Examples of COM-B in practice
Here are some examples of how people have been successfully helped to change certain health behaviours with the use of COM-B.
Weight loss
Client X had a referral to a commissioned healthy lifestyle service with a wish to lose weight. Their BMI sat at 35.7, indicating they were 'clinically obese'.
A detailed initial assessment took place. This was to look at the client's capability, opportunity and motivation to change some key behaviours and help them lose weight.
The client's main goal, taken from the initial assessment, was to lose 5% of their total body weight.
To achieve this the professional had to investigate the client's current lifestyle behaviours. This would show which caused weight gain and stopped them losing weight. Those behaviours included excess snacking and limited physical activity.
Here's how they tackled those behaviours using COM-B.
Capability - The professional talked through completing a food diary. This showed the client how many snacks they were having. With that knowledge, a goal was set at having no more than 3 snacks a day, all 100 calories or less. It allowed the client to plan and pay more interest in the food they were buying and consuming.
Opportunity - During the session the professional discussed the support network around the client. It became clear the client's partner shared a similar diet to them. This would make it hard to make the changes if they were consuming similar snacks, etc. After talking at home, the client and their partner agreed to take on this journey together. This gave them more opportunity to succeed with the support of others.
Motivation - the client put reminders around the home to motivate them to not go to the snack cupboard. This included notes on the fridge, reminders on their phone and weekly weigh-ins.
They also reduced portions at dinner and increased physical activity. The client started to lose weight and see the results. This increased their motivation, reflecting on the changes made and results shown.
Over 7 months the client lost almost 20kg and reduced their blood pressure. They achieved their desired goal and lost almost 20% of their body weight.
Physical activity
Client B visited their GP to have an NHS Health Check. The results of the check showed they had high blood pressure. They were also sitting in the overweight category with a BMI of 28.
Client B talked through the results with the GP. They said wanted to make some changes to improve their health. Both agreed that increasing exercise was a good place to start.
But the client felt it was going to be a struggle to fit it into their busy schedule. They also lacked confidence to attend group sessions.
The client agreed for the GP to refer them to the local exercise referral scheme. After support workers linked to the GP got in contact, the client discussed the options available to them.
Here's how they looked at those options, breaking it down into the key elements of COM-B.
Capability - Client B was physically able to do the exercise sessions. So this wasn't a barrier to participation. Where the client lacked confidence, the support workers talked through the activity in a way the client could understand. This increased the skill and motivation to undertake it. Talking about a lack of confidence also meant they were able to identify the need for an activity buddy.
Opportunity - Walking and cycling were activities the client could do when and where they wanted. A search of organised and structured classes showed a variety that were close to home for the client. This again increased the likelihood of participation.
Motivation - Weekly weigh-ins and signs of progress enhanced Client B's motivation. They were further boosted by their activity buddy. The buddy supported them to attend classes and provided motivation to improve.
Self-reporting mechanisms were also included. For example, goal setting and an activity diary for them to keep. All these factors increased the likelihood of Client B undertaking the 'new' behaviour. With the support of the GP and others this helped towards a positive behaviour change.
After regular exercise for a period of 12 weeks the hard work started to pay off and the results showed. Client B reduced their BMI to 24 and their blood pressure moved in the right direction too.
Client B has agreed that this is a lifestyle change. It's not only had a positive effect on their body but their mind and wellbeing.
Smoking
Client C visited their local pharmacy for stop smoking advice. This followed a conversation with their housing officer about stopping smoking.
Client C was in financial hardship. They felt cigarettes were a contributing factor as one of their key expenditures. Also, following a stop-smoking campaign, they felt the need to improve their health and quit. This was due to a new grandchild - they wanted to reduce the risk of second-hand smoke within the family.
The pharmacy which Client C attended offered 1-to-1 smoking cessation support. So they booked themselves in at the next convenient time. During the appointment they talked about addiction, cravings, and frequency of smoking.
It turned out Client C was smoking around 10 cigarettes a day. The advisor thought it would be best alongside the 1-to-1 support to put in place a smoking cessation aid.
In this case they thought a vape would be best. This would help with the hand to mouth habit and provide a safer level of nicotine to support a complete quit.
The local public health team ran an e-cigarette service. This was via a voucher scheme accessed through the pharmacy. The advisor provided Client C with the voucher and pointed them to the nearest participating vape shop.
Here is the journey explained in more detail via the components of COM-B.
Capability - To make the behaviour change Client C would need to know how to use a vape and how to access the vape shop. The shop wasn't far from a bus route accessible to them and the shop staff were able to show how to use the vape.
Opportunity - The vape shop voucher increased the opportunity of the behaviour change. This was because it didn't incur any costs and allowed the client to reduce the cost of tobacco.
Motivation - The advisor seen by Client C had training in behaviour change. Client C said their family and new grandchild motivated them to quit smoking. The advisor reminded Client C of this during each visit. This motivated them to continue with the new behaviour and stay quit.
Following many appointments over six months, Client C has stayed quit and now only uses a vape twice a day. They would like to reduce this in time and feel with the tools they have they'd be able to do this by themselves.
Suggestions from the advisor included writing a diary to show when they use the vape. This means in time they can replace this action with something else.
Alcohol
A GP referred Client D to the community social prescriber based at the surgery. This followed a chat about their health and wellbeing which raised concerns about alcohol intake.
Client D was drinking alcohol every evening, usually in a bid to relax and wind down. It became clear that this was becoming an unhealthy habit, which could in time cause serious ill health.
The social prescriber gave clients a space to explore and discuss potential scope to changing behaviour. During a session the social prescriber asked Client D to complete an alcohol diary. This included information on type of drink and quantity.
It showed Client D was consuming 1 to 2 medium glasses of wine, amounting to roughly 2-5 units per day. This also worked out as about 200-300 calories in one session. Over the course of the week, based on 2 glasses a night, it came to 31.9 units of alcohol across the week. The recommended maximum is 14.
At this point Client D knew they needed to act. The social prescriber advised Client D to start by having two alcohol-free days a week. This was to allow the liver to restore and recover from the alcohol.
Client D needed to put some tools in place to reduce the chances of consuming alcohol on those days. Here's how the journey progressed using the key elements of COM-B.
Capability - Client D was now aware of the dangers of drinking every day. So they recognised the need for change and had the knowledge to do so. This was through not buying as many bottles on the food shop and buying alternatives instead.
Opportunity - Client D's wife agreed to also have two alcohol free days a week. This made it easier to put in place and provide support in the home environment. They also bought some alternative drinks including flavoured waters and fruit teas. They could drink these at the time they would usually grab the bottle of wine.
Motivation - Both Client D and the social prescriber felt they should agree the 'set' alcohol-free days. This would increase the likelihood of sticking to them. Client D found setting reminders on their phone on the two days kept them motivated. There was also less chance of forgetting and consuming alcohol on those days.
Reflecting on their behaviour and being aware of the possible dangers and effects motivated Client D to make the changes. Client D attended four sessions with the social prescriber. Within this small time they made some significant changes to their diet and health by reducing their alcohol intake.
Over time Client D wants to move to three, then four alcohol-free days a week. They recognise the benefits of this long-term change.