Conference PaperPDF Available

Align and Combine, Customer Journey Mapping and COM-B Analysis to Aid Decision-Making During the Design Process

Authors:

Abstract and Figures

This paper explores a new methodology for solving complex problems that focus on changing end-users' behavior by combining customer journey mapping and COMB analysis. This method visually representing gaps and opportunities in a sequential way aligned with barriers to behaviors, creating a unique tool that can be used by both service designers and behavioral scientists. Using such tools can help us gain a more thorough understanding of a problem space, leading to the design of efficient, cost-effective behavior change interventions, improvement in the target outcomes and the achievement of business goals. We illustrate this "align and combine" method by applying it to the case study of an insurance company that wants to address the high risk of dental complications among their diabetic membership cohort. We conclude that visually combining the service design and behavioral science approaches creates a symbiotic relationship, where doing one type of analysis complements the other, and vice versa.
Content may be subject to copyright.
This work is licensed under a Creative Commons Attribution-NonCommercial-Share Alike 4.0
International License.
https://creativecommons.org/licenses/by-nc-sa/4.0/
Align and Combine, Customer Journey Mapping and
COM-B Analysis to Aid Decision-Making During the
Design Process
ELIZAROVA, Olga a* and KAHN, Paula,b
a Mad*Pow
b Information Design and Visualization, College of Arts Media and Design, Northeastern University
* Corresponding author e-mail: oelizarova@madpow.net
doi: 10.21606/dma.2017. 208
This paper explores a new methodology for solving complex problems that focus on
changing end-users’ behavior by combining customer journey mapping and COM-B
analysis. This method visually representing gaps and opportunities in a sequential way
aligned with barriers to behaviors, creating a unique tool that can be used by both
service designers and behavioral scientists. Using such tools can help us gain a more
thorough understanding of a problem space, leading to the design of efficient, cost-
effective behavior change interventions, improvement in the target outcomes and the
achievement of business goals. We illustrate this “align and combine” method by
applying it to the case study of an insurance company that wants to address the high
risk of dental complications among their diabetic membership cohort. We conclude
that visually combining the service design and behavioral science approaches creates
a symbiotic relationship, where doing one type of analysis complements the other,
and vice versa.
Keywords: design tools, design methods, behavior change, interdisciplinary
Introduction
Working in a design agency means exposure to multiple problems coming from different industries
and sectors. Though the sectors are different, it is not hard to see repeating patterns. We work to
solve complex, systemic problems that are intertwined with elements and touchpoints both inside
and outside the defined sector (Buchanan, 1992). There is great benefit to seeing how everything is
connected, but a side effect of such interconnectedness is the need to address each problem on
multiple levels. Sometimes it feels like we are designing for an ecosystem within an ecosystem of
another ecosystem. For example, when designing digital solutions for a health insurance client, we
must consider how the insurance customer experiences this in relation to the websites of their
To appear in Proceedings of the DRS 2018 Conference
2
pharmaceutical supplier and their healthcare provider, all of which exist within the larger ecosystem
of the U.S. healthcare system. Proposed solutions have to consider both the front-stage that directly
faces the customer, such as interaction with a web-based application, and the back-stage systems
that support that application. Once we change something on the front-stage, we must be thinking of
accompanying back-stage changes including the systems needed to support this service and any new
actors (Glushko and Tabas, 2008).
Another pattern we see is demand for products and services intended to change end-users’ behavior
(Consolvo, McDonald and Landay, 2009). In many cases, the target behavior is related to health,
finance, or education. One constant across all these sectors is that in order to change a behavior, we
first need to understand it. We need to understand the source and the logic of behavior, as well as
potential barriers and facilitators to the behavior occurring (Michie et al, 2008). In addition, we need
to fully understand the context in which behavior resides. That context includes the person or target
audience whose behavior you want to change, the specific behaviors, the settings in which these
behaviors occur and the desired long-term outcomes enabled by executing target behaviors.
As a rule, these two patterns of complex problems mapping out the front-stage and back-stage
touchpoints and support systems for a service and designing for behavior change are addressed by
different professionals. Service and experience designers work on untangling the complexities of the
system problems, analyzing the gaps and opportunities that exist within the defined ecosystem, and
designing an improved experience for all the actors (Zomerdijk and Voss, 2010). Behavioral and
social scientists, in their turn, are focused on untangling the complexities of behavioral systems
identifying sources of behaviors, behavioral determinants and building a logic model of change
(Michie, van Stralen and West, 2011).
We know that addressing any one aspect of a problem may lead to measureable consequences in
the other elements of the system. Designing a new Electronic Health Record is a good example. Even
the simplest design change assumes a change on the front-stage (the interface where medical
professionals interact with the EHR) and back-stage (securely storing and transmitting data to other
3rd party organizations). If we dig in deeper, we can see that these changes will impact medical
professionals’ experience of the entire system and their behaviors, their coding errors and
intersystem interactions within the workplace, to name just a few.
Having collaboratively worked on both sides of this problem, we hypothesize that there is
tremendous value in combining the analysis tools used by service designers and behavioral
scientists. After all, each team is trying to solve the same complex problem and improve the
experience for everyone involved in this process.
The objective of this paper is to examine the benefits of combining two methods the COM-B model
(Capability, Opportunity, and Motivational behavioral barriers and facilitators) of behavioral analysis
and customer journey mapping. The combination can lead to a more thorough understanding of a
problem space, leading to the design of efficient, cost-effective behavior change interventions that
improve the target outcomes and achieve business goals. We describe a methodology of combining
the two processes using a conceptual design case study. We hypothesize that using this combined
methodology, more than COM-B or customer journey mapping alone, adds value by supporting the
level of analysis and insights that allows you to initially design and iterate a product or service, as
well as systematically evaluate its effectiveness.
Behavior Change and COM-B analysis
Behavior change intervention design is a set of processes and activities used to design an
intervention (e.g. product, service) that aims to change a defined and modifiable behavior. Behavior
change intervention design thrives at the intersection of behavioral and social sciences, motivational
psychology, data science, human-computer interaction, and design (Sundel M. and Sundel S., 2017).
To appear in Proceedings of the DRS 2018 Conference
3
It aims to understand target behaviors and systems interactions in their contexts, implement
human-centered solutions addressing these behaviors, and evaluate their effects.
Let’s have a look at some examples of behavior change interventions in the health sector. Within the
prevention and wellness space, behavior change interventions frequently aim to reduce risks of
disease or disease complication and promote health, e.g. increasing the level of physical activity or
reducing the amount of stress. Within the healthcare space, interventions often aim to improve
medication adherence or adherence to a prescribed diet or exercise regimen. Targeted behaviors are
often complex, as they are comprised of several interactions among multiple systems. That’s why
behavior change interventions rarely target only individuals whose health outcomes we want to
improve. In many cases they are designed with the ecological perspective in mind, as discussed by
Rimer and Glanz (2005), and aim to influence multiple levels (intrapersonal, interpersonal, and
community levels). For example, we may want a child to follow a healthy diet, but we know that the
decision of what she eats is determined by the decisions and behavior of peers, parents, and school
administrators.
