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Background Enabling behaviour change in health care is a complex process. Although the use of theory to inform behaviour change interventions is advocated, there is limited information about how this might best be achieved. There are multiple models of behaviour change, however, due to their complexity they can be inaccessible to both researchers and healthcare practitioners. To support health care practitioner behaviour change, this was addressed by the development of the Theoretical Domains Framework (TDF) in 2005. Citations of the TDF and associated papers have increased exponentially. Although not predicted or intended by the authors, the TDF has also been used to investigate health behaviour change interventions. Therefore our aim was to narratively synthesize empirical evidence on how the TDF and subsequent iterations have been applied in health behaviour change to inform future intervention development. Methods Systematic search of four online databases, combined with searches for citations of key papers and key author searches, resulted in 3551 articles eligible for screening. Of these 10 met the pre-determined inclusion criteria. Screening of full-texts, data extraction and quality appraisal were independently performed by both authors. Disagreements regarding eligibility were resolved through discussion. Results Of the 10 included studies three used the TDF and seven used subsequent iterations, the Capability, Opportunity, Motivation to Behaviour / Behaviour Change Wheel to assess and /or categorise behavioural determinants to identify relevant behaviour change techniques. Two studies reported feasibility testing. Most interventions were targeted at diet and exercise. Eight reported an explicit and systematic process in applying the framework. Conclusion There is limited evidence of how the framework has been used to support health behaviour change interventions. In the included studies the process of using the framework is not always reported in detail or with clarity. More recent studies use a systematic and judicious process of framework application. From the limited evidence available we tentatively suggest that the steps proposed in the BCW appear to be sufficient for development of interventions that target health behaviour change interventions. Further research is needed to provide evidence in how the framework may be most effectively applied to intervention development. Protocol registration PROSPERO CRD42018086896 .

Psychopharmacology prescriptions are complex, partly due to the complexity of the relationship between diagnosis and its etiology, as well as the iatrogenic impact on symptomatology. Many multidisciplinary tools exist to optimize their management and improve evidence-based practice. However, their multidisciplinary integration seems to be a challenge. This study aimed to collect information on barriers and facilitators perceived by hospital health professionals regarding the use of multidisciplinary tools to address complex situations in psychopharmacology. A mixed-methods research approach using semi-structured interviews was conducted with physicians and pharmacists from 11 hospital institutions. An interview guide developed from the COM-B model (Capability, Opportunity, and Motivation - Behavior) was used to identify barriers and facilitators to the use of multidisciplinary tools. Data were analyzed using thematic analysis to identify emerging themes and mapped to the COM-B model. 28 professionals were interviewed. Identified barriers were: lack of knowledge and time to address complex situations, incomplete medical records, lack of easily accessible multidisciplinary tools, insufficient levels of evidence in psychopharmacology. Identified facilitators were: continuing education, communication and networking among professionals, implementation of adapted and shared resources, deprescribing, awareness of medication-induced iatrogenesis, accessibility of tools for all populations. Identified barriers and facilitators in the use of multidisciplinary tools for complex situations in psychopharmacology helped to model factors that enable behavior change. Answers need to be provided to help professionals ensure and optimize psychopharmacological therapies.

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.

Psychosocial determinants influence healthcare workers' compliance with surgical site infection (SSI) preventive interventions. In order to design needs-based interventions promoting compliance, such determinants must first be assessed using valid and reliable questionnaire scales. To compare professional groups without bias, the scales must also be measurement-equivalent. We examine the validity/reliability and measurement equivalence of four scales using data from physicians and nurses from outside the university sector. Additionally, we explore associations with self-reported SSI preventive compliance. N = 90 physicians and N = 193 nurses (response rate: 31.5%) from nine general/visceral or orthopedic/trauma surgery departments in six non-university hospitals in Germany participated. A written questionnaire was used to assess the compliance with SSI preventive interventions and the determinants of compliance based on the Capability-Opportunity-Motivation-Behavior-Model. Psychometric testing involved single- and multiple-group confirmatory factor analyses, and explorative analyses used -tests and multiple linear regression. The scales assessing individual determinants of compliance (capability, motivation, and planning) were found to be reliable (each Cronbach's α ≥ 0.85) and valid (each Root-Mean-Square-Error of Approximation ≤ 0.065, each Comparative-Fit-Index = 0.95) and revealed measurement equivalence for physicians and nurses. The scale assessing external determinants (opportunity) did not demonstrate validity, reliability, or measurement equivalence. Group differences were found neither in compliance (p = 0.627) nor determinants (p = 0.192; p = 0.866; p = 0.964). Capability (β = 0.301) and planning (β = 0.201) showed associations with compliance for nurses only. The scales assessing motivation, capability, and planning regarding SSI preventive compliance provided reliable and valid scores for physicians and nurses in surgery. Measurement equivalence allows group comparisons of scale means to be interpreted without bias.

