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Table 4 Barriers and facilitators mapped to the COM-B and TDF

From: Understanding public attitudes to death talk and advance care planning in Northern Ireland using health behaviour change theory: a qualitative study

COM-B Component TDF Domain Barriers Facilitators
Psychological Capability Knowledge Lack of understanding of how to engage in death talk in a way that is helpful and supportive (overlaps with apprehension at navigating conversations)
Uncertainty about when and with whom it is appropriate to engage in death talk (overlaps with social role/responsibility)
Increase quality and availability of tangible information resources (tailored to different contexts & groups) to facilitate understanding of options at the end of life and key terms/processes
Experts across various sectors to share process and experience-based knowledge of the death system (overlaps with social influences)
Provide education along the life course to empower and emotionally prepare individuals
Skills Lacking the interpersonal skills to facilitate constructive (i.e. sensitive and culturally respectful) conversations about death (overlaps with beliefs about capabilities) Increase interpersonal support and communication skills training for people across demographic groups to facilitate death talk
Support individuals to talk about death and dying in a way which enables participation of people from diverse belief systems
Memory, Attention and Decision Processes - -
Behavioural Regulation - -
Physical Capability Skills - -
Social Opportunity Social Influences Perception that other people are unwilling to engage in constructive conversations around death
Death is not commonly discussed within NI culture and religious diversity invites sensitivity toward death talk
Normalize death talk through early intervention by embedding discussion with children and adolescents within formal education and the family (overlaps with intentions)
Harness existing communities such as workplaces to embed discussion such as death cafes
Physical Opportunity Environmental Context and Resources Conversations about death with close others occurring at a late stage and this timing issue is a challenge Optimise access to specialist palliative care and embed palliative care approaches within generalist health and social care structures to facilitate earlier and more routine conversations
Reflective Motivation Social/Professional Role and Identity Death talk is perceived to be only appropriate within the context of families or with professionals Encourage individuals to acknowledge they have a personal role in initiating and engaging in conversations around death and dying (overlaps with intentions)
Provide training and support for healthcare professionals to have more routine ACP conversations (overlaps with skills)
Beliefs about Capabilities Individuals believe they are not capable of discussing death in a helpful way (overlaps with skills Provide guidance on ‘conversation openers’ to facilitate individuals to instigate conversations
Beliefs about Consequences Individuals believe that discussing death will result in social and/or personal discomfort (psychosocial repercussions) Help individuals to understand why talking about death and dying might be relevant to them, at different stages in life
Help individuals to understand the benefits of developing plans for end of life at an early stage, within supportive conversations
Help individuals to develop a positive attitude to death, by using death to facilitate a focus on living meaningfully
Intentions Assumption that others generally are not willing to/ do not want to discuss death Help individuals to recognize that others wish to have conversations around death and dying
Goals - -
Automatic Motivation Optimism - -
Reinforcement - -
Emotion Anticipated emotional reactions hinder conversation about death (unpleasant emotions underpin social and personal barriers) Help individuals to disassociate superstitions and to address fear around talking about death and dying