Every good behavior change intervention starts with research because we need to understand
behaviors in context in order to be able to identify the types of interventions that are likely to be
effective at changing them. Ultimately, we want to create a holistic behavior change intervention
targeting root causes of the problems. Research helps us understand these root causes through
analyzing the behavioral and environmental barriers specific to our target population.
Purposeful behavior change projects call for a Logic Model. Our goal is to identify what is causing the
problem, what, if anything, needs and can be changed, and for whom. Needs assessment is one
methodology, as discussed in Bartholomew’s (2016) Intervention Mapping protocol for developing
theory- and evidence-based health interventions. Important outputs of analyzing the problem using
this tool are a Logic Model of the Problem and Logic Model of Change. Another way to analyze and
represent a logic model of behavior is through using the Behavior Change Wheel (BCW), a
theoretically-driven framework based on multiple models of health behavior (Michie, van Stralen
and West, 2011). BCW was designed to support systematic development of behavior change
interventions.
The foundation on this framework is the COM-B model, a theoretical model to understand the
predictors of behavior that was developed by Michie, van Stralen and West (2011). This model is
based on nineteen existing frameworks of behavior change identified in a systematic review. The
COM-B model was initially designed as a tool to explain the full range of possible influences that
cause behavior, and ultimately systemize and improve the intervention design process.
To appear in Proceedings of the DRS 2018 Conference
4
Figure 1 Behavior Change Wheel (Michie, van Stralen and West, 2011)
COM-B derives its name from three domains: capability, opportunity and motivation. According to
this model, any behavior is more likely to happen when the person has capability, opportunity and
motivation to carry it out. The relationship between these factors and behaviors are reciprocal,
which means that certain behaviors if taking place might influence capabilities, opportunities and
motivations as well. The three domains could be broken down further. Capability includes
psychological (e.g. knowledge) and physical (e.g. strength) abilities. Opportunity includes physical
(e.g. time) and social (e.g. social influence) environmental factors. Motivation includes reflective
(e.g. thinking) and automated (e.g. attitudes) motivation. The COM-B model helps us understand
how these domains and subdomains interact with a person’s behavior and vice versa.
The COM-B model is made up of non-temporal factors; that is, it does not make any determinations
about an order in which the factors must be present for a behavior to occur. The model helps us
understand which factors make the behavior more or less likely to happen in a systemic way,
without providing the insight in the order of their occurrence. This is a limitation in the COM-B
model.
If we want to address these factors in a product or service, it is crucial to know where in the
customer journey these factors occur. For example, let’s say we want to increase the frequency of
lab tests done among patients at risk for heart disease. We could talk to our target audience and
identify that lack of reflective motivation, low perceived risk of having a disease, low awareness of
the symptoms, fear of needles, lack of knowledge of the lab diagnostic process, lack of opportunities
due to low awareness about the health insurance benefits, and social stigma are the factors that
serve as barriers to testing. However, nothing in this analysis helps us understand which of these
barriers would happen first and would prevent patient from taking the first step towards the
behavior. The COM-B model allows us to understand what needs to be changed, and how it needs to
change. However, it doesn't show us where in the experience this improvement should happen.
Enter customer journey mapping.
Experience Design and Customer Journey Mapping
Customer journey mapping is a set of visualization techniques that seek to describe a person’s
experience. Kalbach (2016) identifies this as one form of alignment diagram used to capture
relationships between business value and customer experience. The experience being analyzed may
be a task or series of tasks that involve interactions with products and services. These techniques are
used to break the person’s experience down into parts and subparts, revealing the steps from which
the experience is made. The map will identify the touchpoints those moments where the person
comes into contact with products and services.
Carbone and Haeckel (1994) introduced the concept of “orchestrating” or “engineering” a
customer’s experience, motivated by the insight that a customer’s experience of a product is
sensory. A product produces an effect or result attaching something to a wall, satisfying hunger,
creating heat but the customer’s experience of that product is shaped by a series of perceptions
before and after the encounter. Purposeful design calls for an experience blueprint which they
define as “a pictorial representation of the experience clues to be engineered, along with
specifications that describes them and their individual functions.” (Kalbach, 2016, p.249)
Creating a customer journey map or service blueprint is a form of task analysis. The journey is made
up of temporal events. Each of the phases and steps are represented as a sequence. While some
journeys may include loops and branches, the basic journey is a sequence of encounters with the
product or services in question.
Such diagrams can be used to analyze existing products or services the way things are or
transformations of existing services the way they should be. The case study “Mapping the Lab Test
Experience” in Kalbach (2016) is similar to the behavior change example above. It illustrates the
To appear in Proceedings of the DRS 2018 Conference
5
process of mapping the phases and steps in a user journey, applying a persona, a representation of
the goals and behavior of a group of users developed through research to simulate a customer’s
emotional response, and then filling out front-stage and back-stage processes to create a service
blueprint. In the first step, the customer journey is broken down into phases representing
experience boundaries. Each phase is then broken down into common steps. These steps are then
aligned with the touchpoints related to the product or service. The experience designer identifies
the customer’s emotional experience by projecting a persona through the steps on the map,
capturing the persona’s response in speech bubbles and symbols (Pruitt and Grudin, 2003).
If the goal of this kind of analysis is to improve an existing product or service, the customer journey
map can be used to identify pain or friction points such as moments of inconvenience, dissatisfaction
or failure. These points in the journey can be identified as opportunities for improvement. The
analysis can also identify gaps in the experience places where the addition of a product or service
could significantly enhance the overall experience. Kalbach points out that this kind of analysis tends
to focus on “moments of truth”, emotionally charged interactions that leave a strong positive or
negative memory. By identifying such charged moments in a journey dropping off a rental car on
the way to catching a plane, choosing the drink to start your day, seeing and touching a piece of
clothing you might want to purchase, taking medication for the first time an experience designer
can build out a strategy for applying resources to assure positive customer experience.
It is important for the purposes of this paper to also point out what the journey map is not. A
customer journey map is not a logic model. We can reuse our Lab Test case study to illustrate this
point as well. The representation of the customer journey is based on a combination of interviews
with and direct observation of lab test customers. From that research, we can conclude that the
customer’s experience of a lab test begins with an awareness of a health problem, leading to a
choice to see a doctor, leading to a prescription for a lab test, etc. However, nothing in this analysis
explains why the customer chooses to see or not see a doctor, or accepts or rejects the prescription
for the lab test. In short, the customer journey map allows us to identify a step where we want to
improve a customer’s experience, but it does not show us how to change a customer’s behavior.
