Table 1 MyComrade intervention: barriers to medication reviewing and operationalisation of MyComrade BCTs
Behavioural analysis using COM-B: what are the barriers to medication review in multimorbidity? | Selected behaviour change technique and definition | Original operationalisation of BCTs in the MyComrade intervention | Revised operationalisation of BCTs in the MyComrade intervention, based on the findings of the feasibility study [19] and contextual requirements | |
|---|---|---|---|---|
Uncertainty about most valuable medications. | Psychological capability | 3.2 Social support—practical Advise on, or provide practical help (e.g. colleagues) for the performance of behaviour | Two GPs collaboratively conduct a medication review | Two GPs or a GP and PBP collaboratively conduct a medication review |
Perceptions related to patient unwillingness to stop long-term medications. | Social Opportunity | |||
Lack of time to properly review medications. | Physical opportunity | 12.2 Restructuring social environment Change or advise to change the social environment in order to facilitate performance of the wanted behaviour 1.4 Action planning Prompt detailed planning of performance of behaviour (must include at least one of frequency, context, duration, intensity) | Plan active medication reviews | Plan active medication reviews |
An instinct to maintain the status quo. | Automatic motivation | 7.1 Prompts/cues Introduce environmental or social stimulus for the purpose of prompting or cueing behaviour | Use of prescribing checklist | Use of prescribing checklist |
Fear of negative consequences. | Reflective motivation | 10.7 Self-incentive Plan to reward self in the future if and only if there has been an effort and/or progress in performing the behaviours | Annual professional appraisal contribution | Annual professional appraisal contribution |
Opportunity cost of reviewing medications. | ||||
Based on the findings of the non-randomised feasibility study [19], an additional BCT was added to the MyComrade intervention to provide the necessary support to address the opportunity cost of reviewing medications. | Reflective motivation | 10.1 Material incentive (behaviour) Inform that money, vouchers or other valued objects will be delivered if and only if there has been an effort and/or progress in performing the behaviour |  | Financial reimbursement for review completion All practices: €500/£430 for the administration associated with recruiting patients Intervention practices only:  • €100/£86 for completing the intervention introduction session  • €50/£43 per completed medication review |