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Table 1 Frequency of quotes (intensity) and participants referring to each domain (count) classified according to COM-B and TDF

From: Identifying barriers to the educational role of midwives in Cyprus and defining determinants in behaviour terms using the Behaviour Change Wheel: a mixed-method formative study

Theoretical Domain Framework

COM-B

Participants

Count

Intensity

Characteristic quote

1

2

3

4

5

6

7

8

9

10

11

(1) Skills (physical)

Physical Capability

           

0

0

 

Skills (cognitive & interpersonal)

Psychological Capability

 

   

7

9

“The skills needed by a midwife who works in the maternity ward, and operates within routine practice, are different from the ones needed by a midwife working with pregnant women [re: antenatal clinic]”

(2) Knowledge

 

   

"I noticed that each midwife offers different ‘knowledge' [re: information], resulting in confusion and misinformation. This is done either….or … or due to actual lack of knowledge

(3) Memory, attention & decision process

   

   

  

3

3

"…small number of midwives … As a result, a midwife is often unable to devote as much time as needed to a pregnant woman”

(4) Behavioural regulation

  

    

   

2

2

"Factors which can facilitate the educational role of the midwife are…., (2) planning of midwifery care, (3) cooperation with other health professionals, (4)…."

(5) Environmental context & Resources

Physical Opportunity

 

10

18

“Personal contact presupposes … a suitable space with a desk and a computer, comfortable chairs, beautiful, friendly environment…”,

“…available, accessible and good-quality educational material and services… there is insufficient resources…"

(6) Social influences

Social Opportunity

 

 

   

6

9

"…the medicalization of the birth but also the mentality of many Cypriots who always seek the opinion of the doctor"

(7) Social or Professional Role & Identity

Reflective Motivation

  

    

 

4

8

“A midwife has a duty to provide equal care to all without discrimination…”

“…midwives work with significant limitations in terms of their autonomy

(8) Beliefs about Capabilities

  

   

    

2

3

“The midwife has accepted this way of working, to monitor the pregnant women only at the time of childbirth… as a result she does not train more, does not specialize, does not take initiative and does not assume her educational role beyond the moment of childbirth and for breastfeeding support”

(9) Beliefs about Consequences

 

  

   

5

6

"[A midwife] has an important role to play with regard to counselling and education, not only for the women but also for the whole family, as well as for the community. Her work includes prenatal education and preparation for parenting but can be extended to women's health, sexual and reproductive health, and pediatric care”

(10) Optimism

      

  

3

3

“Today's midwives must have the courage [to dare] to showcase their abilities in order to promote their autonomy as midwives.”

(11) Intentions

      

 

  

2

2

“…indifference on the part of midwives”

“…it depends on the personal will, desire and time each midwife has”

(12) Goals

       

 

3

3

"… the most important [facilitating] factor is to have or be able to build a relationship based on trust between the pregnant woman and the midwife"

(13) Reinforcement

Automatic Motivation

  

 

  

6

7

“…there isn’t any common code of practice or guidelines, which if existed the problem would be resolved.”

(14) Emotion

        

3

5

“…increases the job satisfaction and enhances professional autonomy and responsibility in the workplace”