Table 4 Themes within the COM-B model

Psychological Capability

Knowledge gaps

Knowledge of OA disease processes and progression

Knowledge or psychological skills to engage in the necessary mental processes

Adequate knowledge about making diagnosis without imaging

Knowledge of effective exercise and weight loss treatments

Skills to facilitate lifestyle change

Communication skills

Facilitation of behaviour change

Confidence to effectively manage OA

Making the diagnosis without x-ray

Delivering lifestyle interventions

Physical Opportunity

System-related factors

Time availability

Opportunity afforded by the environment

Access to other services for exercise and weight management advice (including cost and ease of referral)

Clinic software

Lifestyle treatments recommended for all chronic disease patients

Patient resources

Ease of access

Social Opportunity

Influences from patients demands and expectations

Opportunity afforded by interpersonal influences, social and cultural norms that impact the way we think about things

Reflective Motivation

GP’s perceived role

Paternalistic role

Reflective processes involving self-conscious intentions, beliefs regarding good and bad, self-talk

Use patient-centred approaches

Assumptions about people with knee OA

Diagnosis of OA may foster fear avoidance behaviours

Patient motivation to adopt lifestyle change

Automatic Motivation

Optimism

Effectiveness of non-drug conservative treatment options

Automatic processes involving emotion, desires, impulses

Habit

Unease discussing weight