Table 3 IMAB domains and corresponding facilitators and barriers categorized according to COM-B components
COM-B | Domain | Facilitators | Barriers |
|---|---|---|---|
Capability | Knowledge | Knowledge of treatment effect Information about necessity Information about alternative medication Information about experiences from others Knowledge of how to administer medication | Knowledge of side effects Knowledge of cost of medication |
Skills | Cognitive abilities Coping strategies Communication skills Fine motor skills | Insufficient cognitive, communicative, or physical skills to understand and/or administer medication | |
Memory and Attention | Treatment effect Aids (to remember) Social support Embedded in daily routine | Lack of daily routine Experiencing side effects Forgetting to take medication Change of appearance of medication Impact on lifestyle Lack of treatment effect | |
Decision-making process | Self-management (patient decides) Satisfying relationship with health professional (communication and trust) | Lack of involvement of health professional (health professional decides, no shared decision making) Doubting own knowledge Influence of health insurance companies | |
Opportunity | Environmental context and resources | Logistics (having medication in stock) Access to health professionals | Quality of product (needle) Logistics (medication storage temperature, pharmacy has no stock) Cost of medication Travelling (clearing injectable medications through customs) Change of name or appearance of medication |
Social influences | Health professionals (rheumatologist, pharmacist, nurse, general practitioner): capabilities, trust, and empathy Health insurance company: reimburses medication, provides clear information Family and friends: support adherence, support in choices of medication, instrumental support Colleagues: support, understanding | Lack of support from colleagues (incomprehension, negative reactions) | |
Motivation | Beliefs about capabilities | Aids (to use, to remember) Self-efficacy Good (overall) health status | Difficulty in adherence because of social and work events Lack of daily routine Worse health status Difficult to inject Experience of side effects Doubting own knowledge with regard to medication (as barrier to adherence) |
Beliefs about consequences | Belief of treatment effect Belief of being able to better participate (social, work) | Experience of (long- and short-term) side effects Belief that medication will be harmful: higher disease activity Lack of belief in efficacy Dependency on medication Less acceptance of (long-term) medication Non-acceptance of diagnosis | |
Emotions | Joy Gratitude Hope Confidence | Anxiety Sadness Anger Dependency on medication Irritation Incomprehension Disparity Powerlessness/helplessness Insecurity Feeling overwhelmed Feeling crestfallen Grief Embarrassment Regret Stress Disappointment Desolation Despair Agitation | |
Motivation and Goals | Improvement of Quality of Life Treatment effect Social participation (including work) Improvement of life expectancy Better relationship with health professional Maintain autonomy | Worse health status/wellbeing Side effects Comorbidity Complexity of regimen Resistance of need for medication Denial of existence of illness Difficulty administering medication Lack of daily routine | |
Goal conflict | Embedded in daily routine Treatment effect leading to active social participation (e.g., work) Instrumental support (aids, information) Social support Method of administration (intravenous or low frequency) Stock (always available) | Experiencing side effects Restrictions due to using medication (no alcohol) Worse well-being (mentally and/or physically) Not able to participate (social, work) Distracted from taking medication Lack of social support |