-B model, and c) ranked the relative importance of TDF domains. Methods Data synthesis included qualitative, quantitative, and mixed-methods research published between 01.01.2010—15.03.2023. Four databases (MEDLINE, PsycINFO, SPORTDiscus, and Scopus) were searched to identify publications on the barriers/facilitators to university students' physical activity. Data regarding study design and key findings (i.e., participant quotes, qualitative theme descriptions, and survey results) were extracted. Framework analysis was used to code barriers/facilitators to the TDF and COM-B model. Within each TDF domain, thematic analysis was used to group similar barriers/facilitators into descriptive theme labels. TDF domains were ranked by relative importance based on frequency, elaboration, and evidence of mixed barriers/facilitators. Results Thirty-nine studies involving 17,771 participants met the inclusion criteria. Fifty-six barriers and facilitators mapping to twelve TDF domains and the COM-B model were identified as relevant to students’ physical activity. Three TDF domains, environmental context and resources (e.g., time constraints), social influences (e.g., exercising with others), and goals (e.g., prioritisation of physical activity) were judged to be of greatest relative importance (identified in > 50% of studies). TDF domains of lower relative importance were intentions, reinforcement, emotion, beliefs about consequences, knowledge, physical skills, beliefs about capabilities, cognitive and interpersonal skills, social/professional role and identity, and behavioural regulation. No barriers/facilitators relating to the TDF domains of memory, attention and decision process, or optimism were identified. Conclusions The current findings provide a foundation to enhance the development of theory and evidence informed interventions to support university students’ engagement in physical activity. Interventions that include a focus on the TDF domains 'environmental context and resources,' 'social influences,' and 'goals,' hold particular promise for promoting active student lifestyles. Trial registration Prospero ID—CRD42021242170.

Background Nonalcoholic fatty liver disease (NAFLD) is a global public health problem. Lifestyle modifications aimed at promoting weight loss and weight maintenance remain the current first‐line treatments for NAFLD. Objective We aim to identify barriers and enabling factors in weight management among patients with NAFLD using the capability, opportunity, motivation, behaviour (COM‐B) model of behaviour. Design This study adopted a qualitative design using semistructured interviews analysed with content analysis and the COM‐B framework. Setting and Participants Interviews were conducted with 27 patients with NAFLD who experienced successful or unsuccessful weight reduction. Results Our study included 27 participants: 15 participants with successful weight loss (successful weight loss refers to a decrease in body weight ≥7% of the initial body weight for patients with NAFLD) and 12 participants with unsuccessful weight loss. Thirty‐five themes (19 barriers and 16 facilitators) were mapped onto the COM‐B model as barriers and facilitators to weight management among patients with NAFLD. The key barriers were lack of time and energy, lack of awareness of weight, lack of attention to NAFLD, treating food as a reward or compensation and social entertainment. The key facilitators were having basic weight loss knowledge and skills, strong motivation, attention to NAFLD, unsuccessful weight loss experiences and positive feedback from phased success. Conclusion In addition to identifying factors consistent with existing studies, this study identified factors that influence weight management in NAFLD patients, such as basic weight loss skills and rational thinking before weight loss, which were not previously reported. This has clinical implications for clinical healthcare providers and health management services for the improvement of education and support regarding lifestyle improvement and weight management in patients with NAFLD. Patient or Public Contribution We recruited potential participants from the Bariatric Clinic, Hepatology Clinic and Physical Examination Center of hospitals between March 2021 and October 2021. Twenty‐seven patients with NAFLD who had successful or unsuccessful weight loss experiences participated in the study and responded to questions on weight management.

Responsive feeding supports nurturing caregiving and encourages healthy eating in early childhood. Food insecurity can hinder families' ability to adopt positive practices and access support. This qualitative study evaluated participants' experiences and behavioural impacts of Eat, Learn, Grow , a co‐designed digital microlearning programme that promotes responsive feeding among families facing food insecurity. Nineteen participants completed semi‐structured interviews after completing the programme, which consisted of 12 brief digital modules and a hard‐copy resource pack. Data were analysed thematically guided by the COM‐B model of behaviour change. Participants found the intervention to be accessible and engaging. The brief, flexible modules aligned with their learning needs and preferences, and the multimedia format and social media‐style interface supported engagement. While the physical resources offered behavioural reinforcement, the digital component was described as more impactful. The programme enhanced participants' capability by increasing knowledge and confidence, reducing stress and mealtime tensions. It created opportunity through flexible learning and priming family discussions on child feeding. Motivation was driven by observable improvements in children's eating behaviours, reduced stress, and alignment with parenting values. Behavioural changes included more positive food experiences and shared family meals, pressuring children to eat less often, and increased repeated food exposure. Eat, Learn, Grow was well‐received and regarded as accessible, practical, and supportive. The design and delivery facilitated the adoption of responsive feeding within challenging family contexts of limited time, high mental load, and stress. Findings provide insight into how theory‐informed microlearning can promote responsive feeding among families facing food insecurity. A co‐designed microlearning programme can effectively support responsive feeding practices. The programme was accepted by families experiencing food insecurity and supported their needs, enabling flexible engagement within busy, high‐stress family routines. Use of the COM‐B model provided a valuable behavioural framework for qualitatively understanding how the intervention influenced family capability, opportunity and motivation to support responsive child feeding. Digital, low‐burden and mobile‐designed formats show promise for scalable responsive feeding support; further adaptation may be needed to ensure accessibility for families with lower literacy or limited digital access.