Abstract BackgroundPhysical activity is an evidence-based, safe second-line approach for improved multiple sclerosis (MS) symptoms and disease progression. This study examined the contributions of Capability-Opportunity-Motivation-Behavior (COM-B) factors for understanding engagement in current and long-term physical activity among persons with MS in the United States (U.S.).MethodAdults with MS in the U.S. (N = 854) completed an online survey that included questions regarding demographic and clinical characteristics, COM-B constructs, Godin Leisure Time Exercise Questionnaire (GLTEQ), and Physical Activity Staging Questionnaire (PASQ). Participants were classified into groups based on the GLTEQ regarding current physical activity behavior and PASQ for long-term physical activity behavior. MANOVA and discriminant function analysis (DFA) identified COM-B constructs that differentiated physical activity groups.ResultsMANOVA analyses indicated that all COM-B constructs were significantly different for both GLTEQ current physical activity groups (Wilks’s λ = .5, F(44, 1432) = 14.8) and PASQ long-term physical activity groups (Wilks’s λ = .4, F(44, 1464) = 16.9) status except Information Provision. DFA analysis regarding GLTEQ identified a function including exclusively Capability and Motivation sources of behavior that differentiated current physical activity groups such as intention and self-efficacy. DFA for PASQ identified a different function of the Capability and Motivation sources of behavior that differentiated long-term physical activity groups; the primary differentiating variables were action control and intention.ConclusionOur results identify internal factors as the primary COM-B predictors of current and long-term physical activity among adults with MS in the U.S., and health promotion interventions may focus on assessing individual competencies and behavioral regulation for changing physical activity in MS.

The voluntary carbon market (VCM) has emerged as a promising mechanism for climate mitigation; however, farmer participation in developing countries remains limited. This study combines the Theory of Planned Behavior (TPB) and the Capability–Opportunity–Motivation–Behavior (COM-B) framework to investigate factors associated with Thai farmers’ intention and self-reported stage of participation in VCM. Data were collected through face-to-face interviews with 240 farmers across multiple crop systems in Thailand and analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). The model explained substantial variance in intention and behavior (R2 = 0.610 and 0.555, respectively), although PLS-Predict indicated limited predictive performance. Perceived behavioral control (PBC) showed the strongest positive association with reported participation behavior (β = 0.493, p < 0.001), followed by intention (β = 0.343, p < 0.001). Access to extension and technical support (AES) was positively associated with intention (β = 0.624, p < 0.001) and PBC (β = 0.338, p < 0.001). Knowledge was positively associated with PBC (β = 0.324, p < 0.001) but negatively associated with intention (β = −0.106, p = 0.045). No significant association was observed between attitude and intention; however, subjective norms were negatively associated with intention (β = −0.336, p < 0.001). Indirect associations through intention and PBC were also observed. Overall, the findings suggest that capability-, opportunity-, and trust-related factors are associated with farmers’ reported participation in VCM and may inform the design of future policies and support programs. Although the model demonstrated useful explanatory capability, its predictive performance was limited, indicating that the findings should be interpreted primarily as explanatory rather than predictive.

Background:Digital health interventions, such as personalized SMS coaching, are considered affordable and scalable methods to support healthy lifestyle changes. SMS, or texting, is a readily available service to most people in Sweden, and personalized SMS coaching has shown great promise in supporting behavior changes.Objective:This study aims to explore the effectiveness of highly personalized SMS coaching for behavior change according to the Capability, Opportunity, Motivation–Behavior (COM-B) model on a sample of physically inactive adults in a nonprofit fitness organization in Sweden.Methods:The study used a mixed methods design in which clients acted as their own controls. The participants were clients (n=28) and fitness consultants (n=12). Three types of data were collected: (1) quantitative data at baseline and after the SMS intervention and the waitlist from the clients, (2) qualitative data from semistructured interviews with the fitness consultants, and (3) pseudonymized texting conversations between the fitness consultants and clients.Results:Overall, the results showed that personalized SMS coaching was effective in supporting the clients’ behavior changes. The quantitative analysis showed how the clients’ capabilities (Cohen d=0.50), opportunities (Cohen d=0.43), and relationship with the fitness consultants (Cohen d=0.51) improved during the SMS intervention in comparison with baseline. Furthermore, the qualitative analysis revealed how personalized texts added value to existing work methods (eg, increasing continuity and flexibility) and how the relationship between the clients and fitness consultants changed during the intervention, which helped motivate the clients.Conclusions:Personalized SMS coaching is an effective method for supporting healthy behavior changes. The human connection that emerged in this study needs to be further explored to fully understand the effectiveness of a digital health intervention.

