Utility of the COM-B model in identifying facilitators and barriers to maintaining a healthy postnatal lifestyle following a diagnosis of gestational diabetes: a qualitative study

Abstract

ObjectivesPrevious qualitative research investigating the experiences of women diagnosed with gestational diabetes (GD) has provided important insights into the development of behaviour change interventions. However, these studies often lack a theoretical underpinning. This study explored the use of the capability, opportunity, motivation and behaviour (COM-B) framework (which proposes that individuals need the capability, opportunity and motivation to perform a particular behaviour) to code and the socioecological model to contextualise participant responses to better inform intervention development.DesignQualitative semistructured interviews are using purposive sampling. Interviews were audio-recorded, transcribed and coded using the COM-B framework. A socioecological approach was adopted to understand the context of intervention facets.SettingInterviews were conducted in a secondary care setting in South Yorkshire.ParticipantsTwenty-seven postnatal women with a previous diagnosis of GD were interviewed.ResultsApplying the COM-B framework to code participant, responses identified 16 key subthemes which reflected either: capability, opportunity or motivation components of the model. Four domains adapted from the socioecological model: individual, family life, community and healthcare provision; contextualised factors are important for these women in terms of behaviour change. Emotional response at the individual level was highly motivating or demotivating. Factors related to family life and community were particularly dominant and had the potential to either facilitate or impede change. We found many participants relied on healthcare provision during the prenatal and postnatal periods with timing and positive relationships being key to good care.ConclusionsOur study provides further insight into the factors crucial for behaviour change in women diagnosed with GD. By innovatively applying the COM-B framework in a socioecological context, it is clear intervention facets need to target microlevel through the macrolevel to engage this population in behaviour change. Future work should consider family-level intervention as this could allow for sustained behaviour change and consequently prevent the development of type 2 diabetes mellitus.

Barriers and facilitators for treatment and control of high blood pressure among hypertensive patients in Kathmandu, Nepal: a qualitative study informed by COM-B model of behavior change

“…In addition, providers perspective was sought on the relevant components of the COM-B Model, for instance, opportunity barriers faced by patients in seeking and maintenance of treatment. This model has been used in similar studies in other settings [ 27 – 30 ] to understand the perspectives of both the service users and providers [ 31 – 33 ].…”

Identifying Targets for Interventions to Increase Earplug Use in Noisy Recreational Settings: A Qualitative Interview Study

“…Authors MTL and SC independently mapped thematic analysis themes to the COM-B. As questions were developed using the COM-B, initial codes reflected these constructs, but as codes were collapsed into barrier and enabler themes it became apparent that certain themes spanned more than one COM-B component, as seen previously in Boyd et al [ 28 ]. Mapping was determined through likelihood of ‘fit’ with the COM-B based upon the description and definitions from Michie et al [ 18 ].…”

Gestational diabetes mellitus follow-up in Norwegian primary health care: a qualitative study

“…To reduce the risk of T2DM among women with previous GDM, effective behavioral change interventions are crucial to make these women sustain change and maintain the healthy lifestyle (45). A key to successful behavioral change, is patient empowerment where ongoing support help patients being responsible for their own health (46).…”