Theoretical models have informed the understanding of pregnancy as a 'teachable moment' for health behaviour change. However, these models have not been developed specifically for, nor widely tested, in this population. Currently, no pregnancy-specific model of behaviour change exists, which is important given it is a unique yet common health event. This study aimed to assess the extent to which factors influencing antenatal behaviour change are accounted for by the COM-B model and Teachable Moments (TM) model and to identify which model is best used to understand behaviour change during pregnancy. Theoretical mapping exercise. A deductive approach was adopted; nine sub-themes identified in a previous thematic synthesis of 92 studies were mapped to the constructs of the TM and COM-B models. The sub-themes reflected factors influencing antenatal health behaviour. All sub-themes mapped to the COM-B model constructs, whereas the TM model failed to incorporate three sub-themes. Missed factors were non-psychological, including practical and environmental factors, social influences, and physical pregnancy symptoms. In contrast to the COM-B model, the TM model provided an enhanced conceptual understanding of pregnancy as a teachable moment for behaviour change, however, neither model accounted for the changeable salience of influencing factors throughout the pregnancy experience. The TM and COM-B models are both limited when applied within the context of pregnancy. Nevertheless, both models offer valuable insight that should be drawn upon when developing a pregnancy-specific model of behaviour change.

Background Obesity rates are higher among people of lower socioeconomic status. While numerous health behaviour interventions targeting obesity exist, they are more successful at engaging higher socioeconomic status populations, leaving those in less affluent circumstances with poorer outcomes. This highlights a need for more tailored interventions. The aim of this study was to enhance an existing weight loss course for adults living in low socioeconomic communities. Methods The Behaviour Change Wheel approach was followed to design an add‐on intervention to an existing local authority‐run weight loss group, informed by mixed‐methods research and stakeholder engagement. Results The COM‐B analysis of qualitative data revealed that changes were required to psychological capability, physical and social opportunity and reflective motivation to enable dietary goal‐setting behaviours. The resulting SMART‐C booklet included 6 weeks of dietary goal setting, with weekly behavioural contract and review. Conclusion This paper details the development of the theory‐ and evidence‐informed SMART‐C intervention. This is the first report of the Behaviour Change Wheel being used to design an add‐on tool to enhance existing weight loss services. The process benefitted from a further checking stage with stakeholders.

Introduction Pre‐exposure prophylaxis (PrEP) is an effective medication to reduce the risk of acquiring HIV. PrEP is available free of charge in the UK from sexual health clinics. Expanding PrEP delivery to community pharmacies holds promise and aligns with UK government goals to eliminate new cases of HIV by 2030. The aim of this scoping review was to describe the existing evidence about the barriers to and facilitators of community pharmacy oral PrEP delivery, for pharmacists and pharmacy clients, as aligned with the Capacity Opportunity, Motivation Behaviour (COM‐B) Model. Methods Five bibliographic and five review databases were searched from inception to August 2023. Literature of any study design was included if it discussed barriers and facilitators of community pharmacy PrEP delivery. Trial registrations, protocols and news articles were excluded. Results A total of 649 records were identified, 73 full texts were reviewed and 56 met the inclusion criteria, predominantly from high‐income/westernized settings. Most of the included literature was original research (55%), from the United States (77%) conducted during or after the year 2020 (63%). Barriers to PrEP delivery for pharmacists included lack of knowledge, training and skills (capability), not having the necessary facilities (opportunity), concern about the costs of PrEP and believing that PrEP use could lead to risk behaviours and sexually transmitted infections (motivation). Facilitators included staff training (capability), time, the right facilities (opportunity), believing PrEP could be a source of profit and could reduce new HIV acquisitions (motivation). For clients, barriers included a lack of PrEP awareness (capability), pharmacy facilities (opportunity) and not considering pharmacists as healthcare providers (motivation). Facilitators included awareness of PrEP and pharmacist's training to deliver it (capability), the accessibility of pharmacies (opportunity) and having an interest in PrEP (motivation). Discussion To effectively enhance oral PrEP delivery in UK community pharmacies, the identified barriers and facilitators should be explored for UK relevance, addressed and leveraged at the pharmacy team, client and care pathway level. Conclusions By comprehensively considering all aspects of the COM‐B framework, community pharmacies could become crucial providers in expanding PrEP accessibility, contributing significantly to HIV prevention efforts.

