Utility of the COM-B model in identifying facilitators and barriers to maintaining a healthy postnatal lifestyle following a diagnosis of gestational diabetes: a qualitative study

Objectives: Previous qualitative research investigating the experiences of women diagnosed with gestational diabetes (GD) has provided important insights for development of behaviour change interventions. However, these studies often lack a theoretical underpinning. This study explored the use of the COM-B framework (which proposes that individuals need the capability, opportunity, and motivation to perform a particular behaviour) to code and the socio-ecological model to contextualise participant responses to better inform intervention development.

Design: Qualitative semi-structured interviews using purposive sampling. Interviews were audio-recorded, transcribed and coded using the COM-B framework. A socio-ecological approach was adopted to understand the context of intervention facets.

Setting: Interviews were conducted in a secondary care setting in South Yorkshire.

Participants: Twenty-seven postnatal women with a previous diagnosis of GD were interviewed.

Results: Applying the COM-B framework to code participant responses identified sixteen key subthemes which reflected either: capability, opportunity, or motivation components of the model. Four domains adapted from the socio-ecological model: individual, family life, community and healthcare provision, contextualised factors important for these women in terms of behaviour change. Emotional response at the individual level was highly motivating or demotivating. Factors related to family life and community were particularly dominant and had the potential to either facilitate or impede change. We found many participants relied on healthcare provision during the pre- and post-natal periods with timing and positive relationships key to good care.

Conclusions: Our study provides further insight into the factors crucial for behaviour change in women diagnosed with GD. By innovatively applying the COM-B framework in a socio-ecological context it is clear intervention facets need to target micro- through to the macro-level to engage this population in behaviour change. Future work should consider family-level intervention as this could allow for sustained behaviour change and consequently prevent the development of T2DM.