Benefits of combining two types of analyses
Both customer journey mapping and COM-B analysis represent problem solving tools. Both tools
help team members understand the problem space. However, there are a few important
differences.
In the case of COM-B analysis, we are focusing on understanding the root causes of behavior, and
the factors that contribute to the outcome. Once we’ve identified the factors contributing to an
outcome, we can use COM-B analysis to choose appropriate intervention functions (such as
education, persuasion, Incentivizing, training, enablement, etc.) and evidence-based behavior
change techniques (“active ingredients” of the intervention such as goal-setting, providing feedback,
etc.) to design an intervention.
When we use customer journey mapping to break down the experience of a product or service that
a person goes through in a sequence of phases, steps and events, we are doing gaps and
opportunities analysis.
If we limit our analysis to customer journey mapping, we don't see the barriers to behaviors. We see
gaps and opportunities arranged in a non-systemic way without an opportunity to identify
appropriate intervention functions and evidence-based behavior change techniques to address
them.
If we use only COM-B analysis, we see many different behavioral and environmental barriers and
facilitators organized in a systemic way, but we don't see the temporal aspect and don't have
guidance on when in the experience we should address them.
To appear in Proceedings of the DRS 2018 Conference
6
Combining behavioral analysis with gaps and opportunities analysis in one process and creating one
visualization allows us to have a systemic way of representing and analyzing barriers to and
facilitators of behavior sequentially. Such a tool can help the team to understand when and how to
address these barriers. The alignment of barriers to phases can be used to map the existing
customer data to the phases in the customer journey map and measure the effectiveness of
individual strategies. Identifying phase-specific barriers allows us to strategize which interventions
are likely to produce the most improvement in behavior.
In a practical scenario, when we have limited resources and aim to design in an iterative manner,
such a detailed analysis provides an important advantage. It allows us to make evidence-based and
data-driven decisions about new product or service development. It can also serve as a working tool
for the team, a representation we can return to when we need to understand the impact and
effectiveness of a chosen strategy or want to refine an existing product or service. Such an iterative
process ensures that the product or service will improve the experience by addressing specific
barriers that were identified in the analysis. Employing this representation, barriers can be
prioritized and addressed in a sequential way, aligned with the arc of the experience itself.
Case study
We illustrate this process below with a simple case study to see how combining the COM-B method
with customer journey mapping can improve decision-making and affects the design.
An insurance company offering medical and dental insurance wants to address the high risk of
dental complications such as periodontitis among their diabetic membership cohort. They hire an
agency to help them design a variety of product and service concepts to help these members. The
concepts should support the company’s business goal to reduce the number of expensive dental
treatments, and thereby reduce total cost of care for members by delivering practical and effective
preventative solutions that target these member’s unmet needs.
We will illustrate our customer journey map/COM-B analysis method by applying it to this project.
Steps 1 and 2 are essential parts of both methodologies. Step 3 is part of the behavioral analysis,
while Step 4 is part of customer journey mapping. Step 5 is unique to combining the two methods.
Table 1 Process Steps
Step
Customer Journey Mapping
1 Literature Review
YES
2 Qualitative & Quantitative Research
YES
3 COM-B Analysis
NO
4 Customer Journey Map
YES
5 Combining the Customer Journey Map
and COM-B Analysis
COMBINATION
Methods
Step 1 Literature review
We begin by focusing on two major themes: (1) the disease and disease complications progressions,
and (2) clinical guidelines and recommendations for effective interventions to address teeth-related
diabetes complications. In the literature research, we learn that one of the best ways to prevent
teeth-related diabetes complications is to have regular preventative dental visits.
Step 2 Qualitative & Quantitative Research
Even though our literature review identified regular preventive dental visits as a potential target
behavior, we still need to learn the context for our target audiences current and future health
insurance members at risk for or having teeth-related diabetes complications and assess their
needs through primary research. In other words, we need to identify whether the potential target
To appear in Proceedings of the DRS 2018 Conference
7
behavior is currently prevalent among the health insurance members at risk, and if not, what are the
reasons it is not happening. Qualitative research can help us understand the audience’s unmet
needs, identify the presence or absence of relevant risk factors, and capture audience-specific
behavioral barriers and facilitators. For this case study, we chose to conduct interviews to gain this
insight. A well-designed moderator’s guide used to facilitate interviews should include questions
about capabilities, opportunities, and motivations and prompt people to talk about those factors.
Specific questions will include but not be limited to past teeth-related diabetes complications, dental
care regimen and diabetes management routine, dental or specialist visits and any prevention or
treatment recommendations. The insights from the qualitative research will be then aggregated in
the final report with key findings and compared to the insights from the literature review.
We perform quantitative research to validate and prioritize issues to be addressed based on the
target audience needs. This provides us with a better understanding of the impact a solution might
have on the entire audience.
Step 3 COM-B analysis
At this stage, we can refer to the COM-B model to do a behavioral analysis of capabilities,
opportunities and motivations. The benefit of performing a COM-B analysis with our target audience
rather than relying solely on behavioral analysis insights from the literature review is that we can
identify the factors most relevant to the audience we are designing for and prioritize designing for
addressing those factors first.
We will start by looking at the data from our literature review, qualitative and quantitative research.
The majority of insights about barriers and facilitators will come from the interviews with our target
audience. Quotes, observations, and key findings from the interviews will be coded and mapped to
COM-B factors (e.g. if respondents mention that they don’t have a dentist or hygienist, it will be
coded under the opportunity barrier as lack of environmental factor). Other insights about barriers
and facilitators will come from the literature review and quantitative research. After synthesizing the
data from all three sources, we can identify the key behavioral factors related to preventive dental
visits that are lacking or missing from our target audience according to our research. So at this point
we know what is lacking or missing, but we don’t know their temporal sequence until we go through
the next step of our process.
