Table 4 Behaviour 1—TDF to expand COM-B components using interview data

Physical capability

Physical skills

• Receive direct training of CFHealthHub

• Receive ongoing support for CFHealthHub skills

• Being able to interpret objective adherence data

• Being able to navigate CFHealthHub

Yes: develop skills for using CFHealthHub and have these regularly refreshed

Psychological capability

Knowledge

• Understand patients’ overall adherence in the centre

• Identify which patients struggle with adherence

• Understand what features are on CFHealthHub

• Understand how to add information to CFHealthHub e.g. prescription updates

Yes: develop knowledge about centre adherence and individual patient adherence. Develop knowledge of CFHealthHub and theory behind it

Memory attention and decision processes

• ‘Forgetting’ when busy

• Only remembering when prompted by discussion with patient or clinician

Yes: notice and remember to open CFHealthHub with every patient.

Behavioural regulation

• MDT meeting as a cue to action

• Data improvements as feedback

• No routine

Yes: develop skills of goal setting, action planning and enable self-monitoring

Physical opportunity

Environmental context and resources

• Having a laptop or computer

• Having Wi-Fi available

• Regular meetings to open and share adherence data

Yes: Alter structure of centre to accommodate CFHealthHub. Problem solve time and space issues.

Social opportunity

Social influences

• Lack of support from senior management

• Lack of support from other team members

• Not having a CFHealthHub champion

Yes: Facilitate support from others via problem-solving

Reflective motivation

Professional/social role and identity

• Deferred responsibility for understanding patient adherence “it isn’t part of my role”

Yes: links to knowledge and skills, educate/demonstrate usefulness of CFHealthHub for all roles. Perceive adherence support as a crucial part of all CF care.

Beliefs about capabilities

• Not confident in how to interpret objective adherence charts

Yes: increase perceptions of capability.

Optimism

• Opening objective adherence data at every encounter is not achievable

No

Beliefs about consequences

• Objective adherence data will be used to tell patients off

• Belief that embedding will require a lot of staff energy

Yes: develop appropriate beliefs about necessity of adherence data, address concerns.

Intentions

• Low intentions within teams, specifically no intention of doing the behaviour if not related to role (see professional role)

Yes: links to professional role and identity, links to skills and knowledge.

Goals

• To improve patient care

• To improve patient health

No.

Automatic motivation

Reinforcement

• There’s no immediate reward for using objective adherence data

• CFHealthHub can show threatening information (links to emotions)

Yes: provide reward for change through individual and centre level feedback. Use threatening information as a mode for change.

Emotion

• Stress caused by overall workload

• Cognitive dissonance caused by threatening data (see reinforcement)

No. Address environmental issues to reduce stress.