Capability, opportunity and motivation to perform a behaviour (COM-B) [37] model applied to patients with respiratory disease and suggested solutions
| Barrier | Potential solution |
| Capability (patient factors) | |
| Psychological ability | |
| Does not understand treatments | Ensure your patient understands the purpose of their medicines |
| Forgets to take medicines | Use reminder apps or an alarm on their phone |
| Does not have a plan to take their treatment | Facilitate implementation intention: work with the patient to help them identify ways that medicines taking could be associated with their established daily activities (e.g. tooth brushing) |
| Physical ability | |
| Poor dexterity | Issue an inhaler device they can readily use or equipment to facilitate its use |
| Opportunity (external to patient) | |
| Physical factors | |
| Restricted access to healthcare system | Encourage regular review (even when well), provide emergency access to care and advice |
| Financial constraints | Provide information on pre-payment or exemption certificates, prescribe several inhalers at once in systems that charge per prescription (rather than per item) |
| Complex regimen | Simplify regimens where possible |
| Dislike of the taste of the medicine | Change to an alternative brand, formulation or delivery device (e.g. some patients distinctly prefer a DPI or pMDI) |
| Social factors | |
| Lack of support from healthcare providers | Be supportive and non-judgemental |
| Lack of social circle support | Engage family members, friends or other patients for support and encouragement |
| Religious/cultural beliefs | This may lead to rejection of an inhaler containing alcohol, so offer a DPI or an inhaler brand without alcohol |
| Motivation | |
| Reflective factors | |
| Patient's beliefs about medicines/about their condition | Support understanding of the disease as present even in the absence of symptoms, and how the use of the chosen medicine treats the disease Describe the benefits of the therapy in terms of short-, medium- and longer-term benefits Acknowledge the potential for side-effects, and contextualise their risk of experiencing them, how to manage them or how long they may persist; this may need to be in comparison to previously tried therapies Reassure the patient that, if necessary, alternatives exist |
| Automatic factors | |
| Patient mood | Addressing low self-esteem, depression and anxiety will support better adherence |
| Habit | Change incongruent regimens to suit the patient's lifestyle/preference (e.g. if evening doses are regularly forgotten, suggest the dose be taken in the morning) |