Introduction Vaccinations are vital for global health; however, since the onset of the COVID‐19 pandemic in 2020, there has been a notable decline in maternal vaccine acceptance in Wales, UK. It is a key part of a midwife's role to promote vaccine uptake in pregnancy. Therefore, gaining an understanding of midwives’ perceptions of the issue is crucial for identifying factors influencing vaccine uptake in Wales. Methods A quantitative, cross‐sectional descriptive survey was conducted amongst 143 registered midwives working in Wales using the Capability, Opportunity, Motivation‐Behaviour (COM‐B) approach to identify factors affecting vaccine uptake. Results Midwives lacked training and confidence to promote vaccines, and some noted language barriers as a problem to providing equitable care. Other problems included lack of access to vaccination appointments and inconsistencies in vaccine promotion depending on care provider. Midwives perceived vaccine hesitancy to be high, with 71% saying they thought vaccine hesitancy was common amongst pregnant women and 40% saying they thought it was common amongst their colleagues. Conclusion A national approach is required to ensure effective vaccination training amongst midwives in Wales, as well as improved availability of language diverse resources. Additional qualitative research is needed in Wales and the United Kingdom to further understand vaccine hesitancy and barriers to promoting vaccine uptake in pregnancy. GRAPHICAL This study reports on midwives working in Wales views regarding pregnancy vaccination. Midwives in Wales face challenges promoting vaccination, including limited training, language barriers, time constraints and inconsistent and inaccessible care. Many perceived there to be high vaccine hesitancy among pregnant women and, to a lesser degree, among colleagues.

Background Effective screening can prevent cervical cancer, but many women choose not to attend their screening tests. Objective This study aimed to investigate behavioural influences on cervical screening participation using the Theoretical Domains Framework (TDF) and COM‐B models of behaviour change. Design A qualitative study and semistructured phone interviews were conducted with women invited for routine screening tests within the national cervical screening programme in Ireland. Setting and Participants Forty‐eight women aged 25–65 years were recruited from the national screening register. Results Seven core themes were identified that mapped to three COM‐B components and 11 TDF domains: (1) knowledge of cervical cancer and screening, (2) coping with smear tests, (3) competing motivational processes—automatic and reflective, (4) cognitive resources, (5) role of social support, (6) environmental influences and (7) perceputal and practical influences. A range of knowledge about screening, perceived risk of cervical cancer and human papillomavirus infection was evident. Factors that influenced screening behaviours may be hierarchical—some were assigned greater importance than others. Positive screening behaviours were linked to autonomous motivation. Deficits in physical and psychological capability (inadequate coping skills) were barriers to screening, while physical and social opportunity (e.g. healthcare professional ‘champions’) could facilitate participation. Older women raised age‐related issues (e.g. screening no longer necessary) and had more negative attitudes to screening, while younger women identified practical barriers. Conclusions This study provides insight into screening participation and will aid development of theoretically informed interventions to increase uptake. Patient or Public Contribution Women invited for screening tests through the national screening programme were interviewed. A Public & Patient Involvement (PPI) Panel, established to provide input into all CERVIVA research projects, advised the research team on recruitment materials and were given the opportunity to review and comment on the interview topic guide. This panel is made up of six women with various cervical screening histories and experiences.

Owing to the high demand for animal parts for traditional medicines in Asia, the unsustainable wildlife trade remains a major threat to regional conservation efforts. We presented a video‐based randomized controlled trial intervention to over 1000 Chinese residents with medicinal needs in a Mekong region seaport. Our results showed that two intervention messages, compared to control, significantly reduced the intention of consumers to use animal‐based medicinal wine. Although structural equation models showed that both interventions directly influenced the capability, opportunity, and motivation (COM) not to purchase animal‐based medicinal wine, their indirect effects through the COM variables varied across the two treatments. Notably, the health‐risk message indirectly affected consumption intention by mediating both health‐related and legal‐related capabilities not to purchase animal‐based medicinal wine, whereas this was not observed for the legal‐risk message. Overall, our experiment provided insights into the effective design of campaigns to reduce intention to consume animal‐based medicinal wine.