Skip to main content

Table 4 Summary of themes arising during interviews corresponding to COM-B domains

From: Understanding health behaviour in pregnancy and infant feeding intentions in low-income women from the UK through qualitative visual methods and application to the COM-B (Capability, Opportunity, Motivation-Behaviour) model

Drivers of behaviour: barriers (−) and facilitators (+) COM-B domain
Remaining smokefree during pregnancy
 Knowledge of potential harm (+), including from health professionals (+/−); high (+) or low (−) Carbon Monoxide test readings; belief that harm from smoking is real (+) or exaggerated (−) Capability – psychological
Opportunity - social
Motivation - reflective
 Pregnancy related nausea (+) Capability - physical
 Stress (−) Capability - psychological
Stigma related to smoking during pregnancy and pressure to stop smoking leads to hidden smoking in the home and car (−); smoking in pregnancy normalised (−); strong family views that smoking is bad (+) Opportunity – social
Opportunity – environmental
Motivation - reflective
 Nicotine addiction (−); cravings to smoke (−); feeling that e-cigarettes were unable to deliver sufficient nicotine to reduce cravings (−); life long non-smoker (+); association between drinking alcohol and smoking leads to reduced cravings when not drinking alcohol (+) Motivation- automatic
Remaining abstinent from alcohol during pregnancy
 Knowledge of guidelines (+/−) including from health professionals (+/−); belief that any alcohol is dangerous (+) or only heavy alcohol use is dangerous (−); belief that alcohol is dangerous reduces appeal (−) Capability – psychological
Opportunity - social
Motivation - reflective
 Pregnancy related nausea and tiredness reduce appeal (+); age and caring responsibilities for children make ‘hangovers’ unappealing (+) Capability – physical
Opportunity - social
Motivation - reflective
 Alcohol consumption in public is highly stigmatised (+/−); partners and family members encourage alcohol consumption in the home (−); Opportunity - social
Opportunity – environmental
 Socialising largely takes place in premises serving alcohol and few non-alcoholic options (−); feelings of isolation from social group when not drinking alcohol (−) Opportunity - social
Opportunity – environmental
 Willpower sufficient to resist alcohol (+); alcohol associated with relaxation and pleasure, leading to strong desire to drink alcohol (−) Motivation- automatic
Opportunity - social
Breastfeed exclusively for six months
 Knowledge of guidelines (+/−) including from health professionals (+/−); belief that breastmilk is superior to formula (+/−); belief that exclusive breastfeeding is important (+/−); belief that breastfeeding beyond the early days and weeks is important (+/−) Capability – psychological
Opportunity - social
Motivation - reflective
 Breastfeeding (+) or formula feeding (−) positioned as the convenient or ‘normal’ choice by the mother, and those around her; Formula feeding culture (−) Capability – psychological
Capability – physical
Opportunity – social
Motivation - reflective
 Pressure to breastfeed from health professionals, family, friends and strangers in the antenatal and early post-natal period (−) Capability – psychological
Opportunity - social
 Understanding of how to physically breastfeed (including latch and positioning) (+/−); physical challenges, including soreness, latch and tongue-tie (−); recovering from traumatic birth or C-section (−); support to overcome physical challenges from health professionals or others (+/−); hospitals have adequate/inadequate resources to support the initiation of breastfeeding (+/−) Capability – psychological
Capability – physical
Opportunity – social
Opportunity - environmental
 Confidence in ability to breastfeed (+/−); inability to see how much milk baby is taking (−); belief in adequacy of milk supply (+/−); exposure to breastfeeding role models (+) or formula feeding role models (−); experience of formula feeding babies (−) Capability – psychological
Capability – physical
Opportunity - social
 Belief that it is OK to breastfeed in public (+); Confidence to breastfeed in public (+/−); belief in ability to ‘discreetly’ breastfeed in public (+/−); knowledge of ‘safe’ places to breastfeed in public (+); confidence-building support from health professionals or others (+) Capability – psychological
Capability – physical
Opportunity – social
Opportunity - environmental
 Partners and family encourage bottle feeding to ‘help’ with care (−) – expressing breastmilk for bottle feeding takes additional time and maternal energy (−); mothers desire/ability to reject formula feeding (+/−); belief breastfeeding takes extra time (−) and lack of support for household chores and caring responsibilities (−) Opportunity – social
Motivation – reflective
Capability – psychological
 Breasts identified as sexual (−); Desire to stop breastfeeding to ‘get my body back’ (−) and quickly return to non-maternal activities/self identity (−) Opportunity – social
Motivation - reflective