Table 4.

Behavior Change Wheel (BCW) framework for EmpowerMyCH Tool

BCW Framework			Intervention Components
COM domains	TDF sub-domains	COM + TDF based Intervention functions (definition)	Examples of EmpowerMyCH Activities Associated with Interventions Functions
Psychological Capability Reflective Motivation	Knowledge Beliefs about capabilities Beliefs about consequences Motivation and goals	Education (Increase knowledge and understanding)	Provide information on CHD care guidelines Raise awareness of the need to establish and maintain care with ACHD specialist
Psychological Capability Physical Opportunity	Memory, attention and decision processes Reinforcement Environmental context and resources	Training (Imparting skills)	Use expert and peer guidance to train CHD patients with confident decision making process as they navigate health care Train patients on using tools (e.g., patient portals) to enhance their care experience
Physical Opportunity	Memory, attention and decision Processes Environmental context and Resources Social influences	Environmental restructuring (Changing the physical or social context)	Provide CHD education components outside the clinic visits, at their own convenience through an app Provide opportunity to carry all their medical information in their pocket all the time through a Digital Medical Passport. Allow easy access to key resources such as ACHD provider directory, CHD community events, etc. on the app
Social Opportunity Automatic and Reflective Motivation	Social/professional role and Identity Beliefs about capabilities Beliefs about consequences Motivation and goals Optimism Emotion Behavioral regulation Reinforcement	Modeling (Providing an example for people to aspire to or imitate)	Use patient stories and experiences to demonstrate and inspire adoption of desired behavior Allow sharing of experiences among the users to develop a sense of belonging and community
Automatic and Reflective Motivation	Social/professional role and Identity Beliefs about capabilities Beliefs about consequences Motivation and goals Optimism Emotion	Persuasion (Using communication to induce positive or negative feelings or simulate action)	Using influential imagery and/or respected messengers to promote behavior change (e.g., “Empowerment” and “Peer Empowerment” quotes)
Psychological Capability Physical and Social Opportunity Automatic and Reflective Motivation	Beliefs about capabilities Beliefs about consequences Motivation and goals Memory, attention and decision Processes Environmental context and Resources Optimism Social influences Emotion Behavioral regulation Reinforcement	Enablement (Increasing means/reducing barriers to increase capability beyond education and training, or opportunity beyond environmental restructuring)	Improve availability and accessibility to credible resources to manage CHD care Nudge or reminders to promote access and adherence to care guidelines Build self-esteem and self-advocacy skills to feel valued partners within the health system