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Table 6 Implementation barriers and enablers coded using the COM-B framework (summary table)

From: Strategies to adapt and implement health system guidelines and recommendations: a scoping review

COM-B category

COM-B subcategory

COM-B definition

Frequency of occurrence

Examples of barriers and enablers

Opportunity

Physical

Environmental context and resources

36

â—‹ Financial constraints and budgets

â—‹ Physical resources to support guideline implementation (water lines, lack of transportation, etc.)

â—‹ Need for extensive human resources

â—‹ Stakeholder support and buy-in

â—‹ Site check-ins

â—‹ Training for end-users and stakeholders

â—‹ Supportive policies and laws

â—‹ Ensuring basic needs are met for workers to support motivation and reduce attrition

â—‹ Local leadership

â—‹ Incentives

â—‹ Strategic implementation and operation plans

Social

Social influences, norms, cultural, social pressures, conformity

22

â—‹ Cultural context

â—‹ Political instability/stability

â—‹ Political commitment

â—‹ Stigma (e.g. HIV+ mothers counselling other HIV+ mothers)

â—‹ Power imbalances

Capabilities

Psychological

Knowledge, memory, decision-making, behavioural regulation

15

â—‹ Knowledge of the guideline and its practices

â—‹ Emotional toll on frontline clinicians working with vulnerable populations

â—‹ Resistance to change

Physical

Skills and abilities

19

â—‹ Adapting training materials for all (e.g. adapting materials for those who are illiterate)

â—‹ Hosting training meetings

â—‹ Continued implementation through training, mentorship, supportive supervision and follow-up documentation

Motivation

Reflective

Roles and identity, beliefs about consequences and optimism

4

â—‹ Resistance to/acceptance of change

â—‹ Trust in guidelines

â—‹ More clear definition of roles and responsibilities

Automatic

Emotions and reinforcement

10

â—‹ Enthusiasm and commitment to implementation

â—‹ Motivation to implement and perform duties