Table 2. COM-B analysis
Capability
Psychological capability
Lack of knowledge about the
recommended frequency of dental visits
for patients with diabetes
Psychological capability
Lack of awareness of risk and potential
timeline for developing teeth-related
diabetes complications
Psychological capability
Lack of knowledge of being at high risk of
teeth-related diabetes complications
(individual risk communicated by dentist or
hygienist)
Psychological capability
Lack of awareness of insurance benefits
covering diabetic condition
Psychological capability
Lack of awareness that teeth-related
diabetes complications are preventable
through care
Psychological capability
Lack of understanding of early symptoms
of diabetes and its progression
Opportunity
Social environment
Not having a dentist and/or hygienist
Social environment
No social norm for regular dental visits
among friends who have diabetes
To appear in Proceedings of the DRS 2018 Conference
8
Motivation
Reflective motivation
Lack of belief that teeth-related diabetes
complications can be prevented
Reflective motivation
Perceived insufficient dental insurance
coverage
Reflective motivation
No perceived need for dental visits
Reflective motivation
Low perceived importance of dental care
Reflective motivation
Overconfidence/over-reliance on the
effectiveness of medication to manage
diabetes
Automatic motivation
Negative emotions associated with dental
visits (pain, fear, anxiety)
Automatic motivation
Fear of having to drill and fill their teeth
Step 4 Customer Journey Map
We will design services intended to address the barriers categorized in the COM-B analysis. Our
qualitative and quantitative research tells us that most of the target audience people at risk for or
diagnosed with teeth-related diabetes complications does not take advantage of the target
behavior identified in the literature review: preventive dental visits. Our hypothesis therefore is, that
a service to promote preventive dental visits could lead to better health outcomes. We go back to
our qualitative research and analyze the interviews with members to understand how the audience
currently relates to preventive dental visits and characterize the future state of the new service. The
details are built up with our client during a customer journey mapping workshop to identify and
prioritize service solutions. In the map, the phases and steps of the service are represented as a
sequence with some cases of branching and loops, unlike the tabular format of the COM-B analysis.
We organize the map into four stages:
Awareness of the program
Onboarding to the program
Attending a first preventive dental visit
Attending regular preventive dental follow-up visits
We fill this in with the steps a member is likely to experience in each phase, then align a row of
touchpoints with each step in the service. We add a row of actors to indicate who will be behind
each touchpoint. Now we can see how the member will experience the service through phone calls,
printed brochures and physical spaces, as well as who or what will be responsible for each customer
interaction.
A customer journey mapping workshop is the opportunity to collaboratively address questions with
our client’s content-matter experts and develop answers that can drive the design of the new
service. We can see where artifacts need to be created, a characterization of the staff needed to
support the program, where the member-staff interactions take place, and how information about
the members’ condition will be captured.
To appear in Proceedings of the DRS 2018 Conference
9
Figure 2: The first phase of the customer journey map (see Appendix A for complete map)
The final result is a future state map (Figure 2) that captures the sequential steps of a new service.
The alignment of steps in the member’s experience (Patient) and the insurer’s service staff (Insurer)
with the touchpoints where members interact with the insurer’s new service (Touchpoints) and the
staffing needed to support the interactions (Actor) gives the team an opportunity to identify gaps in
the planned service and opportunities to add member-facing and insurer- or provider-facing value.
Step 5 Combining the Customer Journey Map and COM-B Analysis
We introduce this step to explicitly integrate the COM-B Analysis with the Customer Journey
Mapping process. By aligning the sequence of service features with the COM-B analysis of barriers
experienced by our target audience we can visualize what has and has not been accounted for. For
example, we align the perception of insufficient dental insurance coverage barrier with the
Awareness stage of the customer journey map (Figure 3). The observation that the member does not
experience social norming from friends who have diabetes for regular preventive dental visits aligns
with the Attend Regular stage. Some barriers may align with more than one stage and one service
feature may address more than one barrier. Some barriers will not be addressed at all by the
services. For example, there is nothing in the onboarding phase to mitigate the member’s fear of
having to drill and fill their teeth.
Visualizing the alignment of the services and barriers, either during the workshop process or in the
production of the final Customer Journey Map, helps the team refine the way services are designed
to address the barriers to accomplish behavior change in the target population. In a systematic
development of behavior change intervention, each of the barriers that we identify should be
addressed using the appropriate intervention functions, policy categories and behavior change
techniques.
Equally important, this visualization highlights the barriers that are not addressed by the proposed
service. After the service has been launched and impact data has been gathered, the team can
return to the customer journey map/COM-B analysis diagram and determine whether changes
should be made to the design of existing service features or if features should be added to address
previously-identified but unaddressed barriers. Performing rigorous process and impact evaluations
of data collected about member interactions with the service allows us to focus on iterating only
those aspects of the intervention that need be improved. The customer journey map/COM-B
analysis diagram will have value beyond the initial planning, becomes a problem-solving and
To appear in Proceedings of the DRS 2018 Conference
10
decision-making tool for creating and refining new service offerings as it is updated and re-used to
make iterations and refinements of services.
Figure 3: The first phase of the customer journey map combined with COM-B analysis (see Appendix B for complete map)
Discussion
We believe that combining customer journey mapping gaps and opportunities analysis with the
Behavior Change Wheel framework COM-B analysis creates a valuable tool for both service
designers and behavioral scientists.
The objective of this paper is to examine how we can systematically analyze and document the
barriers to behavior and subsequently design potential solutions addressing those barriers by
combining a COM-B analysis with the customer journey mapping process. While in the paper we
focused primarily on presenting a collaborative analysis tool, the work of experience designers and
behavioral scientists does not stop there. From this analysis, we need to develop detailed
intervention strategies and specifications, covering all aspects of the intervention logic model,
content, and delivery. The process that service designers and behavioral scientists follow from this
point branches out. See Figure 4 for more details.
After identifying gaps and opportunities using customer journey mapping and mapping the COM-B
barriers, service designers prototype the artifacts needed to build out a service, be they a website,
mobile application, signage display or printed brochure; test the usability of those artifacts; then use
that feedback to refine the service design.
After classifying barriers, behavioral scientists will go back to the BCW framework for a systematic
development of behavior change interventions. According to the BCW framework, each of the
identified behavioral barriers should be addressed using the appropriate intervention functions,
policy categories, and behavior change techniques. The BCW framework currently encompasses 10
intervention functions, 7 policy categories, and 93 behavior change techniques (Michie, Richardson
& Johnston, 2013). Specific capabilities, opportunities, and motivations are linked to certain
To appear in Proceedings of the DRS 2018 Conference
11
intervention functions that can be implemented through different features. Behavior change
techniques are linked to the relevant chosen intervention functions.
In the future research, we hope to explore how service design teams and behavioral scientists
collaborate on behavior change intervention development starting with a customer journey
mapping/COM-B analysis diagram followed by application of the theoretically-driven BCW
framework.
Figure 4: The alignment of stages/steps/opportunities with COM-B barriers can be used to integrate the Service Design and
Behavior Science approaches.
Following the systematic theoretically-driven framework throughout the behavior change
intervention development process creates the opportunity to incorporate evidence and insights
from the research, design the intervention logic model and strategy that will increase the likelihood
of an effective intervention, and generate findings that will contribute to the broader evidence base
for behavior change.
Conclusions
As the problems that interdisciplinary teams are solving become more complex, our tools must
evolve and become more comprehensive. Purposeful complex projects call for iterative design
approaches.
