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 ○ Incentives ○ 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 |