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The COM-B system - a framework for understanding behaviour.

The COM-B system - a framework for understanding behaviour.

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Improving the design and implementation of evidence-based practice depends on successful behaviour change interventions. This requires an appropriate method for characterising interventions and linking them to an analysis of the targeted behaviour. There exists a plethora of frameworks of behaviour change interventions, but it is not clear how well...

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... Models for successful organizational change encourage systematic opportunities to collaboratively absorb, question and consolidate new knowledge over time to ameliorate uncertainty and promote optimal uptake of new processes (Michie et al., 2011). Essential implementation strategies (Waltz et al., 2015) such as training, education, evaluation, iterative processes, and development of new relationships were not possible when the pandemic started. ...
Presentation
Music therapy programs in hospitals are a high growth area for the profession in many countries. With teams of up to 15 therapists, management positions are also emerging as a key professional role. Managers are responsible for the delivery of efficient services, advocacy for the place of music therapy, and the development of programs to meet anticipated patient needs. While music therapists are well trained to provide clinical services in hospitals, advanced learning about management relies on the individual to develop in isolation. MT managers use their own initiative to develop a range of new skills and traverse issues of their new identity. There is little representation of management or manager identity in the literature todate meaning the significant work of management is largely invisible. The [name of group removed for review] was created in April 2020 and serves as a reflexive practice group for managers in eight hospitals in two countries. The group has used collaborative reasoning to construct insight around issues such as manager identity, liminal status within and beyond their team, and insights about sustainable team and program development. In this workshop, the managers group will engage participants in collaborative reasoning exercises to reflexively consider where they are in terms of leadership potential and realities, working on key structures to support independent thinking and action.
... In this paper, we aim to answer the following research question: "How and why do adolescents manage their privacy when creating videos on TikTok?" We build on the COM-B model for behavioral analysis, an established conceptual framework for behavior change widely applied in health communication and beyond [62]. This model allows us to explore not only privacy behavior, but also related users' motivations, skills and desires. ...
... As we were interested in the components that shape privacy behavior, we chose the COM-B model, which has been used in exploratory studies (e.g., [32]) and a series of contexts to change behavior (e.g., [3]), as the conceptual framework for our analysis. Many behavioral theories have been developed, often with overlapping but differently named constructs [60] and limited guidance on The COM-B model [62]. The three components capability (C), opportunity (O) and motivation (M) must be present for a behavior (B) to occur. ...
... choosing an appropriate theory for a particular, real-world context [62]. As a consequence, theories are often under-used to understand real-world contexts and to design real-world solutions, which makes replication, implementation, evaluation, and improvements difficult [25,62]. ...
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TikTok has been criticized for its low privacy standards, but little is known about how its adolescent users protect their privacy. Based on interviews with 54 adolescents in Switzerland, this study provides a comprehensive understanding of young TikTok users' privacy management practices related to the creation of videos. The data were explored using the COMB model, an established behavioral analysis framework adapted for sociotechnical privacy research. Our overall findings are in line with previous research on other social networks: adolescents are aware of privacy related to their online social connections (social privacy) and perform conscious privacy management. However, we also identified new patterns related to the central role of algorithmic recommendations potentially relevant for other social networks. Adolescents are aware that TikTok's special algorithm, combined with the app's high prevalence among their peers, could easily put them in the spotlight. Some adolescents also reduce TikTok, which was originally conceived as a social network, to its extensive audiovisual capabilities and share TikToks via more private channels (e.g., Snapchat) to manage audiences and avoid identification by peers. Young users also find other creative ways to protect their privacy such as identifying stalkers or maintaining multiple user accounts with different privacy settings to establish granular audience management. Based on our findings, we propose various concrete measures to develop interventions that protect the privacy of adolescents on TikTok.
... The Behaviour Change Wheel (BCW; see, Figure 1) framework may be used to develop evidencebased behaviour change interventions (Michie et al., 2014(Michie et al., , 2011West et al., 2019). BCW offers a comprehensive, systematic method applicable to individuals, groups, and populations, and indeed any behaviour (Michie et al., 2014). ...
... The COM-B model of behaviour change (see, Figure 2), the inner ring of BCW (see, Figure 1), offers a simple but effective account of human behaviour (Michie et al., 2014(Michie et al., , 2011West et al., 2019). COM-B asserts that when Capability (including psychological capability and physical capability), Opportunity (including social opportunity and physical opportunity), and Motivation (including reflective motivation and automatic motivation) are sufficient, behaviour occurs, whereas when one or more of them is insufficient, it does not. ...
