Barriers and facilitators to the use of digital systems in primary care to deliver physical activity advice using COM-B and theoretical domains framework
Authors: Bondaronek Paulina , Dicken Samuel James , Jennings Seth , Mallion Verity , Stefanidou Chryssa 
Published: November 2021

Background: Physical inactivity is a leading risk factor for many health conditions, including cardiovascular disease, diabetes and cancer; increasing physical activity (PA) is therefore a public health priority. Healthcare professionals (HCPs) in primary care have been identified as being pivotal in addressing physical inactivity, yet few HCPs provide PA advice to patients. There can be obstacles to delivering PA advice, including a lack of time, confidence or knowledge. Digital technology has the potential to overcome obstacles and facilitate delivering PA advice. However, it is unknown if and how digital systems are used to deliver physical activity advice in primary care consultations, and what factors influence their use.The aim of this study was to understand the use of digital systems to support primary care consultations and to identify the barriers and facilitators to using these systems.Methods: 25 semi-structured interviews were conducted with HCPs in primary care. Professionals were sampled purposively based on profession (general practitioners, practice nurses and healthcare assistants), prevalence of long-term conditions within their practice area, and rural-urban classification. Data were analysed using thematic analysis to identify influences on the use of digital systems. Themes were categorised using COM-B and the theoretical domains framework (TDF) to identify the barriers and facilitators to using digital systems to support the delivery of PA advice in primary care consultations.Results: Identified themes fell within eight TDF domains (linked COM-B component follows in parentheses): Knowledge (Psychological Capability), Skills (Psychological Capability), Environmental Context and Resources (Physical Opportunity), Social Influence (Social Opportunity), Beliefs about Capabilities (Reflective Motivation), Beliefs about Consequences (Reflective Motivation), Reinforcement (Automatic Motivation), and Emotions (Automatic Motivation). The most prominent barrier/facilitator within psychological capability was ‘having the skills to use digital systems’. ‘Training in the use of digital systems’ was also mentioned several times. The most notable barriers/facilitators within physical opportunity were ‘time constraints’, the ‘efficiency of digital systems’, the ‘simplicity and ease of use’ of digital systems, and ‘integration with existing systems’. Other physical opportunity barriers were ‘lack of access to digital systems’ and ‘technical support in the use of digital systems’. With respect to social opportunity, a notable barrier was the sense that ‘digital systems reduce interpersonal communications’ with patients. ‘Patient preference’ was also mentioned as a barrier/facilitator. Several important barriers and/or facilitators were within reflective motivation, including ‘confidence to use digital systems’, ‘beliefs about the usefulness of digital systems’, the ‘belief that digital systems ‘are the way forward’’, ‘beliefs related to data privacy and security concerns’, and ‘perceptions about patient capabilities’. With respect to automatic motivation, barriers/facilitators included ‘familiarity and availability’ regarding digital systems, and the fact that digital systems ‘prompt behaviour’. Conclusions: A variety of influences were identified on the use of digital systems to support primary care consultations. These findings provide a foundation to design a digital system that addresses the barriers and leverages the facilitators to support PA advice provision within primary care, to elicit patient behaviour change and increase PA.