Table 6.

Implementation barriers and enablers coded using the COM-B framework (summary table)

COM-B category	COM-B subcategory	COM-B definition	Frequency of occurrence	Examples of barriers and enablers
Opportunity	Physical	Environmental context and resources	36	○ Financial constraints and budgets ○ Physical resources to support guideline implementation (water lines, lack of transportation, etc.) ○ Need for extensive human resources ○ Stakeholder support and buy-in ○ Site check-ins ○ Training for end-users and stakeholders ○ Supportive policies and laws ○ Ensuring basic needs are met for workers to support motivation and reduce attrition ○ Local leadership ○ Incentives ○ Strategic implementation and operation plans
	Social	Social influences, norms, cultural, social pressures, conformity	22	○ Cultural context ○ Political instability/stability ○ Political commitment ○ Stigma (e.g. HIV+ mothers counselling other HIV+ mothers) ○ Power imbalances
Capabilities	Psychological	Knowledge, memory, decision-making, behavioural regulation	15	○ Knowledge of the guideline and its practices ○ Emotional toll on frontline clinicians working with vulnerable populations ○ Resistance to change
	Physical	Skills and abilities	19	○ Adapting training materials for all (e.g. adapting materials for those who are illiterate) ○ Hosting training meetings ○ Continued implementation through training, mentorship, supportive supervision and follow-up documentation
Motivation	Reflective	Roles and identity, beliefs about consequences and optimism	4	○ Resistance to/acceptance of change ○ Trust in guidelines ○ More clear definition of roles and responsibilities
	Automatic	Emotions and reinforcement	10	○ Enthusiasm and commitment to implementation ○ Motivation to implement and perform duties