In this paper, we present a way to visualize the relationship between two problem-solving methods:
behavioral analysis using the COM-B model, and gaps and opportunities analysis using customer
journey mapping. Combining journey maps and COM-B analysis in the design process helps to
overcome the limitations of each method, while leveraging the advantages of each to create a more
powerful behavior change solution. Our case study is a hypothetical example of the many situations
where combining customer journey mapping and COM-B analysis can lead to a more thorough
understanding of a problem space, and to the design of efficient, cost-effective behavior change
interventions. Both methods are aimed at understanding the problem space and designing improved
experiences. The differences between the two create a symbiotic relationship, where doing one type
of analysis complements to the other, and vice versa.
Having a customer journey mapping/COM-B analysis diagram can be an important competitive
advantage. Working on long-term interdisciplinary projects involves multiple hand offs, iterations
and external/internal team collaborations. The customer journey mapping/COM-B analysis diagram
creates transparency and allows us to see at a glance where the service touches the customer, and
how each part of a service aligns with barriers that have and have not been addressed. Therefore, it
can serve as a working tool that teams can come back to after testing and evaluation, to understand
To appear in Proceedings of the DRS 2018 Conference
12
the impact and effectiveness of chosen strategies, and evaluate the need to tackle unaddressed
barriers. This hybrid tool supports evidence-based and data-driven decision-making and preserves
insights frequently lost in the design process due to external business considerations. Presenting
information in this temporal visual format helps the team prioritize and sequence the parts of the
service.
To sum it all up, creating a systemic way of visually representing and analyzing gaps, opportunities
and barriers to behaviors in a sequential way creates a unique tool that can be used by service
designers and behavioral scientists to facilitate productive and efficient collaborations on projects
that require complex problem solving mapping out the front-stage and back-stage touchpoints and
support systems for a service, and designing for behavior change.
Acknowledgements
The authors would like to thank our colleagues at Mad*Pow, as well as Paul Pangaro, James Kalbach
and Olga Perski for their support in helping us prepare this paper, and the support of our clients for
giving us the opportunity to put these ideas into practice. We extend a special thanks to Andrew
Klein for his design of the original maps and his assistance preparing the figures for this paper.
Sources
Buchanan, Richard. (1992) "Wicked problems in design thinking." Design issues 8.2: 5-21.
Consolvo, Sunny, David W. McDonald, and James A. Landay. (2009) "Theory-driven design strategies for
technologies that support behavior change in everyday life." Proceedings of the SIGCHI conference on
human factors in computing systems. ACM.
Carbone, L. P., & Haeckel, S. H. (1994). Engineering customer experiences. Marketing Management, 3(3), 8.
Eldredge, L., Bartholomew, K., Markham, C. M., Ruiter, R. A., Kok, G., & Parcel, G. S. (2016). Planning health
promotion programs: an intervention mapping approach. John Wiley & Sons.
Glushko, Robert J., and Lindsay Tabas. (2008) "Bridging the “front stage” and “back stage” in service system
design." Hawaii International Conference on System Sciences, Proceedings of the 41st Annual. IEEE.
Kalbach, J. (2016). Mapping experiences: A complete guide to creating value through journeys, blueprints, and
diagrams. " O'Reilly Media, Inc.
Michie, S., van Stralen, M. M., & West, R. (2011). The behaviour change wheel: a new method for
characterising and designing behaviour change interventions. Implementation science, 6(1), 42.
Michie, Susan, et al. (2008) "From theory to intervention: mapping theoretically derived behavioural
determinants to behaviour change techniques." Applied psychology 57.4: 660-680.
Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., ... & Wood, C. E. (2013). The
behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an
international consensus for the reporting of behavior change interventions. Annals of behavioral
medicine, 46(1), 81-95.
Pruitt, John, and Jonathan Grudin. (2003) "Personas: practice and theory." Proceedings of the 2003 conference
on Designing for user experiences. ACM.
Rimer, B. K., & Glanz, K. (2005). Theory at a glance: a guide for health promotion practice.
Sundel, Martin, and Sandra S. Sundel. Behavior change in the human services: Behavioral and cognitive
principles and applications. Sage Publications, 2017.
Zomerdijk, Leonieke G., and Christopher A. Voss. (2010) "Service design for experience-centric
services." Journal of Service Research 13.1: 67-82.
About the Authors:
Olga Elizarova is a dentist, public health professional, senior behaviour change
analyst and entrepreneur. She works in digital health space and is interested in
exploring how design interventions can address the root causes of recurring public
problems and inequities.
Paul Kahn is a writer and designer practicing information architecture and
experience design with a special focus on information visualization techniques and
To appear in Proceedings of the DRS 2018 Conference
13
practice. He founded the design firms Dynamic Diagrams (USA) and Kahn+Associates
(France). He teaches history of information design.
!""#$%&'(%&)*#+,%-.
/0123405/)
$%6.+7(7)$%)&8()9+&+,():&-&(
3(.("8#%$6);(%&-.)<-%-=(,))
;(%&-.)>$:?)!::(::'(%&
@A<#%&8)B;;B)B,#=,-')
B,(C(%DC();$-E(D6);(%&-.)B,#=,-')FB;;BG)E,#68+,(
H$,:&)<((D%=)B,#&#6#.