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Pre-registration is an open research practice that can mitigate against questionable research practices and contribute to enhanced research outcomes, such as increased research transparency. This paper explores barriers and enablers to pre-registration, and develops an evidence-based behaviour change intervention specification to increase its uptake. The Behaviour Change Wheel (BCW) framework of intervention development and COM-B model of behaviour change were used to inform the development of a mixed-methods online questionnaire, assessing barriers and enablers to pre-registration. Data were collected from 18-05-2020 to 12-07-2020, and explored using descriptive statistics, reflexive thematic analysis, and COM-B. BCW was used to develop an intervention specification. Respondents were researchers (n = 105) who were mostly engaged in psychological research (71%) and had pre-registered before (75%). Insufficient knowledge and skill (psychological capability), social support (social opportunity), time (physical opportunity), and incentivisation (reflective motivation) were the most substantial barriers to pre-registration, whereas belief in pre-registration contributing to desirable research outcomes (reflective motivation) was the most substantial enabler. These findings informed the development of an intervention specification to increase pre-registration uptake by researchers. This paper demonstrates the strong potential of BCW to facilitate open research practices. The identified barriers and enablers, intervention specification, and the behaviour change approach outlined, may be used to increase pre-registration uptake; for example, developing new or refining existing training and incentivisation interventions. This paper may inspire others to consider the strong potential of BCW to facilitate open research practices and so contribute to enhanced research outcomes.
... While McBride et al.'s (2003) model (hereafter referred to as the TM model) appears to explain pregnancy as a teachable moment, Olander et al. (2016) have suggested that the Capability-Opportunity-Motivation Behaviour model (COM-B; Michie, van Stralen, & West, 2011) provides a broader explanation of health behaviour change during pregnancy. The COM-B model has been posited as a 'behaviour system', that involves three essential conditions to generate behavioural change: capability (physical and psychological), opportunity (physical and social), and motivation (reflective and automatic). ...
... The COM-B model has been posited as a 'behaviour system', that involves three essential conditions to generate behavioural change: capability (physical and psychological), opportunity (physical and social), and motivation (reflective and automatic). All conditions, except for reflective motivation, are thought to be necessary to generate a behaviour (Michie et al., 2011). Olander et al. (2016 argue that existing definitions of teachable moments rely mainly on motivation to explain behaviour change and that the COM-B model offers a greater understanding by moving beyond motivation and incorporating both an individual's capability and opportunity (also described as the 'context') to change their behaviour. ...
... The existing TM model constructs capture women's internal cognitive processes relating to risk, emotions, and identity, but fail to account for any factors beyond these internal psychological processes or those presented in the external environment. Accordingly, the unmapped sub-themes that mapped to the 'opportunity' construct of the COM-B model (also described as the 'context') are defined as factors that 'lie outside the individual' (Michie et al., 2011). Numerous studies have highlighted the important role that social, and practical or environmental factors play in women's decision-making around their health during pregnancy (Harrison et al., 2018;Omidvar et al., 2018;O'Brien et al., 2017). ...
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Objectives Theoretical models have informed the understanding of pregnancy as a ‘teachable moment’ for health behaviour change. However, these models have not been developed specifically for, nor widely tested, in this population. Currently, no pregnancy-specific model of behaviour change exists, which is important given it is a unique yet common health event. This study aimed to assess the extent to which factors influencing antenatal behaviour change are accounted for by the COM-B model and Teachable Moments (TM) model and to identify which model is best used to understand behaviour change during pregnancy. Design Theoretical mapping exercise. Methods A deductive approach was adopted; nine sub-themes identified in a previous thematic synthesis of 92 studies were mapped to the constructs of the TM and COM-B models. The sub-themes reflected factors influencing antenatal health behaviour. Findings All sub-themes mapped to the COM-B model constructs, whereas the TM model failed to incorporate three sub-themes. Missed factors were non-psychological, including practical and environmental factors, social influences, and physical pregnancy symptoms. In contrast to the COM-B model, the TM model provided an enhanced conceptual understanding of pregnancy as a teachable moment for behaviour change, however, neither model accounted for the changeable salience of influencing factors throughout the pregnancy experience. Conclusions The TM and COM-B models are both limited when applied within the context of pregnancy. Nevertheless, both models offer valuable insight that should be drawn upon when developing a pregnancy-specific model of behaviour change.
