Table 4.
COM-B Subcomponent | Patient Level | Provider Level | Service Level | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Barrier | Source | Facilitator | Source | Barrier | Source | Facilitator | Source | Barrier | Source | Facilitator | Source | |
Physical capability | Lack of training and skills | [55, 57, 60, 63, 64, 66, 69, 73] | Skills-based training | [56, 59, 60, 62, 64, 65, 67, 70, 73–75] | Receptionist involvement | [38, 40, 41, 44, 48, 66, 67, 69, 70, 74, 75] | Receptionist involvement | [38, 40, 41, 44, 48, 66, 67, 69, 70, 74, 75] | ||||
Practice nurse involvement | [58–60, 71] | Practice nurse involvement | [55, 58, 59, 63, 66, 69, 71] | |||||||||
Psychological capability | Lack of patient education, knowledge, and awareness | [51, 55, 60, 73] | Increase knowledge, education, and awareness | [37, 41, 43, 48, 49, 51, 54, 55, 61, 62, 64, 67, 68, 73] | Lack of provider knowledge and awareness | [55, 60, 63–66, 71, 75] | Increasing knowledge, awareness, and education | [54–56, 59, 62, 64, 65, 67, 70, 73, 75] | Lack of testing guidance | [64] | Prompts and reminders | [55, 66, 67, 70, 75] |
Forgetfulness | [41, 48, 75] | Forgetfulness | [51, 52, 55, 60, 66, 68, 70, 75] | Lack of knowledge, education, and general awareness | [55, 60, 63–66, 71] | Testing guidelines | [55, 60] | |||||
Reflective motivation | Beliefs regarding perceived risk | [37, 41, 42, 44–46] | Beliefs that testing is responsible, mature, and healthy | [37, 38] | Assumptions and perceptions of patients | [53–55, 61, 66, 69, 70, 74, 75] | Increase confidence | [59, 62, 70] | Targets set too high | [70, 74] | ||
Beliefs about consequences of offering | [54, 66, 69, 70, 73, 74] | Testing policy: new patients’ health checks | [64] | |||||||||
Automatic motivation | Embarrassment and shame | [37, 40–43, 48, 49, 55, 69, 70, 73] and [37, 38, 40, 42, 43] | Asymptomatic infection worries | [37, 44, 45] | Difficult to discuss | [52, 60–62, 64, 66, 68–70, 73, 75] | Testing policy: based on behaviour | [41, 48] | Reward and incentive programmes | [51, 55, 61, 62, 66–69, 74, 75] | ||
Fear | [38, 41–43, 48, 50] | |||||||||||
Feedback on efforts | [70, 74, 75] | |||||||||||
Physical opportunity | Time constraints | [40, 41, 48] | PCP offering testing | [41, 47] | Time constraints | [51, 52, 55, 57–64, 66, 68–75] | Mode of testing | [55, 62, 64, 73, 75] | Time constraints | [40, 41, 48] and [51, 52, 55, 57–64, 66, 68–75] | Promotional materials | [54, 63, 70, 74, 75] |
Receptionist involvement | [38, 40, 41, 44, 48, 66, 67, 69, 70, 74, 75] | Mode of testing | [39–41, 44, 48] | Receptionist involvement | [38, 40, 41, 44, 48, 66, 67, 69, 70, 74, 75] | Reception area | [38, 40, 41, 44, 48, 70] and [74, 75] | Testing policy: inclusion in other consultations | [48, 66, 67] | |||
Written invitations | [61, 67] | System to record offers | [66] | |||||||||
Service cost to patient | [37, 39, 47, 60] | Simplified laboratory systems | [59, 62, 66, 68] | |||||||||
Absence of systems to record test offers | [66, 69] | Support for partner notification | [62, 64, 69] | |||||||||
Lack of support for partner notification | [55, 60, 62–64, 73] | |||||||||||
Social opportunity | Stigma | [37, 38, 40–43, 55, 61, 71] | Normalisation | [38, 41–43, 61] | Practice social norms | [66, 73] | Normalisation | [54, 61, 66, 67, 70, 74] | Testing policy: women only | [37, 38, 69] | Normalisation | [52, 54, 55, 61, 63, 66, 67, 70] |
Provider-patient relationship | [48, 55, 58, 59, 66, 74] | Consultation social context | [45, 55, 56, 61, 64, 67, 70, 73] | Cultural norms | [66, 73] | Testing policy: blanket testing | [38, 48] |
COM-B capability, opportunity, motivation, behaviour