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Table 2 Main Themes (Barriers/Facilitators for Lifestyle Adherence) from Focus Groups, Structured into TDF and COM-B

From: Psychosocial barriers and facilitators for adherence to a healthy lifestyle among patients with chronic kidney disease: a focus group study

COM-B component (definition) TDF Domain (definition) Themes patients Themes health professionals
(Patients’ psychological and physical capacity to engage in a healthy lifestyle)
Knowledge (An awareness of the existence of something) Knowledge of healthy lifestyle Knowledge of healthy lifestyle;
Beliefs about healthy lifestyle; Beliefs about financial burden
Memory, Attention and Decision Processes (The ability to retain information, focus selectively on aspects of the environment and choose between two or more alternatives) - Confusion due to information overload
Skills (An ability or proficiency acquired through practice) Creativity; Coping with temptations/social pressure Creativity; Assertiveness
Behavioral Regulation (Anything aimed at managing or changing objectively observed or measured actions) Breaking habits; Creating routines Breaking habits; Creating routines
(All factors external to patients that encourage or discourage healthy lifestyle behaviors)
Environmental Context and Resources (Any circumstance of a person’s situation or environment that discourages or encourages the development of skills and abilities, independence, social competence, and adaptive behavior) Disease characteristics; Material support tools; Characteristics of health care system; Societal characteristics Disease characteristics; Material support tools; Characteristics of health care system; Societal characteristics; Competing tasks; Psychiatric or cognitive problems
Social Influences (Those interpersonal processes that can cause individuals to change their thoughts, feelings, or behaviors) Instrumental/emotional support by social environment; Peer pressure Instrumental/emotional support by social environment; Peer pressure; Professional support
(Patients’ reflective and automatic brain processes that energize and direct behavior, such as habitual processes, emotional responding, and analytical decision-making)
(Social/Professional) Role & Identity (A coherent set of behaviors and displayed personal qualities of an individual in a social or work setting) - Obedience; Conscientiousness
Beliefs about Capabilities (Acceptance of the truth, reality, or validity about an ability, talent, or facility that a person can put to constructive use) - Locus of control; Self-efficacy
Optimism (The confidence that things will happen for the best or that desired goals will be attained) Focusing at opportunities; Acceptance; Resilience Focusing at opportunities; Acceptance
Emotion (A complex reaction pattern, involving experiential, behavioral, and physiological elements, by which the individual attempts to deal with a personally significant matter or event) Depressive feelings; Stress; Anxiety Depressive feelings; Stress; Anxiety
Beliefs about Consequences (Acceptance of the truth, reality, or validity about outcomes of a behavior in a given situation) Beliefs about consequences of lifestyle behaviors; Previous experiences with consequences Beliefs about consequences of lifestyle behaviors; Previous experiences with consequences
Reinforcement (Increasing the probability of a response by arranging a dependent relationship, or contingency, between the response and a given stimulus) Noticeable effects; Healthy behaviors experienced as punishment Noticeable effects; Unhealthy behaviors as short-term reward; Punishing unhealthy behaviors
Intentions (A conscious decision to perform a behavior or resolve to act in a certain way) Intrinsic motivation; Higher-order purposes Intrinsic motivation; Higher-order purposes
Goals (Mental representations of outcomes or end states that an individual wants to achieve) Flexibility; Discipline Goal setting
  1. Parts of this Table are adapted from “Validation of the theoretical domains framework for use in behavior change and implementation research.”, by J. Cane, D. O’Connor, and S. Michie, 2012, Implementation Science, 7 [37], p. 13–15. Copyright 2012 by Cane et al. Adapted with permission. TDF: Theoretical Domains Framework; COM-B: Capability, Opportunity, Motivation – Behavior