B(,:#%-.)I#-.)/(J%=)!::(::'(%&
B;;B)4%9#)K$&
*#+,%-.)/8-,$%=
!"#$%&'()*'"+*&),'&+*-'.)"/0*/$*01'&)*/1)2&*3443*'--$2"/5)"/*6$%&"'7*
,2/1*-)&2$+$".0/8*
L-,,$(,:)!77,(::(7
9
9
9
9
:'#;*$<*','&)")00*$<*&20;*'"+*-$/)".'7*.5)72")*<$&*+)=)7$-2"(*
+2'>)/)0*/))/1?&)7'/)+*#$5-72#'.$"0*
:'#;*$<*>)72)<*/1'/*+2'>)/)0*/))/1?&)7'/)+*#$5-72#'.$"0*#'"*>)*
-&)=)"/)+*
:'#;*$<*','&)")00*/1'/*+2'>)/)0*/))/1?&)7'/)+*#$5-72#'.$"0*'&)*
-&)=)"/'>7)*/1&$%(1*#'&)
@$*-)&#)2=)+*25-$&/'"#)*$<*+)"/'7*#'&)
@A<#%&8)B;;B)B,#=,-'
3&)0)"/*/1)*-&$(&'5*$<*A*5$"/17B*5))."(0C*,2/1*%-*/$*D*-&$(&'50*-)&*DE?5$"/1*
-)&2$+8**F)/*($'70*/$*'#12)=)*,2/12"*)'#1*A?5$"/1*-)&2$+C*'7$"(*,2/1*/1)*0%>($'70*
<$&*)'#1*5$"/17B*5))."(8*G';)*2/*#7)'&*/1'/*-)$-7)*'&)*)"#$%&'()+*/$*&)?)"&$77*'/*
/1)*)"+*$<*/1)*H&0/*3)&2$+*/$*'#12)=)*"),*($'708
L-,,$(,:)!77,(::(7
9
9
9
9
:'#;*$<*','&)")00*/1'/*+2'>)/)0*/))/1?&)7'/)+*#$5-72#'.$"0*'&)*-&)=)"/'>7)*
/1&$%(1*#'&)
:'#;*$<*','&)")00*$<*>)")H/*#$=)&2"(*+2'>).#*#$"+2.$"
3)&#)2=)+*2"0%I#2)"/*+)"/'7*2"0%&'"#)*#$=)&'()
:'#;*$<*>)72)<*/1'/*+2'>)/)0*/))/1?&)7'/)+*#$5-72#'.$"0*#'"*>)*-&)=)"/)+
;(%&-.)MN=(%()/"-6()7(:$=%)))
4)=)7$-*'"+*-&$5$/)*'"*'J&'#.=)*5$>27)*0-'*+)02("*?*)K%2-5)"/C*72(1."(C*0)'."(*L*/1'/*#'"*>)*25-7)5)"/)+*2"*7$#'7*<'#272.)08
G$>27)*0-'*#'"*1'=)*=202>7)*#%0/$5*01$)*#'/'7$(%)0C*0'5-7)0*$<*#%0/$5*2"0$7)0*'"+*720/*$<*4G!*F%--72)&0*,1$*-'&.#2-'/)*2"*G)+2#'&)*01$)*&)25>%&0)5)"/*-&$(&'5
G$>27)*F-'*#'"*1'=)*2"<$&5'.$"*'>$%/*F-)#2'720/*$"*4)5'"+*3&$(&'5C**)72(2>272/B*&)K%2&)5)"/0*'"+*)"&$775)"/*-&$#)008*
L-,,$(,:)!77,(::(7
9
9
9
9
9
9
9
9
9
3&)<)&)"#)*<$&*1$5)*#'&)
F)7<?5$.='/)+*/$*0));*0-)#2'720/*#'&)
M,'&)")00*/1'/*<$$/*#$5-72#'.$"0*'&)*-&)=)"/'>7)*/1&$%(1*#'&)
N"$,7)+()*'"+*'+)K%'/)*#$5-&)1)"02$"*$<*+2'>)/)0*'"+*2/0*/&)'/5)"/
N"$,7)+()*'"+*%"+)&0/'"+2"(*$<*%7#)&0C*'5-%/'.$"0*(what&it&is,&what&causes&
them,&how&they&are&connected&etc.)
M,'&)")00*/1'/*<$$/*#$5-72#'.$"0*'&)*-&)=)"/'>7)*/1&$%(1*#'&)
O)72)<*/1'/*4PQ0*'"+*'5-%/'.$"0*#'"*>)*-&)=)"/)+
M,'&)")00*/1'/*0-)#2'7*<$$/*#'&)*20*25-$&/'"/*/$*-&)=)"/*'5-%/'.$"*&20;
M,'&)")00*$<*>)")H/*#$=)&2"(*+2'>).#*#$"+2.$"
9
9
9
9
9
9
N"$,7)+()*$<*/1)*-&$#)00*<$&*()R"(*-&$-)&*F1$)0*'"+*&)(%7'&*-&$<)002$"'7*<$$/*
#'&)*(where&to&start,&who&to&contact,&how&to&make&appointments,&where&to&get&
prescrip8on&approved)
M##)00*/$*3$+2'/&20/*-'&.#2-'."(*2"*/1)*G)+2#'&)*F1$)*3&$(&'5
S'=2"(*'*TK%'72H)+U*+$#/$&*<$&*<$$/*$=)&02(1/
V)72'"#)*$"*3W3X0*&)#$55)"+'.$"*<$&*#'&)
F25-7)*'"+*#7)'&*(easy)&-&$#)00
N"$,7)+()*/1'/*'*-&$<)002$"'7*20*"))+)+*/$*-)&<$&5*"'27*/&2552"(
B;;B)!""#$%&'(%&)*#+,%-.
4'27B*7$((2"(*5'/)&2'70*(print&journal&or&phone&app).&!"#$%&'()*
-'.)"/0*/$*&)#$&+*-&$(&)00*/$,'&+0*/1)2&*($7'0*'"+*0%>($'708*
L-,,$(,:)!77,(::(7
9
9
9
9**
:'#;*$<*','&)")00*$<*&20;*'"+*-$/)".'7*.5)72")*<$&*+)=)7$-2"(*+2'>)/)0*/))/1?
&)7'/)+*#$5-72#'.$"0*
:'#;*$<*>)72)<*/1'/*+2'>)/)0*/))/1?&)7'/)+*#$5-72#'.$"0*#'"*>)*-&)=)"/)+
@$*-)&#)2=)+*"))+*<$&*+)"/'7*=202/0*
@$*-)&#)2=)+*25-$&/'"#)*$<*+)"/'7*#'&)*
3(.("8#%$6);(%&-.)<-%-=(,
4%&2"(*/1)*/)7)-1$"2#*#$"=)&0'.$"*5';)*5)5>)&0*','&)*$<*/1)*>)")H/C*'++&)00*
#$"#)&"0*'&$%"+*2"0%Y#2)"/*#$=)&'()*'"+*5';)*5)5>)&0*','&)*$<*/1)*25-$&/'"#)*
$<*/1)*0-)#2'7*+)"/'7*#'&)8*
L-,,$(,:)!77,(::(7
9
9
9
:'#;*$<*','&)")00*$<*>)")H/*#$=)&2"(*+2'>).#*#$"+2.$"
:'#;*$<*','&)")00*/1'/*0-)#2'7*+)"/'7*#'&)*20*25-$&/'"/*/$*-&)=)"/*/$$/1*7$00
3)&#)2=)+*2"0%I#2)"/*+)"/'7*2"0%&'"#)*#$=)&'()*
;(%&-.)>$:?)!::(::'(%&
4%&2"(*/1)*/)7)-1$"2#*#$"=)&0'.$"*4)"/'7*G'"'()&*+$)0*/1)*'00)005)"/*/$*Z+)".<B*
