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Table 4 Target behaviors categorized by COM-B components and TDF domains

From: Identifying target behaviors for weight management interventions for women who are overweight during pregnancy and the postpartum period: a qualitative study informed by the Behaviour Change Wheel

COM-B component TDF domain Target behavior
 Physical capability Skills Barriers:
- Lack of skills needed to cook healthy food
- Lack of skills needed to follow instructions for healthy lifestyle choices
 Psychological capability Knowledge Barriers:
- Lack of professional information about the risks of obesity
- Lack of concrete counseling on how to eat or exercise
- Lack of consistent ways to broach the weight management topic
Memory, attention and decision processes Barrier:
- Overweight as a feature of women’s identity
- Individual weight management counseling
Facilitator or barrier:
- Previous experiences with weight management
Behavioral regulation Facilitator:
- Utilizing information from health technology (smart wearables) in antenatal visits
 Physical opportunity Environmental context and resources Barriers:
- Pregnancy related physical discomfort
- Lack of time during antenatal visits
- Lack of postnatal counseling
 Social opportunity Social influences Barrier:
- Lack of perinatal peer-support groups
- Support from partners and family
- Peer support
 Automatic motivation Reinforcement Facilitators:
- Motivating counseling
- Positive feedback
- Encouragement to make small changes
- Asking questions and listening
Facilitator or barrier:
- Tone of voice
Emotions Barriers:
- Despair and feelings of shame
- Denial and defense reactions
- Low self-esteem
- Psychological reasons for eating
- Discreet counseling
 Reflective motivation Social/professional role and identity Barriers:
- Conflict: Public health nurses’ self-described role as advisors, which conflicted with women’s expectation of a robust stance and professional counseling
- Overweight women’s reluctance to take responsibility for their actions
Beliefs about capability Barriers:
- Difficult to change lifestyle
- Women’s inability to lose weight in the past despite their efforts
- Other problems in women’s lives that affect their capabilities
- Lack of desire to change their lifestyle on the part of some women
- Mapping the women’s life situations
Beliefs about consequences Barriers:
- Pregnancy as an excuse
- Belief that women can eat anything they want while breastfeeding
- Public health nurses’ duty to defend and protect the unborn baby
- Unborn child as a source of motivation
- Positive effects of breastfeeding
Optimism Facilitator:
- Women’s belief that they could exercise after birth just as they did before pregnancy
Intentions Barrier:
- Willingness to change but a lack of motivation to make concrete changes
- Intentions to change lifestyle after the baby’s birth
Goals Barrier:
- Paternalistic goals made by public health nurses
- Goals made in collaboration with public health nurses