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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

Capability

 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

Facilitator:

- 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

Opportunity

 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

Facilitators:

- Support from partners and family

- Peer support

Motivation

 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

Facilitator:

- 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

Facilitator:

- 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

Facilitators:

- 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

Facilitator:

- Intentions to change lifestyle after the baby’s birth

Goals

Barrier:

- Paternalistic goals made by public health nurses

Facilitator:

- Goals made in collaboration with public health nurses