/1)*"))+*<$&*3&)=)".=)*42'>).#*4)"/'7*3&$(&'5*[3443\*'"+*'++&)00*/1)*<$77$,2"(*
>'&&2)&0]
L-,,$(,:)!77,(::(7
9
9
9
:'#;*$<*','&)")00*$<*>)")H/*#$=)&2"(*+2'>).#*#$"+2.$"
:'#;*$<*','&)")00*/1'/*0-)#2'7*+)"/'7*#'&)*20*25-$&/'"/*/$*-&)=)"/*/$$/1*7$00
@$*-)&#)2=)+*"))+*<$&*+)"/'7*=202/0
B,(C(%DC();$-E(D6);(%&-.)B,#=,-')FB;;BG)E,#68+,(
O&$#1%&)*2"#7%+)0*+)0#&2-.$"*$<*/1)*3443C*0/)-?>B?0/)-*(%2+'"#)*$"*)"&$77)5)"/*'"+*
-$0/?)"&$77)5)"/*-&$#)+%&)0*'"+*'++&)00)0*/1)*<$77$,2"(*>'&&2)&0]
L-,,$(,:)!77,(::(7
9
9
9
9
@$*-)&#)2=)+*25-$&/'"#)*$<*+)"/'7*#'&)
:'#;*$<*;"$,7)+()*'>$%/*/1)*&)#$55)"+)+*<&)K%)"#B*$<*+)"/'7*=202/0*<$&*-'.)"/0*,2/1*+2'>)/)0
^=)&#$"H+)"#)_$=)&*&)72'"#)*$"*/1)*)Y)#.=)")00*$<*5)+2#'.$"
:'#;*$<*','&)")00*/$*&20;*'"+*-$/)".'7*.5)72")*<$&*+)=)7$-2"(*/))/1?&)7'/)+*#$5-72#'.$0
9
9
9*
P)'&*$<*1'=2"(*/$*+&277*'"+*H77*/1)2&*/))/1*
:'#;*$<*>)72)<*/1'/*/))/1?&)7'/)+*+2'>)/)0*#$5-72#'.$"0*#'"*>)*-&)=)"/)+*
:'#;*$<*%"+)&0/'"+2"(*$<*)'&7B*0B5-/$50*$<*+2'>)/)0*'"+*2/0*-&$(&)002$"*
L!>>4O>/
%#&)-77,(::(7)P$&8$%)
:#.+D#%:
9
9
9
9
9
:'#;*$<*;"$,7)+()*$<*>)2"(*'/*12(1*&20;*$<*+2'>)/)0*/))/1?&)7'/)+*#$5-72#'.$"0*
(individual&risk&communicated&by&den8st&or&hygienist)
@$/*1'=2"(*'*+)".0/*'"+_$&*1B(2)"20/*
@$*0$#2'7*"$&5*<$&*&)(%7'&*+)"/'7*=202/0*'5$"(*<&2)"+0*,1$*1'=)*+2'>)/)0
P)'&*$<*1'=2"(*/$*+&277*'"+*H77*/1)2&*/))/1*
:'#;*$<*>)72)<*/1'/*+2'>)/)0*/))/1?&)7'/)+*#$5-72#'.$"0*#'"*>)*-&)=)"/)+*
@$/*1'=2"(*'*+)".0/*'"+_$&*1B(2)"20/*
@$*0$#2'7*"$&5*<$&*&)(%7'&*+)"/'7*=202/0*'5$"(*<&2)"+0*,1$*1'=)*+2'>)/)0
^=)&#$"H+)"#)_^=)&*&)72'"#)*$"*/1)*)Y)#.=)")00*$<*5)+2#'.$"
:'#;*$<*%"+)&0/'"+2"(*$<*)'&7B*0B5-/$50*$<*+2'>)/)0*'"+*2/0*-&$(&)002$"*
^=)&#$"H+)"#)_$=)&*&)72'"#)*$"*/1)*)Y)#.=)")00*$<*5)+2#'.$"*
@$/*1'=2"(*'*+)".0/*'"+_$&*1B(2)"20/
@$*0$#2'7*"$&5*<$&*&)(%7'&*+)"/'7*=202/0*'5$"(*<&2)"+0*,1$*1'=)*+2'>)/)0*
@)('.=)*)5$.$"0*'00$#2'/)+*,2/1*+)"/'7*=202/0*[-'2"C*<)'&C*'"`2)/B\
Preventive Diabetic Dental Program (PDDP)
APPENDIX B: THE FIRST PHASE OF THE CUSTOMER JOURNEY MAP COMBINED WITH COM-B ANALYSIS (FULL MAP)
Concept Journey
H232>O)/3!3O
BM!/O
a$%#1-$2"/
B-D(%&
4%:+,(,
M#/$&
W7'250*0#&))"2"(
W7'250*4)-'&/5)"/
!6'()<+&+-.)%#DQ(7)
#9)'('E(,)7$-=%#:$:
31$")
a)7)-1$"2#*4)"/'7*
G'"'()&***
3(.("8#%$6);(%&-.)
<-%-=(,)"(,9#,':)
;(%&-.)>$:?)/+,C(NR
31$")
a)7)-1$"2#*4)"/'7*
G'"'()&***
0+&,(-68)9,#')!6'()
<+&+-.);(%&-.)
B,#=,-'
V20;*F%&=)B*
V)0%7/0
a)7)-1$"2#*4)"/'7*
G'"'()&***
S+-.$Q(:)9#,);(%&-.)
B,(C(%D#%)B,#=,-':
M+52"*FB0/)5
a)7)-1$"2#*4)"/'7*
G'"'()&**
<-$.(,)-%7)T##,7$%-&#,)
T-..),(U+(:&)".-6(7
31$")
a)7)-1$"2#*4)"/'7*
G'"'()&***
4%&,#7+6(7)&#)
B,(C(%DC();$-E(D6)
;(%&-.)B,#=,-')FB;;BG
O&$#1%&)
G'27
>(6($C()V)>(C$(P)
B;;B)L,#68+,(
31$")
3443*W$$&+2"'/$&
;$:6+::)",#=,-')
7(&-$.:W)&,-%:"#,&-D#%W)
-%7):68(7+.(
B-D(%&)(X"(,$(%6(:)
7$-E(D6)$::+(:
42'("$020*"$/)
F-)#2'720/
AWARENESS
M+52"*FB0/)5
3443*W$$&+2"'/$&
/68(7+.$%=)6#%Q,'-D#%)
:(%&)&#);(%&-.)MN=(%()
/(,C$6(
31$")
3443*W$$&+2"'/$&
O%,#..)$%)@)'#%&8)
",#=,-'
S$5)
Y-$&)9#,)Q,:&)B;;B)
-""#$%&'(%&)7-&()
ONBOARDING
3443*M--/*b$%&"'7
4)"/'7*SB(2)"20/
>(6#,7):(::$#%)%#&(:Z)
=#-.:)V)-""#$%&'(%&)
7-&(:
3443*Z"<$*N2/
4)"/'7*SB(2)"20/
>(6($C()B;;B)M#'()K$&
c'2."(*F-'#)
4)"/'7*SB(2)"20/
;$:6+::)-%7):(&)
",#=,-')=#-.:
3443*M--/*b$%&"'7
4)"/'7*SB(2)"20/
>(6#,7):(::$#%)%#&(:Z)
6#%7$D#%)#9)=+':
4)"/'7*^I#)
4)"/'7*SB(2)"20/
>(6($C()&,(-&'(%&Z)
,#+D%()9##&)(X-')
(7+6-D#%W)%-$.)&,$'W)
P-:8)V).#D#%
4)"/'7*^I#)
4)"/'7*SB(2)"20/
/(::$#%)%#&(:):8-,(7)P$&8)
-[(%7$%=);(%&-.)MN=$(%$:&
4)"/'7*^I#)
3443*'J)"+))0
4)"/'7*^I#)
4)"/'7*SB(2)"20/
>(C$(P)8#'()7(%&-.)
