Table 1.

Barriers: relationship between survey statement, Theoretical Domains Framework domain, and COM-B source of behavior and intervention function.

Statement (barrier)
TDF domainDomain descriptionkConFab womenCliniciansCOM-B source of behaviorIntervention function
Social/professional role and identityA coherent set of behaviors and displayed personal qualities of an individual in a social or work settingNot applicableIt is not my role to discuss RRM
GoalsMental representations of outcomes or end states that an individual wants to achieveI have another medical condition that outweighs my BC concernsThere are other things I wish to achieve in most consultations that interfere with my ability to discuss RRMsEducation
Beliefs about capabilitiesAcceptance of the truth, reality, or validity about an ability, talent, or facility that a person can put to constructive useI have trouble remembering to take a daily tabletPatients don't ask me about RRMsReflective motivationPersuasion
I am not confident in providing advice/information to pts about RRMsIncentivization
I have inadequate training and confidence in BC risk assessmentCoercion
I have difficultly explaining to pts the pros and cons of RRMs
OptimismThe confidence that things will happen for the best or that desired goals will be attainedI'm too old to bother trying to prevent BCNot applicable
If cancer is going to happen it will happen, I do not believe you can change your own risk
I don't believe RRMs would reduce my risk of BC at all
I don't believe RRMs would reduce my risk of BC enough to make it worthwhile
Beliefs about consequencesAcceptance of the truth, reality, or validity about outcomes of a behavior in a given situationI am concerned about drug interactionsThere is no evidence that they reduce mortality
I am worried my family/friends would assume I have been diagnosed with BC or may ask questions about our family historyMedication side effects
I wouldn't know whether RRMs were actually workingI don't believe they decrease the risk of BC
My risk of BC is not high enough to justify taking RRMsI'm concerned I might increase the patient's worry about BC
Possible side effects
I've seen family/friends experience side effects when taking medicines like this, so I am likely to experience the same
If cancer is going to happen it will happen, I do not believe you can change your own risk
I don't believe RRMs would reduce my risk of BC at all
I don't believe RRMs would reduce my risk of BC enough to make it worthwhile
IntentionsA conscious decision to perform a behavior or a resolve to act in a certain wayI prefer healthy lifestyle choices alone to medicationsI don't routinely assess BC risk with my pts
I don't believe in taking medicines for prevention, only for illness
RRMs are unnatural
ReinforcementIncreasing the probability of a response by arranging a dependent relationship, or contingency, between the response and a given stimulusNot applicableThere are no incentives/rewards for discussing RRMs with ptsPersuasion
EmotionA complex reaction pattern, involving experiential, behavioral, and physiologic elements, by which the individual attempts to deal with a personally significant matter or eventIt would be a reminder of family members or friends cancer experiencesI feel uncomfortable prescribing a “cancer drug” to healthy womenAutomatic motivationIncentivization
Taking a daily tablet for 5 years would be a daily reminder of my cancer riskI'm concerned I might increase the pt's worry about BCCoercion
Environmental restructuring
Memory, attention, and decision processesThe ability to retain information, focus selectively on aspects of the environment, and choose between two or more alternativesI would prefer to have both breasts removed rather than take the medicationI forget to discuss RRMs with pts
I would prefer BC screening (e.g., mammograms) alone, rather than screening and taking RRMsEducation
I have trouble remembering to take a daily tabletPsychological capabilityTraining
KnowledgeAn awareness of the existence of somethingI don't know what my BC risk isI have insufficient knowledge of RRMs
I don't know how much they cost
I think of these as medicines to treat BC, not prevent it
I don't have enough information about RRMs to make an informed decision
Behavioral regulationAnything aimed at managing or changing objectively observed or measured actionsMy doctor doesn't talk to me enough about RRMsThere are no procedures (e.g., a checklist that facilitates discussion) that encourage me to discuss RRMs
Environmental context and resourcesAny circumstance of a person's situation or environment that discourages or encourages the development of skills and abilities, independence, social competence, and adaptive behaviorI am already taking too many medicationsIt is difficult to measure whether the medication is workingPhysical opportunityRestriction
The inconvenience of taking a daily tabletI find it hard to access tools/resources to help me estimate patients BC riskEnvironmental restructuring
Taking them would mean I couldn't take the OCPI find it hard to access good information/resources for my pts, e.g., pt information sheetsEnablement
Taking them would mean I would have to delay becoming pregnantLack of time during consultations
Social influencesThose interpersonal processes that can cause individuals to change their thoughts, feelings, or behaviorsIf family/friends did not think taking RRM was a good ideaI don't think pts want to discuss taking medications for prevention of BCSocial opportunityRestriction
Environmental restructuring
SkillsAn ability or proficiency acquired through practiceNot applicableI have difficulty identifying pts suitable for RRMPhysical capabilityTraining Enablement
I have inadequate training and confidence in BC risk assessment
I have difficulty explaining to pts the pros and cons of RRMs
  • Abbreviations: BC, breast cancer; COM-B system, capability, opportunity and motivation behavior system; TDF, Theoretical Domains Framework; OCP, oral contraceptive pill; RRM, risk reducing medication.