Table 7 Mapping of the HV-level barriers to the domains of Capability, Opportunity, Motivation model of behaviour (COM-B)
Potentially modifiable barriers | Relevant COM-B components | What needs to happen at individual HV-level, for the target behaviours to occur |
|---|---|---|
• Lack of knowledge, skills, and confidence • Lack of familiarity with guidelines/ guideline content | Psychological capability | • Understanding of the causes and consequences of rapid weight gain during infancy • Having the knowledge and skills to tailor interventions and device strategies when required • Having the confidence that they can perform the recommended practices even when experiencing parental resistance/ lack of interest |
• Uncertainty about identifying infants as having excess weight • Belief: Disagreement with guidelines/evidence • Belief: my advice does little to prevent childhood obesity | Reflective motivation | • Understanding of the consequences of delay in intervention to prevent rapid infant weight gain • Having knowledge of the quality and strength of evidence underpinning guideline recommendation • Believing that HVs’ preventive efforts have the potential to produce positive health outcomes for the child and family |
• Belief: preventing excess weight gain in young children is primarily parents’ responsibility • Belief: parents lack motivation to change • Belief: Parents lack knowledge and parenting skills • Parents misperceive heavier infants as healthier • Belief: Harm to practitioner-parent relationship • HVs lack time and have many competing priorities to manage during their visits • HVs lack tools and resources | Reflective motivation Social Opportunity Physical opportunity | • Believing that motivating a parent who appears to be not concerned is part of their role • Believing that providing parents with information, advice and support can help improve parents’ skills and confidence • Believing that correcting parents’ misperceptions of healthy infant weight gain is part of their role • Have the skills to manage parental resistance (actual or perceived) and sensitively engage with parents • Believing that even if resistance is experienced, discussing the topic will influence the perception of parents (and potentially their practices) • HVs having the skills and confidence to provide advice in a manner that does not threaten their existing relationship with the families • HVs prioritising discussing weight related behaviours especially when assessment suggests increased risk of rapid infant weight gain • Having skills and tools (e.g., decision making, guideline summaries, prompts) to perform the behaviours quickly and efficiently |
• Sensitive topic: fear of offending parents/provoking negative reactions and emotions from parents | Automatic motivation Social opportunity | • Adopting the position that development of excess weight is a societal and environmental issue, whilst at the same time emphasising the importance of implementing practices that are known to promote healthy infant weight and prevent excessive weight gain • Feeling the need to change some existing practice routines: able to resist the instinct to avoid the topic (not wanting to ‘rock the boat’) • Recognising that it can be difficult for parents to initiate the topic because of the social stigma associated with obesity |