Table 8 Details of HV-level barriers (listed in order of Capability, Opportunity, Motivation), intervention functions, selected BCTs and their operationalized versions
HV-level modifiable barriers | COM-B component | Intervention function | BCT label and name | Intervention components: operationalisation of the BCT within the intervention |
|---|---|---|---|---|
Lack of knowledge of childhood obesity Lack of familiarity with guidelines Skills (cognitive and interpersonal) for performing the practice behaviours | Psychological capability (Knowledge) Psychological capability (Skills) | Education Persuasion Enablement Training Modelling Enablement | 5.1 Information about health consequences 12.5 Adding objects to the environment 4.1 Instruction on how to perform a behaviour 6.1 Demonstration of the behaviour 1.4 Action planning 1.2 Problem-solving 8.7 Graded tasks | Provide information on excess and rapid weight gain in 0-2 year olds; early prevention interventions; present and discuss guidelines Provide HVs with educational materials (training pack) (e.g., copies of slides used in the session, key published papers, links to websites) Provide training pack and information about resources (web-based and key published papers) on best practice techniques Show video clips of good communication with parents on healthy weight; group discussions to include awareness/recognition of best practice and empathic communication techniques HVs discuss what changes they should and can implement in their practice routines and how they will go about it; support HVs to generate their own plans to implement practices they perceive as particularly challenging HVs identify their own barriers to implement recommended clinical behaviours; HVs then work in groups to identify their own solutions to those barriers, which will enable them to perform the clinical behaviours; HVs write down their own ‘if-then’ coping plans to manage barriers Working in groups of 2 or 3, HVs first set easy-to-perform tasks and then proceed to increasingly challenging but achievable tasks until they perform the practice behaviour in a challenging situation |
Lack of time/ competing priorities Belief: parents lack interest, motivation, and skills Belief: preventing excess weight gain in young children is parents’ responsibility Belief: Parents perceive heavier infants as healthier Disagreement with evidence underpinning the guidelines Uncertainty about identifying infants as having excess weight Low confidence in successfully performing the behaviours Belief: my advice/ intervention does little to prevent childhood obesity | Physical opportunity Psychological capability (memory, attention) Social opportunity (Social influences); Reflective motivation (Professional role and identity) Reflective motivation (Professional role, Intention) Reflective motivation (Beliefs about capabilities) Reflective motivation (Beliefs about consequences) | Training Enablement Education Persuasion Modelling Persuasion | 7.1 Prompts and cues 12.5 Adding objects to the environment 6.3 Information about other’s approval 6.2 Social comparison 9.1 Credible source 12.5 Adding objects to the environment 1.6 Discrepancy between current and expected behaviour 6.1 Demonstration of the behaviour 15.3 Focus on past success 15.1 Verbal persuasion of capability 5.1 Information about health consequences 5.2 Salience of consequences | Prompt HVs to discuss (1) using service delivery prompts as reminders; (2) strategies that can help to reduce time demand and/or competing time demands; Work with HVs to explore potential for designing reminders by adapting existing NHS resources (e.g., ‘Ready to Relate’ cards) [52] Provide HVs with information (UK literature) on parents’ expressed need for support from PCPs and parents’ preferences for how weight related information is communicated; Suggest that raising the topic of child’s weight is particularly important given greater difficulties for parents to initiate the topic because of the social stigma of obesity; suggest that, even if resistance is experienced, discussing the topic will influence the perception of parents (and potentially their practices) Provide information (citing UK and other relevant literature) on (1) positive outcomes of trained (PCP)-led prevention interventions; (2) PCP’s role in motivating parents and correcting misperceptions on healthy weight gain in infants Inform HVs about the credibility of the evidence underpinning the guidelines Provide HVs with educational materials (training pack) Provide information (UK literature) of gaps in evidence-based practices; draw attention to the link between recommended practices and two high impact areas of health visiting (infant nutrition, healthy weight); discuss implications of practice gaps Show video clips of good communication around raising the topic of weight and discussing weight related topics with parents HVs (individually and/in groups of 2-3) reflect on personal experiences of positive and negative weight-related communication in practice; prompt HVs to consider how their existing beliefs impact on their attitudes and intention to perform the behaviours Facilitator provides constructive feedback, links feedback with HV’s ability to provide guidance in real life settings, and counters any doubts with credible arguments Present and discuss motivational videos, testimonials, and success stories (health visiting Case Studies) |
Fear of negative reactions from parents Concerns about harm to relationship with parents/ family | Automatic motivation (impulses, habits); Social opportunity (social influences) | Modelling Enablement | 6.1 Demonstration of the behaviour 13.2 Framing/reframing 3.2 Social support – practical | Show video clips of sensitive communications with parents that minimise potential offence and embarrassment Reframe discussing weight issues as meeting child/ parent’s needs (focus on child’s health and not on weight); emphasise the role of the ‘obesogenic’ environment Suggest that raising the topic of child’s weight is particularly important given greater difficulties for parents to initiate the topic because of the social stigma of obesity Encourage HVs to use staff meetings to offer their peers and colleagues moral support, positive interaction, sharing and comparison |