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Table 4 Themes within the COM-B model

From: General practitioners’ views on managing knee osteoarthritis: a thematic analysis of factors influencing clinical practice guideline implementation in primary care

COM-B component Theme Code
Psychological Capability Knowledge gaps Knowledge of OA disease processes and progression
Knowledge or psychological skills to engage in the necessary mental processes
  Adequate knowledge about making diagnosis without imaging
Knowledge of effective exercise and weight loss treatments
Skills to facilitate lifestyle change Communication skills
Facilitation of behaviour change
Confidence to effectively manage OA Making the diagnosis without x-ray
Delivering lifestyle interventions
Physical Opportunity System-related factors Time availability
Opportunity afforded by the environment Access to other services for exercise and weight management advice (including cost and ease of referral)
Clinic software
Lifestyle treatments recommended for all chronic disease patients
Patient resources Ease of access
Social Opportunity Influences from patients demands and expectations  
Opportunity afforded by interpersonal influences, social and cultural norms that impact the way we think about things
Reflective Motivation GP’s perceived role Paternalistic role
Reflective processes involving self-conscious intentions, beliefs regarding good and bad, self-talk
Use patient-centred approaches
Assumptions about people with knee OA Diagnosis of OA may foster fear avoidance behaviours
  Patient motivation to adopt lifestyle change
Automatic Motivation Optimism Effectiveness of non-drug conservative treatment options
Automatic processes involving emotion, desires, impulses
Unease discussing weight