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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 Financial constraints and budgets
Physical resources to support guideline implementation (water lines, lack of transportation, etc.)
Need for extensive human resources
Stakeholder support and buy-in
Site check-ins
Training for end-users and stakeholders
Supportive policies and laws
Ensuring basic needs are met for workers to support motivation and reduce attrition
Local leadership
Strategic implementation and operation plans
Social Social influences, norms, cultural, social pressures, conformity 22 Cultural context
Political instability/stability
Political commitment
Stigma (e.g. HIV+ mothers counselling other HIV+ mothers)
Power imbalances
Capabilities Psychological Knowledge, memory, decision-making, behavioural regulation 15 Knowledge of the guideline and its practices
Emotional toll on frontline clinicians working with vulnerable populations
Resistance to change
Physical Skills and abilities 19 Adapting training materials for all (e.g. adapting materials for those who are illiterate)
Hosting training meetings
Continued implementation through training, mentorship, supportive supervision and follow-up documentation
Motivation Reflective Roles and identity, beliefs about consequences and optimism 4 Resistance to/acceptance of change
Trust in guidelines
More clear definition of roles and responsibilities
Automatic Emotions and reinforcement 10 Enthusiasm and commitment to implementation
Motivation to implement and perform duties