... The results of the studies that have explored children's eating behaviours mirror those with adults; a study of children with obesity living in Italy found decreases in self-reported exercise and increases in self-reported intake of energy-dense foods at the beginning of lockdown compared to the previous year (Pietrobelli et al., 2020), while a survey of parents in France revealed increases in snacking and emotional eating among children, with child boredom also being associated with snack intake (Philippe, Chabanet, Issanchou, & Monnery-Patris, 2021). Parents who were highly stressed in this study were also more likely to grant autonomy over eating to their children, which dovetails with evidence for an association between parental stress and children's intake of energy-dense foods (Parks et al., 2012) and the authors called for qualitative research to explore the reasons for and experiences of these changes (Philippe et al., 2021). A qualitative study with parents of pre-school children in the UK recently investigated the ways in which the pandemic has affected younger children's (aged two to four years) eating behaviour (among other health-related behaviours such as exercise and screen-time; Clarke et al., 2021). ...
... It could tentatively be assumed that families' engagement with a healthy eating pilot trial is indicative of parents' motivation to improve the eating habits of their children. However, the COM-B model of behaviour specifies that motivation alone is not sufficient in order for a behaviour to occur; the actor must also have the capability (including knowledge and skills) to perform it and the opportunity (including having the time, money, equipment/ resources and necessary social environment) to do so (Michie, van Stralen, & West, 2011). Many interventions for improving diet focus on education and building skills (i.e. ...
... due to cost) and the effort required to manage competing priorities also denies people the luxury of focusing on health when choosing food (Puddephatt et al., 2020). A relationship between parental stress and child intake of fast-food has also been observed previously (Parks et al., 2012), as has a relationship between parental stress and indulgent feeding behaviours (Loth, Uy, Neumark-Sztainer, Fisher, & Berge, 2018), which dovetails with the finding here that parents were more likely to give in to children's food requests and purchase convenient energy-dense foods when stressed or short on time as a way of getting by. The finding that fears of food shortages and hunger led some families to break existing habits of not keeping energy-dense foods in the house also aligns with previous research with low-income parents, which found that fears of child hunger drove parents to provide children with foods that they felt guilty about providing (Pescud & Pettigrew, 2014). ...
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Background: The eating habits of children and adults have been impacted by the COVID-19 pandemic, with evidence of increases in snacking and emotional eating, including eating to relieve boredom. We explored the experiences of families with children aged 4-8 years who had recently participated in a healthy eating pilot trial when the first national lockdown began in England. Methods: Eleven mothers were interviewed in April and May 2020. Interview questions were developed based on the COM-B model of behaviour. Four main themes were constructed using inductive thematic analysis. Results: The first theme related to an initial panic phase, in which having enough food was the primary concern. The second related to ongoing challenges during the lockdown, with sub-themes including difficulties accessing food, managing children's food requests and balancing home and work responsibilities. The perception that energy-dense foods met families' needs during this time led to increased purchasing of (and thus exposure to) energy-dense foods. In the third theme, families described a turning point, with a desire to eat a healthier diet than they had in the early stages of the lockdown. Finally, in the fourth theme, families reported a number of strategies for adapting and encouraging a balanced diet with their children. Conclusions: Our results suggest that even if parents have the capability (e.g. knowledge) and motivation to provide a healthy diet for their family, opportunity challenges (e.g. time, access to resources, environmental stressors) mean this is not always practical. Healthy eating interventions should not assume parents lack motivation and should be sensitive to the context within which parents make feeding decisions.
... However, earlier studies already suggested that this hypothesis does not hold for TAVI patients because an increase in physical capacity does not simply lead to altered behavior [20]. Barriers for many patients to eat healthy or be more active is not only influenced by the physical capacity but also by environmental opportunity, psychological capability, and motivation [42]. Our results confirm that the TAVI procedure is not sufficient to improve the nutritional status and physical activity of patients within six months after the procedure. ...
Article
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It is suggested that older patients waiting for an elective surgical procedure have a poor nutritional status and low physical activity level. It is unknown if this hypothesis is true and if these conditions improve after a medical procedure. We aimed to determine the trajectory of both conditions before and after transcatheter aortic valve implantation (TAVI). Included patients (n = 112, age 81 ± 5 years, 58% male) received three home visits (preprocedural, one and six months postprocedural). Nutritional status was determined with the mini nutritional assessment—short form (MNA-SF) and physical activity using an ankle-worn monitor (Stepwatch). The median MNA-SF score was 13 (11–14), and 27% of the patients were at risk of malnutrition before the procedure. Physical activity was 6273 ± 3007 steps/day, and 69% of the patients did not meet the physical activity guidelines (>7100 steps/day). We observed that nutritional status and physical activity did not significantly change after the procedure (β 0.02 [95% CI −0.03, 0.07] points/months on the MNA-SF and β 16 [95% CI −47, 79] steps/month, respectively). To conclude, many preprocedural TAVI patients should improve their nutritional status or activity level. Both conditions do not improve naturally after a cardiac procedure.
