Table 5.

Barrier and facilitator themes linked to COM-B constructs and Behaviour Change Wheel intervention functions

COM-B construct		Theme	Behaviour Change Wheel linked potential intervention functions
Physical capability: physical skill, strength, or stamina		None	None
Psychological capability: knowledge or psychological skills, strength or stamina to engage in the necessary mental processes	Barriers	Knowledge gaps	Education Training Environmental restructuring Modelling Enablement
	Facilitators	Adequate knowledge and education
Physical opportunity: opportunity afforded by the environment involving time, resources, locations, cues, physical affordance		Time constraints and inadequate staffing	Training Restriction Environmental restructuring Enablement
	Barriers	Cost and lack of resources
		Resident complexity
		Compromised communication and information flow
		Staff turnover
		Competing priorities
		Guideline complexity and associated workload
		Healthcare system structure
		Limited physical environment
		Conflicting guidelines
		Impractical guideline
	Facilitators	Well-designed strategies, protocols, and resources
		Adequate services, resources, and time
		Innovative environmental modifications
Social opportunity: opportunity afforded by the interpersonal influences, social cues and cultural norms that influence the way that we think about things	Barriers	Lack of teamwork	Restriction Environmental restructuring Modelling Enablement
		Lack of organizational support
		Inconsistent practices
		Reactive approach
	Facilitators	Leadership and champions
		Support and coordination among staff
		Involving residents and families
		Good communication and information flow
Reflective motivation: reflective processes involving plans (self-conscious intentions) and evaluations (beliefs about what is good and bad)	Barriers	Conflict with clinical autonomy	Education Persuasion Modelling Enablement Incentivisation Coercion
		Belief against the guideline
		Moral distress Lack of noticeable outcomes from guideline implementation
	Facilitators	Noticeable outcomes from guideline implementation
		Conviction that the guideline is evidence-based and will demonstrate improvement
Automatic motivation: automatic processes involving emotional reactions, desires (wants and needs), impulses, inhibitions, drive states and reflex responses	Barriers	Reluctance to change	Training Incentivisation Coercion Environmental restructuring Persuasion Modelling Enablement
		Emotional responses to work and confidence in skills
		Simultaneous changes or change fatigue
	Facilitators	Positive emotional responses to work and the intervention