Table 3 Summary of patient and clinician behavioural determinants mapped to the COM-B framework
From: Identifying the factors affecting ‘patient engagement’ in exercise rehabilitation
COM-B | Patient | Clinician | |
|---|---|---|---|
Capability | Facilitator | Knowledge about personal health [15, 21, 25, 32] Knowledge of suitable PA intervention strategies [15, 26, 28, 31, 32] Knowledge of PA guidelines [31, 32] Knowledge of the benefits of PA for their condition [12, 19, 32] Developing behavioural regulation skills (action planning and action control) [24, 27,28,29, 32, 34] | Providing patient with education to increase health knowledge Knowledge in client’s condition and condition management [15,16,17, 19] Experience with client’s condition and condition management [15, 17, 19] Communication skills (to facilitate lifestyle change) [16, 17, 19] Accounting for the patient’s previous experiences with PA when designing exercise programs [20] Tailoring PA to individual’s physical capacity [20] |
Capability | Barrier | Limited knowledge about personal health [18, 25, 27, 30] Limited knowledge of suitable PA intervention strategies [21, 22, 26, 28, 30, 31] Limited knowledge of PA guidelines [26, 28, 31] Limited knowledge of PA benefits for their condition [21, 22, 27, 30] Negative perceptions (Fear/Dislike) of exercise [18, 20, 21, 23, 34] Perceived lack of time [21] Lacking behavioural regulation skills (action planning and action control) [22, 27, 28, 33] Poor mental health [30] Inadequate physical capacity to engage in PA [15, 18, 21,22,23, 25, 26, 30, 34] | Inadequate knowledge in client’s condition and condition management [15,16,17, 19] Lacking communication skills (to facilitate lifestyle change) [16, 17] Patient lacking strategies to regulate their own behaviour [19] |
Opportunity | Facilitator | Easy access to PA resources and services [15, 18, 20, 25, 31, 32, 34] Affordable resources and services [15, 31] Adequate time for PA [15, 20, 25, 31, 34] Safe/suitable physical environment for PA [21, 25, 32, 34] Clinician support [15, 18, 25, 27, 34] Supportive primary healthcare provider [15, 34] Positive social/cultural influences [25, 31, 32] Social support (friends, family, partners) [18, 20, 25,26,27,28, 34] | Providing patients easy access to PA resources and services [17, 19, 20, 22] Participant’s perceived relevance [15] Incorporating exercise rehabilitation in a hospital/rehabilitation setting [21] Longer consultations to focus on PA [17, 19] Giving professional PA counselling and follow-ups [20] Issuing an exercise prescription to the patient [20] Providing educational material as basis for intervention [15] |
Opportunity | Barrier | Difficulty in accessing PA resources and services [20, 21, 28, 30, 34] Lack of time [15, 20, 21, 25, 26, 28, 30, 31, 33] Unable to afford resources and services [21, 26, 28, 30, 31] Unsafe/unsuitable physical environment for PA [22, 25, 26, 30, 33] Complex social situations [15, 30] Lack of social support [22, 23, 30, 33] PA not supported by patient’s primary healthcare provider [15] Unsupportive healthcare workers [25, 30] Social norms against exercise [30] | Patient’s competing priorities [15] Patient’s lack of perceived relevance [15, 16] Insufficient allocated time with patients [16, 17, 19] Lack of availability of resources for patients [17, 19] High costs to refer patients for exercise interventions [17] |
Motivation | Facilitator | Perceived personal relevance [15, 18, 20, 21, 24,25,26,27,28, 30,31,32, 34] High intention for action [20, 24, 28, 29, 32, 34] Sense of responsibility [25, 26, 28, 34] Self-efficacy [15, 18, 24, 28, 29, 31, 32] Enjoying doing PA [18, 20, 24, 26, 34] Effective use of goal setting [18, 24, 28, 29, 32, 34] Encouraging clinicians [15, 18, 20] Effective incentives to engage in target behaviour [15, 20, 27, 32, 34] Receiving emotional and mental support for condition [25, 28] | Patient-centred approach [15, 17, 18, 22] Providing health education to increase understanding of conditions [18, 21,22,23] Rapport with participant [15] Positive health messages (focus on positive aspects) [15, 21, 22] Providing constant encouragement [3] Clinician’s attitudes/behaviours during treatment (e.g. using optimistic tones towards rehabilitation treatment) [17, 19] Self-efficacy towards providing PA for patients with health conditions [19] |
Motivation | Barrier | Lack of perceived personal relevance [15, 18, 21, 23, 26, 30, 31, 33, 34] Lack of self-efficacy [22, 23, 26, 28, 30] Emotional responses and mental issues related to condition [22, 25, 27, 28, 30, 34] Unable to break habits/mindsets [28, 30] Lack of enjoyment in doing PA [20, 30] In denial of condition [21] | Clinical decision-making within constraints of randomised control trial [15] Clinician’s attitudes/behaviours during treatment (e.g. using inconsistent tones towards rehabilitation treatment) [19] Improper use of goal-setting for patients [19] Lack of peer support [19] |