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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]
Being fit prior to health condition [20, 24, 28]
Physical capacity to engage in PA [15, 25, 27, 31, 32]
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]
Pain/fatigue related to condition [27,28,29,30, 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]
Social support (peers) [18, 23, 26, 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]
Supportive social influences/ enablers [16, 19]
Using peer support groups for interventions [22, 23]
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]
Negative social influences [17, 19]
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]
Fear of consequences [28, 32]
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]
Peer support [15, 22]
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]