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Table 1 Sub-behaviour, related barriers, organised by COM-B element, and resulting behavioural targets

From: Developing a theory-based multimedia intervention for schools to improve young people’s asthma: my asthma in school (MAIS)

Sub-behaviour COM-B categorya Barriers to specific behavioursb Behavioural targets in participants
A) Adherence to medication Capability
-Physical
Unpleasant side-effects (F and QN) A1. Knowledge of how to manage side effects
  -Psychological • Forgetfulness (F and QN)
• Lack of knowledge and understanding regarding: (a) medication (F and QN), (b) side effects (F), (c) symptom severity (QN)
A2. Awareness of situations in which they could forget their medication
A3. Knowledge of how different inhalers function
A4. Knowledge what to do in case of side effects
A5. Awareness of the differences between long-acting corticosteroid inhalers and short-term acting SABA inhalers
A6. Comprehension of what is meant by well-controlled asthma
A7. Appreciation of different asthma symptoms and symptom severity
A8. Knowledge how a peak flow meter can be used to monitor symptom severity
Opportunity
-Physical
• Medication not available when needed: (a) misplaced inhaler (SABA or corticosteroid) (QN), (b) forgot SABA inhaler at home (QN), (c) inhaler expired (QN)
• Inconvenient to take medication (F and QN)
A9. Ensure sufficient medication in different locations if appropriate
A10. Awareness of the importance of reminders, prompts and cues, as well as the ability to set them up
-Social Social environment does not support taking medication: (a) not feeling comfortable taking inhaler at school (QN), (b) embarrassment (F), (c) reluctance to use in public (F) A11. Competent talking about asthma
A12. In participant’s peers: understanding what it means to live with asthma
Motivation
-Automatic
Uncomfortable with medication—unspecified (QN) A13. Awareness of the importance of medication adherence
-Reflective • Belief that medication is ineffective (QN)
• Inhaler efficacy (F), in particular SABA efficacy (QN)
• Belief that medication not required: (a) corticosteroid inhaler, (b) SABA inhaler and (c) tablets (QN)
• Fear of reliance (F)
• Use other medication instead: (a) SABA instead of corticosteroid inhaler (QN), (b) corticosteroid inhaler instead of SABA (QN), (c) different medication instead of tablets (4 tablets) (F)
• Do not want to take the medication: (a) corticosteroid inhaler, (b) SABA inhalers, and (c) tablets (F & QN)
• Laziness (QN)
• Inhaler apathy (F)
• Excuse to miss class (F)
A13. Awareness of the importance of medication adherence (s.a.)
A3. Understanding how different inhalers work (s.a.)
A5. Awareness of the differences between long-acting corticosteroid inhalers and short-term acting SABA inhalers (s.a.)
A6. Comprehension what is meant by well-controlled asthma (s.a.)
A7. Appreciation of different asthma symptoms and symptom severity (s.a.)
B) Inhaler technique Capability
-Psychological
Lack of knowledge: (a) inhaler technique (F), (b) spacer usage (QN) B1. Proficiency in the correct inhaler technique
B2. Understanding how a spacer acts and what the benefits are of using a spacer
  Opportunity
-Physical
Limited spacer usage (QN) B3. Knowledge about how to acquire a spacer
  -Social Spacer is embarrassing [19,20,21] B4. Proficiency in problem-solving skills for managing emotions and difficult social situations related to spacers
  Motivation
-Automatic
Spacer is embarrassing, see also above, social opportunity B4. Proficiency in problem-solving skills for managing emotions and difficult social situations related to spacers (s.a.)
C) Trigger avoidance Capability
-Psychological
Lack of knowledge of which triggers exist, what triggers do C1. Knowledge about different triggers and how to mitigate their effect
Opportunity
-Social
Lack of social support in reducing effect of triggers (esp. for exercises) (F) C2. Proficiency in problem-solving skills for difficult social situations related to triggers
D) Emergency response Capability
-Psychological
Lack of knowledge about how to respond to an asthma emergency (F) D1. Skilled in asthma emergency response
E) Effective communication with healthcare professionals Opportunity
-Physical
Lack of consistency of care (F) [Possible solutions lie outside planned school-based intervention]
  -Social Perceived problems with the communication of healthcare professionals (F) including: (a) they do not feel fully informed by healthcare professionals, (b) communication from healthcare professionals is confusing, (c) feeling that the healthcare professional did not respond adequately to their concerns E1. Appreciation of good communication with healthcare professionals
E2. Understanding of the role of a healthcare professional
E3. Proficiency in methods of preparation for a visit with a healthcare professional
F) Empowerment to self-manage Capability
-Psychological
Belief of people with asthma that they do not know enough about their own condition (F), including (a) belief they are lacking general skills and information (F), (b) not knowing what causes asthma (F) F1. General understanding about asthma
A11. Competent talking about asthma (s.a.)
F2. Knowledge why someone develops asthma
  Opportunity
-Social
• Perceived lack of understanding by non-asthmatics (F): (a) feeling not taken seriously, (b) people without asthma are not listening, (c) asthma is not talked about, (d) fear of being bullied or ridiculed, (e) peer awareness
• Perceived stigma (F)
F3. In participant’s peers: awareness and acceptance of asthma
F4. Proficiency in problem solving skills for difficult social situations related to (a) ridicule, (b) communicating symptoms, (c) responsibility to self-manage
  Motivation
-Reflective
Embarrassment and not wanting to address asthma: (a) embarrassment, (b) not wanting to accept and deal with asthma F5. Acceptance that asthma is part of them
F6. Appreciation that asthma is very common
F7. Appreciation of possibilities and limitations of a life with asthma
F8. Proficient in methods aimed to change their asthma themselves, including (a) where to get support, (b) how to break down a problem to find the most effective solution, (c) SMART goal setting technique
F4. Proficiency in problem-solving skills for difficult social situations related to the responsibility to self-manage (s.a.)
  1. aNot all sub-behaviours show barriers within each COM-B category
  2. b(F) evidence from SAP focus groups, (QN) evidence from SAP questionnaire