... Quality improvement interventions were categorized using the Behavior Change Wheel (BCW) [29]. The BCW is a model that was developed as a comprehensive synthesis of several other behavior change frameworks. ...
... The BCW is a model that was developed as a comprehensive synthesis of several other behavior change frameworks. It centers on the COM-B system, which recognizes that behavior change stems from capability, opportunity, and motivation [29]. Surrounding the COM-B system are intervention functions, which are then encompassed by policy categories. ...
... Surrounding the COM-B system are intervention functions, which are then encompassed by policy categories. This acknowledges that policies (e.g., guidelines, regulations) can influence behavior through interventions (e.g., enablement, environmental restructuring) [29]. The described QI interventions within each study were coded as intervention functions (e.g., education, enablement, modeling) and/or policy categories (e.g., guidelines, regulations) [29]. ...
Article
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Background An unplanned extubation is the uncontrolled and accidental removal of a breathing tube and is an important quality indicator in pediatric critical care. The objective of this review was to comprehensively synthesize literature published on quality improvement (QI) practices implemented to reduce the rate of unplanned extubations in critically ill children. Methods We included original, primary research on quality improvement interventions to reduce the rate of unplanned extubations in pediatric critical care. A search was conducted in MEDLINE (Ovid), Embase, and CINAHL from inception through April 29, 2021. Two reviewers independently screened citations in duplicate using pre-determined eligibility criteria. Data from included studies were abstracted using a tool created by the authors, and QI interventions were categorized using the Behavior Change Wheel. Vote counting based on the direct of effect was used to describe the effectiveness of quality improvement interventions. Study quality was assessed using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS). Results were presented as descriptive statistics and narrative syntheses. Results Thirteen studies were included in the final review. Eleven described primary QI projects; two were sustainability studies that followed up on previously described QI interventions. Under half of the included studies were rated as high-quality. The median number of QI interventions described by each study was 5 [IQR 4–5], with a focus on guidelines, environmental restructuring, education, training, and communication. Ten studies reported decreased unplanned extubation rates after the QI intervention; of these, seven had statistically significant reductions. Both sustainability studies observed increased rates that were not statistically significant. Conclusions This review provides a comprehensive synthesis of QI interventions to reduce unplanned extubation. With only half the studies achieving a high-quality rating, there is room for improvement when conducting and reporting research in this area. Findings from this review can be used to support clinical recommendations to prevent unplanned extubations, and support patient safety in pediatric critical care. Systematic review registration This review was registered on PROSPERO (CRD42021252233) prior to data extraction.
... This finding provides some support for the intervention components identified in a recent meta-analysis [25]. The message used in Study 2 focused on enhancing perceived goal similarity (i.e., motivation), which might not have been effective because it ignores important differences between the behaviors in terms of capability, opportunity, and motivation [37]. For SPILLOVER FROM PERSONAL TO COLLECTIVE MITIGATION BEHAVIOR example, most of the personal behaviors included in the checklist are easy to perform and widely accessible (e.g., turning off lights), whereas the collective behaviors tend to require more effort (e.g., identifying and punishing companies that are opposing steps to reduce climate change). ...
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Both lifestyle and structural changes are needed to reduce carbon emissions and limit the impacts of climate change. In a series of three studies, we examine whether undertaking behaviors at the personal level affects (i.e., spills over onto) people's willingness to engage in behaviors at the collective level. In Study 1, we find that none of the personal behaviors measured are negatively associated with collective behavior intentions (willingness to join a campaign to convince elected officials to take action to reduce climate change), but some of the personal behaviors are positively associated with collective behavior intentions. In Study 2, we find that increasing the salience of past personal behaviors does not spill over to collective behavioral intentions. In Study 3, we find that increasing the salience of past personal behavior does not spillover to collective behavioral intentions but does increase support for a carbon tax on companies. We also find that increasing the salience of past behavior increases environmental identity and the perception that one is already taking enough action to reduce climate change. Overall, the results suggest that there are no spillover effects of personal mitigation behaviors on collective mitigation behavioral intentions. Messages that directly encourage collective mitigation behaviors may be more effective at promoting these behaviors than messages that emphasize past personal behaviors.
