Table 2 Facilitators and barriers mapped onto behaviors, themes, and COM-B domains (Capability, Opportunity, Motivation)
Themes | Testing | Answering | Participating in Interview | Isolation/Quarantine | |
|---|---|---|---|---|---|
Capability | |||||
Symptom Severity | B | - | Symptoms limit ability to answer | Symptoms limit ability to speak | Symptoms increase difficulty |
F | - | - | - | - | |
Essential Knowledge | B | Lacking awareness of where/when to get tested limits uptake | Cases/contacts are surprised by call due to being unaware of tracing | Lacking understanding of tracing limits participation | Lacking understanding of I/Q protocols increases confusion |
F | - | - | Education increases participation | - | |
Opportunity | |||||
Structural Context | B | Lacking insurance or transportation impedes care seeking and testing | Language barriers limit receptiveness | Language barriers impede communication; Work/home responsibilities limit availability | Lacking food or secure/spacious housing and need for work limit feasibility |
F | In-home testing and policies increase uptake | - | Having staff who are able to speak the patient’s preferred language increases receptiveness | Organizational support, paid work leave, and spacious housing increase feasibility | |
Interpersonal Ties | B | - | When cases withhold contact info for any reason, they close off the possibility of outreach workers screening their contacts | - | Caregiving responsibilities make complete adherence not feasible |
F | Prompting by family/peers increases uptake | Cases alert contacts to incoming calls; Family assistance of ill cases increases feasibility | Family assistance of ill cases increases feasibility; Shared experiences reduce fears | Peer/family encouragement increases adherence; Providing food, housing, financial support increases feasibility. | |
Motivation | |||||
Symptom Severity | B | - | - | - | Lack of symptoms reduces motivation |
F | Symptoms increase motivation | - | - | Symptoms increase motivation | |
Anticipated Outcomes | B | Belief that testing will not lead to support, assumed infection status, and desire to exit quarantine quickly limit uptake | Belief that answering will not lead to support limits uptake | - | - |
F | Curiosity and desire to ensure medical care increases uptake | Desire for information increases uptake | Desire for information, for medical/resource support, and to protect community increase uptake | Desire to protect community increases uptake | |
Trust in Authority | B | - | - | Potential for data misuse and disorganized outreach lead to fear and loss of credibility | - |
F | Trust in guidance increases uptake | Use of Caller ID limits concerns about scam callers | Caller’s advance knowledge of client birth date increases trust | Trust in guidance increases adherence | |
Emotional Responses | B | - | - | Shock/anxiety/anticipated stigma impede interviews; Disorganized outreach upsets clients | Boredom and loneliness negatively impact mental health |
F | - | - | Contributing to public health is gratifying; Communication skills address negative emotions | Coping strategies improve mental health; Follow-up calls provide reassurance during I/Q | |