&,(-&'(%&)
31$")
W'&*F)&=2#)
>(6($C()-""#$%&'(%&)
,('$%7(,)6-..
W'&
W'&*F)&=2#)
3,-%:"#,&(7)&#)7(%&-.)
#\6(
c'2."(*0-'#)
4)"/'7*SB(2)"20/
Y-$&)9#,)&,(-&'(%&
ATTEND
c'2."(*F-'#)
4)"/'7*SB(2)"20/
>(C$(P)=#-.:)-%7)
",#=,(::
c'2."(*F-'#)
4)"/'7*SB(2)"20/
>(A(%,#..)$%)%(X&)@)
'#%&8)",#=,-'
ATTEND REGULAR
!""#$%&'(%&)*#+,%-.
/0123405/)
$%6.+7(7)$%)&8()9+&+,():&-&(
3(.("8#%$6);(%&-.)<-%-=(,))
;(%&-.)>$:?)!::(::'(%&
@A<#%&8)B;;B)B,#=,-')
B,(C(%DC();$-E(D6);(%&-.)B,#=,-')FB;;BG)E,#68+,(
H$,:&)<((D%=)B,#&#6#.
B(,:#%-.)I#-.)/(J%=)!::(::'(%&
B;;B)4%9#)K$&
Preventive Diabetic Dental Program (PDDP)
APPENDIX A: THE FIRST PHASE OF THE CUSTOMER JOURNEY MAP (FULL MAP)
Concept Journey
H232>L)/3!3L
BM!/L
!"#$%&"'()
B-D(%&
4%:+,(,
*$)"+
,-.'/010$+22('(3
,-.'/0142&.+)/2()
!6'()<+&+-.)%#DN(7)
#9)'('E(,)7$-=%#:$:
5%"(2
!2-2&%"('$142().-1
6.(.32+111
3(.("8#%$6);(%&-.)
<-%-=(,)"(,9#,':)
;(%&-.)>$:?)/+,C(OP
5%"(2
!2-2&%"('$142().-1
6.(.32+111
0+&,(-68)9,#')!6'()
<+&+-.);(%&-.)
B,#=,-'
7'0819#+:2;1
720#-)0
!2-2&%"('$142().-1
6.(.32+111
Q+-.$N(:)9#,);(%&-.)
B,(C(%D#%)B,#=,-':
*</'(19;0)2/
!2-2&%"('$142().-1
6.(.32+11
<-$.(,)-%7)R##,7$%-&#,)
R-..),(S+(:&)".-6(7
5%"(2
!2-2&%"('$142().-1
6.(.32+111
4%&,#7+6(7)&#)
B,(C(%DC();$-E(D6)
;(%&-.)B,#=,-')FB;;BG
=+"$%#+2
6.'-
>(6($C()T)>(C$(U)
B;;B)V,#68+,(
5%"(2
54451,""+<'(.)"+
;$:6+::)",#=,-')
7(&-$.:W)&,-%:"#,&-D#%W)
-%7):68(7+.(
B-D(%&)(X"(,$(%6(:)
7$-E(D6)$::+(:
4'.3("0'01(")2
9&2$'.-'0)
AWARENESS
*</'(19;0)2/
54451,""+<'(.)"+
/68(7+.$%=)6#%N,'-D#%)
:(%&)&#);(%&-.)MO=(%()
/(,C$6(
5%"(2
54451,""+<'(.)"+
L%,#..)$%)@)'#%&8)
",#=,-'
>"/2
Y-$&)9#,)N,:&)B;;B)
-""#$%&'(%&)7-&()
ONBOARDING
54451*&&)1?"#+(.-
42().-1>;3'2('0)
>(6#,7):(::$#%)%#&(:Z)
=#-.:)T)-""#$%&'(%&)
7-&(:
54451@(A"1B')
42().-1>;3'2('0)
>(6($C()B;;B)M#'()K$&
C.'D(319&.$2
42().-1>;3'2('0)
;$:6+::)-%7):(&)
",#=,-')=#-.:
54451*&&)1?"#+(.-
42().-1>;3'2('0)
>(6#,7):(::$#%)%#&(:Z)
6#%7$D#%)#9)=+':
42().-1EF$2
42().-1>;3'2('0)
>(6($C()&,(-&'(%&Z)
,#+D%()9##&)(X-')
(7+6-D#%W)%-$.)&,$'W)
U-:8)T).#D#%
42().-1EF$2
42().-1>;3'2('0)
/(::$#%)%#&(:):8-,(7)U$&8)
-[(%7$%=);(%&-.)MO=$(%$:&
42().-1EF$2
54451.G2(<220
42().-1EF$2
42().-1>;3'2('0)
>(C$(U)8#'()7(%&-.)
&,(-&'(%&)
5%"(2
,.+192+:'$2
>(6($C()-""#$%&'(%&)
,('$%7(,)6-..
,.+
,.+192+:'$2
3,-%:"#,&(7)&#)7(%&-.)
#\6(
C.'D(310&.$2
42().-1>;3'2('0)
Y-$&)9#,)&,(-&'(%&
ATTEND
C.'D(319&.$2
42().-1>;3'2('0)
>(C$(U)=#-.:)-%7)
",#=,(::
C.'D(319&.$2
42().-1>;3'2('0)
>(A(%,#..)$%)%(X&)@)
'#%&8)",#=,-'
ATTEND REGULAR
ResearchGate has not been able to resolve any citations for this publication.
vated to seek specialist care Awareness that foot complica.ons are preventable through care Knowledge and adequate comprehension of diabetes and its treatment Knowledge and understanding of ulcers, amputa.ons (what it is
  • Self-Mo
Self-mo.vated to seek specialist care Awareness that foot complica.ons are preventable through care Knowledge and adequate comprehension of diabetes and its treatment Knowledge and understanding of ulcers, amputa.ons (what it is, what causes them, how they are connected etc.)
Lack of awareness to risk and poten.al .meline for developing teeth-related complica.os • • • Fear of having to drill and fill their teeth Lack of belief that teeth-related diabetes complica.ons can be prevented Lack of understanding of early symptoms of diabetes and its progression
  • Overconfidence
Overconfidence/over reliance on the effec.veness of medica.on Lack of awareness to risk and poten.al.meline for developing teeth-related complica.os • • • Fear of having to drill and fill their teeth Lack of belief that teeth-related diabetes complica.ons can be prevented Lack of understanding of early symptoms of diabetes and its progression