Increasingly, brief digital interventions are being implemented to combat alcohol misuse. While the utility of incorporating personalized feedback into these interventions has been explored, less work has concentrated on how consumer-driven research might be harnessed to better tailor personalized feedback. Critically, the relative efficacy of co-designed interventions vs those designed by research teams without stakeholder input has not typically been explored. This study aimed to use an exploratory sequential mixed methods approach to elicit user-designed personalized feedback to incorporate into an existing brief digital intervention developed to combat hazardous drinking; investigate differences in capacity, opportunity, and motivation (as per the Capacity, Opportunity, Motivation-Behavior model) to alter alcohol use behavior; examine whether participants prefer the co-designed product over those designed by research teams; and evaluate change in actual consumption over time as a function of co-designed (image-based) vs researcher-designed (image- or text-based) personalized feedback. Part 1 used an online co-design process involving a convenience sample of young adult focus group participants (N=40; mean age 21.87, SD 7.51 years). Part 2 surveyed a convenience sample of young adults who drank alcohol regularly (N=222; mean age 21.14, SD 4.69 years). Participants were assigned to 1 of 3 personalized feedback conditions (researcher designed, text-based; researcher-designed, image-based; and co-designed, image-based) using block allocation with stratification based on alcohol intake and impulsivity level. Feedback was delivered via email, and impact on capacity, opportunity, and motivation to alter alcohol use behavior, plus preferred format of feedback, was examined (10.76, SD 14.05 days) via mixed and 1-way ANOVAs and post hoc tests. Change in alcohol consumption (89.70, SD 21.59 days) was investigated via a series of repeated-measures ANOVA and post hoc tests. In Part 1, qualitative thematic analysis of focus group data identified 6 overarching themes: visual representation, clarity, accessibility, brevity, peer comparison, and harm. Following this analysis, personalized feedback regarding alcohol intake and brain health was available in 3 formats: researcher designed, text-based; researcher-designed, image-based; and co-designed, image-based. In Part 2, there were no differences in capacity, opportunity, and motivation to alter alcohol use behavior as a function of feedback format (η =0.01). Participants preferred co-designed, image-based feedback over researcher-designed, image-based (d=0.55) or researcher designed, text-based (d=0.83) feedback. Regardless of feedback format, all participants significantly reduced total alcohol intake (η =0.11) and alcohol-related harm (η =0.05). Participants in image-based conditions (researcher-designed or co-designed) reduced frequency of drinking to a greater extent (d=0.56) than those in the researcher-designed, text-based feedback condition (d=0.39). Though the principles of co-design are undeniably valuable, the efficacy of co-designed interventions, over and above those designed by research teams without user input, requires further research. OSF Registries osf.io/rnbv8; https://osf.io/y4bhs.

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.

The aim of the study was to identify components of the COM-B (capability, opportunity, motivation and behaviour) model that influences behaviour to modify dietary patterns in 40-55-year-olds living in the UK, in order to influence the risk of cognitive decline in later life. This is a qualitative study using the COM-B model and theoretical domains framework (TDF) to explore beliefs to adopting the Mediterranean-DASH Intervention for Neurodegenerative delay (MIND) diet. Northern Ireland. Twenty-five participants were recruited onto the study to take part in either a focus group or an interview. Participants were men and women aged between 40 and 55 years. Participants were recruited via email, Facebook and face to face. Content analysis revealed that the main perceived barriers to the adoption of the MIND diet were time, work environment, taste preference and convenience. The main perceived facilitators reported were improved health, memory, planning and organisation, and access to good quality food. This study provides insight into the personal, social and environmental factors that participants report as barriers and facilitators to the adoption of the MIND diet among middle-aged adults living in the UK. More barriers to healthy dietary change were found than facilitators. Future interventions that increase capability, opportunity and motivation may be beneficial. The results from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.