Utility of the COM-B model in identifying facilitators and barriers to maintaining a healthy postnatal lifestyle following a diagnosis of gestational diabetes: a qualitative study

Boyd, J., McMillan, B., Easton, K., Delaney, B. and Mitchell, C. (2020) Utility of the COM-B model in identifying facilitators and barriers to maintaining a healthy postnatal lifestyle following a diagnosis of gestational diabetes: a qualitative study. BMJ Open, 10(8), e037318. (doi: 10.1136/bmjopen-2020-037318) (PMID:32753450) (PMCID:PMC7406111)

Abstract

Objectives: Previous qualitative research investigating the experiences of women diagnosed with gestational diabetes (GD) has provided important insights into the development of behaviour change interventions. However, these studies often lack a theoretical underpinning. This study explored the use of the capability, opportunity, motivation and behaviour (COM-B) framework (which proposes that individuals need the capability, opportunity and motivation to perform a particular behaviour) to code and the socioecological model to contextualise participant responses to better inform intervention development. Design: Qualitative semistructured interviews are using purposive sampling. Interviews were audio-recorded, transcribed and coded using the COM-B framework. A socioecological approach was adopted to understand the context of intervention facets. Setting: Interviews were conducted in a secondary care setting in South Yorkshire. Participants: Twenty-seven postnatal women with a previous diagnosis of GD were interviewed. Results: Applying the COM-B framework to code participant, responses identified 16 key subthemes which reflected either: capability, opportunity or motivation components of the model. Four domains adapted from the socioecological model: individual, family life, community and healthcare provision; contextualised factors are important for these women in terms of behaviour change. Emotional response at the individual level was highly motivating or demotivating. Factors related to family life and community were particularly dominant and had the potential to either facilitate or impede change. We found many participants relied on healthcare provision during the prenatal and postnatal periods with timing and positive relationships being key to good care. Conclusions: Our study provides further insight into the factors crucial for behaviour change in women diagnosed with GD. By innovatively applying the COM-B framework in a socioecological context, it is clear intervention facets need to target microlevel through the macrolevel to engage this population in behaviour change. Future work should consider family-level intervention as this could allow for sustained behaviour change and consequently prevent the development of type 2 diabetes mellitus.

• Item Type: Articles
• Additional Information: This work was supported by the Royal College of General Practitioners Scientific Foundation Board, grant number SFB 2015–04. The interviews were completed while BM was employed as a National Institute for Health Research (NIHR) Academic Clinical Fellow (award reference: 1897).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Boyd, Dr Jennifer
• Authors: Boyd, J., McMillan, B., Easton, K., Delaney, B., and Mitchell, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: BMJ Open
• Publisher: BMJ Publishing Group
• ISSN: 2044-6055
• ISSN (Online): 2044-6055
• Published Online: 04 August 2020
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in BMJ Open 10(8): e037318
• Publisher Policy: Reproduced under a Creative Commons License