Table 4.

Overview of results: Summary of barriers and facilitators across levels (patient, provider, and service) and theoretical component

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