Table 4 Demonstration of how the COM-B Model could be applied to intervention development.
Barriers and facilitators | BCTs and implications for interventionsa |
COM-B: Capability | |
Theoretical domain: Knowledge | |
Negative result is not as informative/useful. For example: | 1. Goals and planning |
If proband tests negative and they do not perceive themselves to be directly affected, they are less likely to inform, as they feel they may not be taken seriously (63). | 1.3 Goal setting (outcome) – share x information with y relatives |
Misconceptions about heritability and illness representations. For example: | 4. Shaping knowledge |
Informing those that are not at risk i.e., if the proband is not a carrier, but then informing children of risk (14). Misconceptions that men are not at risk of BRCA1/2 alterations (25). | 4.1 Instructions on how to perform the behaviour |
Poor comprehension of information. For example: | 5. Natural consequences |
Do not communicate as think family are not at risk (64). Not all or correct information is communicated (24). | 5.1 Information about health consequences of performing the behaviour 5.3 Information about social consequences 5.6 Information about emotional consequences |
Additional notes: Include information about the importance of sharing negative results and myth busting. Consider adapting the ‘to whom it may concern letter from the HP needs to be easy to read, with infographics and less words to send as simple a message as possible to encourage relative to contact clinic, emphasise that you won’t have to have a test, just discuss the best option. Consider the use of web applications for intervention and sharing of results (Anonymous et al., 2019a). | |
COM-B: Capability | |
Theoretical domain: Skills | |
Competence, ability, practice, interpersonal skills, coping strategies. For example: | 1. Goals and planning 6. Comparison of the behaviour |
If the first attempt fails, it becomes much less likely the information will be communicated (65). Do not know what to say (65). Men less likely to communicate than women (66). | 1.4 Action planning – how, when, who, where. Preparation – start with the easiest person first, use that experience to help with relatives they think will be more difficult. 6.1 Demonstration of the behaviour 6.2 Social comparison |
Additional notes: Consider using scripts and templates for emails and message to help with action planning. | |
COM-B: Capability | |
Theoretical domain: Memory, attention and decision-making | |
Attention. For example: | 7. Associations |
The proband only being asked to share results with relatives only once at a counselling appointment. | 7.1 Prompts/cues |
COM-B: Capability. | |
Theoretical domain: Behavioural regulation | |
No follow up from health professional regarding whether the proband has communicated their test result to relevant others. | 2. Feedback and monitoring 2.4 Self-monitoring of outcome(s) of behaviour 2.5 Monitoring outcome(s) of behaviour by others without feedback 2.7 Feedback on outcome(s) of behaviour |
COM-B: Opportunity | |
Theoretical domain: Social influences. | |
Barriers. For example: | 3. Social support |
Family communication patterns (other family members normally do this communication) (51). | 3.1 Social support (unspecified) |
Estrangement and family disruption (67). | 3.3 Social support (emotional) |
Facilitators. For example: | |
Physical and emotional closeness, family cohesion, open communication, good relationship, in close contact (51,63,64,66,68). | Consider using modelling – construct vignettes based on real life case studies, emphasising informing relevant relatives that probands are also not close to. Digital assistance to enable quick and anonymous communication if necessary (Anonymous et al., 2019a). Consider adding an application which maps closeness of each person who needs informing, so more attention can be directed to the those less likely to be contacted. |
COM-B: Motivation | |
Theoretical domain: Emotion | |
Barriers. For example: | 5. Natural consequences |
Proband has felt anxious for years about risk and does not want relatives to suffer the same worry (30,64). | 5.5 Anticipated regret – induce or raise awareness of implications of not performing the behaviour |
Proband felt burden, guilt and anxiety of passing on the risk (25). | 5.6 Information about emotional consequences |
Emotionally difficult to share the information, guilty, anxious, poor psychological functioning associated with greater perceived barriers (14). | 11. Regulation 11.2 Reduce negative emotions/increase positive emotions |
Facilitators. For example: | |
Wish to prevent disease and anticipated regret by not sharing (14,63). | 11.2 Reduce negative emotions/increase positive emotions |
COM-B: Motivation | |
Theoretical domain: Social role and identity | |
Social and group norms, boundaries and roles. For example: | 13. Identity |
Family communication patterns (e.g., other family members normally do this communication) (51). | 13.1 Identification as self as role model 13.3 Incompatible beliefs – draw attention to discrepancies 13.4 Valued self-identity – identify cherished values to confirm identity 13.5 Identity associated with changed behaviour – person who communicates health information to relatives |
COM-B: Motivation | |
Theoretical domain: Beliefs about capability | |
Self-efficacy, perceived competence and empowerment. For example: | 15. Self-belief |
Encouragement and support from HPs (14). | 15.2 Mental rehearsal of successful performance 15.3 Focus on past success |
COM-B: Motivation | |
Theoretical domain: Goals | |
Barriers. For example: | 1. Goals and planning |
Not being able to find the right time to communicate results (26). | 1.5 Review behaviour goal(s) – review outcome and make modifications accordingly |
Deciding to communicate at a time when it is more actionable i.e., prostate cancer when in 40 s (25). | 1.6 Discrepancy between current behaviour and goal – point out that not all relatives informed |
Facilitators. For example: | |
Intrinsic motivation: Obligation/responsibility (14). | 1.7 Review outcome goal(s) 1.8 Behavioural contract – written specification of the behaviour witnessed by another 1.9 Commitment – ask the person to use an “I will” statement to affirm commitment to behaviour 9. Comparison of outcomes 9.1 Credible source – communication from a credible source for or against the behaviour 9.2 Pros and cons - of doing and not doing the behaviour 9.3 Comparative imagining of future outcomes – of doing and not doing the behaviour |
COM-B: Motivation | |
Theoretical domain: Beliefs about consequences | |
Assumptions made about relatives wishes/state. For example: | 5. Natural consequences |
The perception that the relative lacks sufficient maturity (70). | 5.5 Anticipated regret – induce or raise awareness of implications of not performing the behaviour |
Assessing relative’s vulnerability or receptivity, didn’t want to add to other burdens (25,26,68). Relative had not indicated a readiness to know (24). Proband considerers relatives right not to know unpleasant or unwanted information (25). Believes that relatives would not be interested in information (66). Fear of getting cancer would prevent their relative from pursing cancer risk information (68). | 5.6 Information about emotional consequences |
