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 |