... These factors include support of key decision makers, managing expectations, employment of expertise, a successful communication strategy, identifying important incentives, stakeholder engagement, and united bottom-up and top-down approaches. Motivation, opportunity and capability, in a framework described by Michie et al. see also [16,31] lead to a well-fitting initiative. Icons used in this figure adapted from resources on www. ...
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Increasing the reproducibility and trustworthiness of biomedical research requires engaging stakeholders from all levels in an institutional setting. The QUEST Center for Responsible Research aims to develop and implement new approaches to improve the culture and practice of research, tailored to the needs of these stakeholders. Members of the QUEST Center organised a brainstorm to reflect on the challenges and new opportunities encountered in implementing different projects through QUEST and share the lessons that working groups have learned over the first five years. The authors informally surveyed and interviewed working groups where relevant and highlight common themes that have influenced the success of many projects, including top-down and bottom-up engagement, managing expectations, the availability of expertise, ensuring sustainability, and considering incentives. The commentary authors conclude by encouraging the research community to view initiatives that promote reproducibility not as a one-size-fits-all undertaking, but rather as an opportunity to unite stakeholders and customise drivers of cultural change.
... The main reason may be that changes in established clinical practice disrupt the existing "status quo", as they require questioning old beliefs and learning of new practices within existing contextual factors [48,49]. Similar to other efforts to change established routines e.g. in quality improvement [50][51][52], the implementation and use of e-PRO assessment represents a multifaceted change process of existing systems and routines, influenced by the relationships between patients and clinical staff, their roles and structural conditions [53]. The experiences of our study suggest, that this complex process requires additional efforts concerning the motivation of all relevant stakeholders and the adjustment of overexpectations [54] as those changes need time. ...
... Future research should focus on long-term implementations in different oncologic settings, apply a multicenter design starting with a pilot center and aim for routine clinical conditions to examine e-PRO assessment in "real-life" application contexts. Scientifically based implementation concepts [50][51][52] and models could be adapted and specified for this application to further enhance and facilitate the implementation of e-PRO assessment. Also, targeted educational interventions to use e-PRO-assessment [56], including communication strategies for the integration of e-PRO results into patient consultations [57] should be developed. ...
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Purpose: Despite evidence for clinical benefits, recommendations in guidelines, and options for electronic data collection, routine assessment of patient-reported outcomes (PROs) is mostly not implemented in clinical practice. This study aimed to plan, conduct and evaluate the implementation of electronic PRO (e-PRO) assessment in the clinical routine of an inpatient radiation oncology clinic. Methods: The guideline- and evidence-based, stepwise approach of this single-center implementation study comprised preparatory analyses of current practice, selection of assessment instruments and times, development of staff training, and evidence-based recommendations regarding the use of the e-PRO assessment, as well as on-site support of the implementation. Process evaluation focused on potential clinical benefit (number of documented symptoms and supportive measures), feasibility and acceptance (patient contacts resulting in completion/non-completion of the e-PRO assessment, reasons for non-completion, preconditions, facilitators and barriers of implementation), and required resources (duration of patient contacts to explain/support the completion). Results: Selection of instruments and assessment times resulted in initial assessment at admission (EORTC QLQ-C30, QSR 10), daily symptom monitoring (EORTC single items), and assessment at discharge (EORTC QLQ-C30). Recommendations for PRO-based clinical action and self-management advice for patients concerning nine core symptoms were developed. Staff training comprised group and face-to-face meetings and an additional e-learning course was developed. Analyses of clinical records showed that e-PRO assessment identified more symptoms followed by a higher number of supportive measures compared to records of patients without e-PRO assessment. Analysis of n = 1597 patient contacts resulted in n = 1355 (84.9%) completed e-PROs (initial assessment: n = 355, monitoring: n = 967, final assessment: n = 44) and n = 242 (15.2%) non-completions. Instructions or support to complete e-PROs took on average 5.5 ± 5.3 min per patient contact. The most challenging issue was the integration of the results in clinical practice. Conclusion: E-PRO assessment in oncologic inpatient settings is acceptable for patients and can support symptom identification and the initiation of supportive measures. The challenge of making the "data actionable" within the clinical workflow and motivating clinical staff to use the results became evident.