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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

Capability

(Patientsā€™ 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

Opportunity

(All factors external to patients that encourage or discourage healthy lifestyle behaviors)

Environmental Context and Resources (Any circumstance of a personā€™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

Motivation

(Patientsā€™ 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 ā€œValidation of the theoretical domains framework for use in behavior change and implementation research.ā€, by J. Cane, D. Oā€™Connor, and S. Michie, 2012, Implementation Science, 7Ā [37], p. 13ā€“15. Copyright 2012 by Cane et al. Adapted with permission. TDF: Theoretical Domains Framework; COM-B: Capability, Opportunity, Motivation ā€“ Behavior