Table 2.

Patient interview results showing themes and subthemes, with example quotes, mapped across the Capability, Opportunity, Motivation, Behaviour (COM-B) framework

Theme	Subtheme	Quote
Capability
Enhancing patient capability through the remote monitoring service opportunities	Technology skills: No special skills needed to use the service when interacting with technology using smart phones	‘I obviously use my smartphone every day. I'm quite happy to go on the internet, and to use it as a phone to use it, use all its facilities really … so it’s nothing new, it’s very straightforward’
	Psychological capability: Development of inner expertise on using the service metrics to correspond to the needs of their current health state	‘Once you get used to it coming in, you sort of get used to the scales and you get used to putting a number on the way you feel, yes piece of cake’
Opportunity
Design of the remote monitoring service supports opportunities for engagement	Technical features: Patient interface with the service, e.g. text arrival timing supports completion	‘Very happy with that as well. I just think it makes life easier. I tend to have my phone with me most the time. When I wake up in the morning, it’s first thing I pick up to see what messages I’ve got or whatever. And if the text is there, I’ll do it very quickly and then get on with my day’
	Resource provision: The remote monitoring service provides opportunities for self-management, e.g. facilitates access to useful resources	‘14 years, it's quite hard to remember how you were. And so, it's quite nice to see that and you could see [in the graph] if there was a peak in pain, you know, like I say, I'm usually the same, I think that's helpful … it's good that they're colour coded. So you can see where you are. And you think, oh, am I more green, or am I a bit more red?’
	Healthcare access: The remote monitoring service provides opportunities for access to clinical care, e.g. to report a flare-up	‘Then there's a screen which asks you if you'd like to add anything about your experiences, or whether you're flaring, or what problems you've got, and then that presumably just get sent off and somebody reviews it and usually somebody comes back little comment, or sorry you were bad week, last week, hope you are resting better now, you know, those sorts of comments’
	Clinical interaction: Suggestions to increase opportunities for engagement in clinical practice, e.g. provide a downloadable graph of results	‘It would be quite nice to be able to get that little graph. Although, you know, I mean, if you can't, you can't, it doesn't matter. It's interesting for that moment … I think it might be useful for consultations … So you'd have that information, because it's quite hard when you've got a limited amount of time on the phone, and you want to get it all in. And you always forget things, always, even if you wrote it down and took it with you, you know, you always forget things. But if you were looking back at your own assessment of how things had been that might help that conversation’
Support to use the remote monitoring service	Ease of use: ‘Intuitive’ and ‘very self-explanatory’ remote monitoring service	‘It's very obvious what it is [the remote monitoring service]. So, I didn't feel like I necessarily needed it explained any further’.
	Patient space: No need to seek support from others in completing the remote monitoring questionnaire	‘I don't even think my family or friends know I get it [laughter] I've not mentioned it. I just do it’
	Patient autonomy: Promoting patients’ independence in having control of disease progress	‘For the most part ... I don’t talk about my condition that much, but my family is quite aware of it and will ask me quite regularly how are things going, and it’s actually really been quite nice to have the graph and data to show them to show how I’m doing really. So, every now and then I will discuss it with someone but for the most part I’m just sorting it out on my own’
Completing the questionnaire fits into patients’ routine	Ease of completion: Completing the questionnaire ‘straight away’	‘Within the hour usually, always within the day’
	Fit into routine: No barriers to completing the remote monitoring questionnaire	‘The only thing that would be doing it would be forgetting. Because obviously, there are other things going on in life and sometimes your rheumatoid arthritis isn't the highest thing on the list, it’s sort of bubbling along the bottom of your list of concerns because life goes on’
Motivation
Automatic motivational processes	Resource provision: Existing relationship with RA services	‘You know, God, just people collecting numbers again, but I think, you know, if I'd stopped to think about it, then I would know that that's actually not my experience with Guy’s [hospital], because a few things have happened over the years that have kind of just let me know subconsciously that somebody is monitoring something somewhere’
	Physical convenience: Motivation to avoid hospital, e.g. previous medical trauma and Covid-19 anxiety; reducing unnecessary trips to the hospital	‘I quite like the remote access to GPs and doctors and hospitals and things. I think it's because I have a bit of a thing because I was in hospital for nearly two years when I was first diagnosed when I was little. And so, if I can avoid going to a hospital, I'm quite happy to do that really. That sounds a bit pathetic, but that's probably the reason’
	Re-assurance mechanism: The remote monitoring questionnaire acts as a way for patients to feel cared for	‘It was also like a bit of reassurance that I was doing this on a monthly basis and even if I didn’t have any appointment with the team or anything like that I felt that I was taking care of, for my condition and I think that was really positive, from a mental perspective’
Reflective motivational processes	Disease state view: The remote monitoring questionnaire acts as a way for patients to view their condition.	‘Because … the questions related to how did you feel last week, so I thought it would be better if it was, “How did you feel since the last Monitoring Service was done?”, so it’s more of a broader picture. During the time, in that week I’ll be fine but the previous weeks I might have experienced some pain, so I felt like it wasn’t capturing everything properly’
	Convenience: Motivation to avoid hospital, e.g. saving time and/or money for NHS and self	‘I suppose, apart from giving me support and information, it's also to release time for the rheumatology services, focus on people that really do need the help, and to prioritise who needs help and who is okay, for a non-face to face contact’
	Access to clinical team: Increased or easier contact with the RA team	‘Before the pandemic it was very, very difficult to get in touch with the rheumatology clinic. You could phone and nobody would answer the phone. And I think, probably, that was one of the reasons I thought it was quite a good idea’
	Patient autonomy: Improved self-monitoring and/or self-management	‘So, I think the way that I manage my condition is by understanding more about it as well. So … knowing when the flare up is severe enough to do something else about it and so having the ability to track it is involving me more in … care of the condition’
	Disease state comprehension: Data use and broader usefulness to RA team or NHS	‘It’s a personal monitoring service but at the same time you’re creating, adding to a database I assume where you can establish or see trends … I always try to respond to requests like that from the hospitals because I think it helps the doctors and everybody to create a database or whatever, which is always good’

NHS: National Health Service.