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Skip to 0 minutes and 8 seconds The COM-B framework proposes that people need the capability, the opportunity, and motivation to perform a particular behaviour. It takes into account the wide range of factors that influence behaviour and was developed with reference to existing theories of behaviour, not just models focused on people’s beliefs. Let’s look at each of these components in turn. Capability is the psychological and/or physical ability to engage in that behaviour. So when applied to medicines’ adherence, psychological capability can include the patient’s capacity to understand, to remember, to plan their treatment. So, for example, a deficit in perspective memory function means that a patient’s ability to remember to do something in the future, i.e. To take their medicines, can be impaired.

Skip to 1 minute and 9 seconds Physical ability refers to the level of physical skill required to actually use the medicines or devices, such as asthma inhaler or an insulin pen needle. Another example of this would be the inability to swallow tablets, either due to dry mouth, which can be a side effect of some medicine or treatment, or simply because of the gag reflex, which could prevent someone from doing so regardless of the size of the tablet. Opportunity covers both the physical and social factors that are external to the individual and that make their behaviour possible or prompted.

Skip to 1 minute and 54 seconds These factors could include the quality of health care communication and also the physical characteristics of the prescribed treatment, such as the regimen complexity and also the taste and smell of the medicine itself. Opportunity factors also include family and friends, i.e. significant others, who can encourage medicine taking and equally discouraging. Social factors refer to the wider social context, which may include religious beliefs and cultural beliefs. For example, a greater acceptance of traditional alternative therapies in comparison to pharmacologic treatments may lead to non-adherence to prescribe medicines. Motivation includes the want or need to perform the behaviour more than any other competing behaviours at that moment. And this is driven by both reflective and automatic brain processes.

Skip to 2 minutes and 56 seconds Reflective, or deliberate, processes referred to the patient’s beliefs about the treatment and the illness. For example, a patient’s beliefs about the negative impact of side effects both anticipated and experienced or the perceived seriousness of their condition, as we identified earlier in the self-regulatory model. Automatic processes include innate dispositions and impulses arising from past learning. For example, patients may establish a routine whereby their medicine-taking becomes associated with a daily behaviour, such as brushing their teeth or setting their alarm clock. When this routine is disrupted, the queue to action may be missed so that medicines are not taken.

Skip to 3 minutes and 47 seconds For example, if the patient associates setting their alarm clock in the evening with taking their tablets, this routine may be disrupted if a patient is on holiday. In addition, the COM-B is a dynamic model in which the three components interact with each other. The complex treatment regimen might be beyond the planning capability of a patient. So it may negatively influence the decision of whether or not to continue taking the treatment over time, especially if a person is worried about a health condition, which they think might have a negative effect on their ability to do their job. So in this example, there’s an interaction between psychological capability, reflective motivation, and the social opportunity factors.

The COM-B framework

It’s not just about beliefs - capability, opportunity and motivation all have a role.

In this presentation, we learn about the COM-B framework which takes into account a wider range of factors that influence medication-taking behaviour.

Developed by Michie and colleagues (2011), this newer psychological model was developed to explain behaviours in general and to advance research in behaviour change.

Let’s hear about how it can be applied to understand medication-taking behaviour.

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This video is from the free online course:

Medicines Adherence: Understanding and Changing Patient Behaviour

King's College London