Table 1

Capability, opportunity and motivation to perform a behaviour (COM-B) [37] model applied to patients with respiratory disease and suggested solutions

BarrierPotential solution
Capability (patient factors)
 Psychological ability
  Does not understand treatmentsEnsure your patient understands the purpose of their medicines
  Forgets to take medicinesUse reminder apps or an alarm on their phone
Does not have a plan to take their treatmentFacilitate 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 dexterityIssue an inhaler device they can readily use or equipment to facilitate its use
Opportunity (external to patient)
 Physical factors
  Restricted access to healthcare systemEncourage regular review (even when well), provide emergency access to care and advice
  Financial constraintsProvide information on pre-payment or exemption certificates, prescribe several inhalers at once in systems that charge per prescription (rather than per item)
  Complex regimenSimplify regimens where possible
  Dislike of the taste of the medicineChange 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 providersBe supportive and non-judgemental
  Lack of social circle supportEngage family members, friends or other patients for support and encouragement
  Religious/cultural beliefsThis may lead to rejection of an inhaler containing alcohol, so offer a DPI or an inhaler brand without alcohol
 Reflective factors
Patient's beliefs about medicines/​about their conditionSupport 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 moodAddressing low self-esteem, depression and anxiety will support better adherence
  HabitChange 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)