Table 1 Capability, Opportunity, and Motivation Constructs of Behavior (COM-B) at the provider/system and patient levels
COM-B construct | Provider/system level themes | Patient level themes |
|---|---|---|
Psychological capability | PCP training/knowledge -Lack of knowledge about CC Error-prone referral processes | Patient education about treatment options Patient’s lack of awareness of their own mental health |
Social opportunity | External environment -Competing primary care initiatives -Restrictive enrollment requirements -Inadequate resources and complex psychosocial needs | Stigma about mental health |
Physical opportunity | Funding -Complex funding streams -Insufficient funding Information technology/infrastructure -Antiquated data management/information technology infrastructure PCP time/resources/personnel -Time constraints on PCPs -Competing PCP demands -Inflexible PCP schedule -High PCP workload limits depression diagnosis and treatment Complex workflows -Infeasible warm handoffs in sustainability phase (also motivation barrier) -Complicated screening, referral, and triaging (also capability, motivation barrier) DCM time/resources/personnel -Competing DCM roles, insufficient DCMs/personnel -Inadequate space -Inflexible mental health workers’ schedule | Treatment accessibility and convenience Providers’ expertise and quality of mental care |
Reflective motivation | Provider engagement -Lack of primary care physician pro-activeness -Poor continuity of care -Poor psychiatrist engagement -Lack of DCM engagement -Inadequate teamwork/communication Workflow logistics -Complicated screening, referral, and triaging (also opportunity, capability barriers) Beliefs about consequences -Inadequate PCP buy-in -PCP concern for the validity of measures | Patients’ beliefs about treatment being ineffective Unaddressed patient needs and preferences Patient engagement/self-efficacy -Depression treatment stigma -Patient non-adherence -Limited language/literacy/cultural beliefs of patients -Infeasible warm handoffs (also opportunity barrier) |
Automatic motivation |  | Patients’ fear of treatment |