Summary of TDF and COM-B determinants identified in the reviews
| Determinants | Interviews | Surveys | Evaluations | COM-B | ||||||
| Capability | Opportunity | Motivation | ||||||||
| Physical | Psychological | Social | Physical | Reflective | Automatic | |||||
| Knowledge/skill | ||||||||||
| Lack of knowledge/skill* | Management of symptoms | ✓ | ✗ | ✓ | #† | #‡ | ||||
| Self-care resources | ✓ | ✓ | # | #§ | ||||||
| Memory, attention and decision-making | ||||||||||
| Decision-making | Made decision alone | ✗ | ✓ | ✗ | The surveys did not clarify whether decision-making impacted on behaviour through capability, opportunity or motivation, therefore, these were not mapped. | |||||
| Did not consider alternatives | ✗ | ✓ | ||||||||
| Information overload (worldwide web) | ✓ | ✗ | # | |||||||
| Emotion | ||||||||||
| Negative emotions | Anxiety/worry | ✓ | ✓ | ✗ | # | |||||
| Reinforcement | ||||||||||
| Past experience/habituated behaviour | Non-self-care due to habituated behavioural patterns in consulting | ✓ | ✓ | ✓ | #¶ | |||||
| Credible source (evaluations only) | Message that self-care is appropriate | ✗ | ✗ | ✓ | #** | |||||
| Beliefs about consequences | ||||||||||
| Severity of symptoms | Persistence | ✓ | ✓ | ✗ | # | |||||
| Impact on day-to-day life | ✓ | |||||||||
| Pain/severity/uncertainty | ✓ | |||||||||
| Unfamiliar | ✓ | |||||||||
| Unspecified | ✓ | |||||||||
| Susceptibility to symptoms | Presence of long-term condition | ✓ | ✓ | ✗ | # | |||||
| Previous related illness | ✓ | ✗ | ||||||||
| Previous family illness and conditions (heredity) | ✓ | ✗ | ||||||||
| Children seen as vulnerable | ✓ | ✓ | ||||||||
| Contagion | ✗ | ✓ | ||||||||
| Health threat | Fear of negative health consequences | ✓ | ✓ | ✗ | See severity and susceptibility of symptoms, and negative emotions†† | |||||
| Conflicts of interest | Pharmaceutical companies | ✓ | ✗ | # | ||||||
| Websites with advertising | ✓ | ✗ | ||||||||
| Treatment expectations | Qualification and experience | ✓ | ✗ | ✗ | # | |||||
| Better facilities/services | ✗ | ✓ | ||||||||
| Expected or actual referral | ✓ | ✓ | ||||||||
| Repetitive and extensive questioning | ✓ | ✗ | ||||||||
| Continuity of care | ✗ | ✓ | ||||||||
| Social influences | ||||||||||
| Social support | Informal advice from friends, family or acquaintance | ✓ | ✓ | ✓ | #‡‡ | |||||
| Social norms | Parental responsibility to do right thing | ✓ | ✗ | # | ||||||
| Appropriate use of healthcare services | ✓ | ✗ | ||||||||
| Did not want to bother GP | ✗ | ✓ | ||||||||
| Environmental context and resources | ||||||||||
| Access | Geographical immediacy of service | ✓ | ✓ | ✗ | # | |||||
| Time taken to access care | ✓ | ✓ | ||||||||
| Convenient opening hours | ✓ | ✓ | ||||||||
| GP not available/could not contact | ✗ | ✓ | ||||||||
| Not registered with GP | ✗ | ✓ | ||||||||
| Environment | Lack of privacy for consultation | ✓ | ✓ | # | ||||||
| Cost of over-the-counter medicines | ✓ | ✓ | ||||||||
| Limited roles | Capacity to prescribe/treat | ✓ | ✓ | ✗ | # | |||||
| Capacity to provide medical certificate | ✓ | ✓ | ||||||||
| (In)access to medical records | ✓ | ✗ | ||||||||
| Capacity to physically examine (pharmacist only) | ✓ | ✓ | ||||||||
| Goals | ||||||||||
| Motivation | Action planning | ✗ | ✗ | ✓ | #§§ | |||||
✗=not present; ✓=present; #=relevant COM-B domain(s); #=relevant COM-B domain targeted in one or more interventions.
*Especially parents with one child and those with a lower socioeconomic status.
†BCTs: problem solving (3 studies); behavioural experiments (2 studies).
‡BCTs: instruction on how to perform the behaviour (10 studies); information about antecedents of the behaviour (8 studies); information about health consequences (10 studies).
§BCTs: instruction on how to perform the behaviour (1 study); information about antecedents of the behaviour (1 study); information about health consequences (1 study).
¶BCT: behavioural substitution (2 studies).
**BCT: credible source (6 studies).
††Given the considerable overlap between perceived health threat, perceptions of severity and susceptibility, and negative emotions, these constructs were treated as synonymous.
‡‡BCTs: social influences (2 studies); vicarious consequences (1 study).
§§BCT action planning (exercise for back pain).
BCTs, behavioural change techniques; COM-B, capability, opportunity, motivation-model of behaviour; GP, general practitioner; TDF, Theoretical Domains Framework.