Table 4.

Main determinants of self-care mapped onto the COM-B model with suggested Behaviour Change Techniques (BCTs) and intervention strategies

Higher order theme	Determinants	Existing interventions	COM-B analysis of interviews and surveys	Intervention function	BCT(s)	Strategy example
Knowledge/skills
Lack of knowledge/skill	Service-users need to know how to accurately and confidently self-manage and alleviate symptoms, and identify warning symptoms that should prompt contact with GP/A&E.	Predominately leaflet-based information that targets psychological aspects of capability.	Psychological and physical capability	Training/education/ enablement	Instruction on how to perform the behaviour, Information about health consequences, Information about antecedents, Self-monitoring, Demonstration of the behaviour, Behavioural rehearsal/practice, Feedback on behaviour, Prompts/cues.	Educate/train/enable service-users (especially parents with one child and those with a lower socioeconomic status) to self-manage and alleviate symptoms, and identify when it is appropriate to contact a GP/A&E, for example, self-monitor symptoms when sick using a daily symptom diary to improve skills in the recognition and treatment of MAs and identification of danger signs and symptoms.
	Service-users need to know how to accurately and confidently access available healthcare (eg, community pharmacy) support services for MAs.	Rarely targeted				Educate/train/enable service-users (especially parents with one child and those with a lower socioeconomic status) how to access support services for self-care of MAs (including community pharmacy, National Health Service (NHS) 111, and NHS walk-in centre) for example, Provide links to credible sources of support (eg, websites, forums, telephone triage) and educate service-users on 24 hours pharmacy access, the benefits of Internet information, and NHS phone services—available 24 hours.
Emotion
Negative emotion (anxiety/worry)	Service-users need to know how to manage their anxiety about the symptoms being a sign of something more serious.	None	Automatic motivation	Persuasion/Enablement	Reduce negative emotions, Problem solving/coping strategies Feedback about the behaviour.	Enable service-users to not be overwhelmed by anxiety (eg, enable service-users to problem solve through identifying anxiety triggers that drive the urge to attend a GP/A&E and develop strategies for managing them). Persuade service-user by giving feedback about the appropriateness of their care-seeking behaviour.
Reinforcement
Past experience/behaviour	Service-users need to reduce the association between non-threatening symptoms and the need for a prescription or to visit a GP/A&E.	Delayed/refusal of antibiotics Credible source to support education interventions.	Automatic motivation	Restriction/restructuring the physical environment	Behaviour substitution, Incentive	Restrict/restructure the environment by refusing or delaying GP appointments. Restrict/restructure the environment by refusing or delaying prescriptions (to reduce associations between symptoms and the need for prescriptions).
Beliefs about consequences
Severity of symptoms (persistence, impact on day-to-day life, painful, unfamiliar, unspecified)	Service-users need the conviction to self-care until appropriate to contact a GP/A&E.	None (though overlap with lack of knowledge/skills above)	Reflective motivation	Education/persuasion	Verbal persuasion about capability, Information about social/environmental and health consequences, Credible source.	Persuade service-users that pharmacists and nurses opinions are trustworthy. Enhance persuasion using a credible source (eg, high-status health professional). Persuade/educate service-user to be responsible for their own health and well-being in the first instance, for example, through provision of normative information that GP/A&E should be utilised for the management of serious health conditions only. Persuade/educate service-user by telling them how much each consultation costs.
Susceptibility (children seen as vulnerable)
Treatment expectations (expected or actual referral/continuity of care)
Health threat	Fear of negative consequences	See anxiety/worry and severity/susceptibility/treatment expectations (above)	Reflective and Automatic motivation	See anxiety/worry and severity/susceptibility/treatment expectations (above)
Social influences
Social support	Service-users need to know how to substitute GP/A&E visits with support from friends, family and others as a first port of call in managing MAs.	Social support from health provider in delivery of education for self-care of MAs.	Social influences	Enablement	Behaviour substitution Social/practical support, Goal setting.	Enable service-users to substitute visiting the GP/A&E with seeking appropriate social/practical support from friends, family, acquaintances and other health professionals (eg, set the goal of contacting community pharmacy if unsure whether symptoms warrant a visit to the GP). Enable service-users to self-care through the provision of reassurance that self-care is appropriate.
Environmental context and resources
Access/convenience (geographical immediacy, time taken to access care, opening hours)	The environment needs to be restructured to improve the accessibility and quality of self-care services for MAs.	Services: Walk-in centres Telephone triage Practice nurses.	Physical opportunity	Environmental restructuring/training	Restructure the environment	Restructure the environment to provide a specialist transport service that can help service-users who are otherwise unable to travel to healthcare services. Restructure the environment to extend opening hours of self-care services such as community pharmacy and offer service-users greater access in the evenings and at weekends.
Environmental factors (cost of over-the-counter medicines)						Restructure the environment to make prescription medication more readily available at self-care services such as community pharmacy.
Limited professional roles (capacity to Prescribe/physically examine)						Train more nurse and pharmacy health professionals with full prescribing rights. Restructure the environment to enable better collaboration between health professionals such as the pharmacist and GP. Restructure the environment to provide health professionals with full read and write access to GP records. Restructure the environment to provide service-users with online access to summary information of their GP records.

A&E, accident and emergency; COM-B, capability, opportunity, motivation-model of behaviour; GP, general practitioner; MAs, minor ailments.