Capability, opportunity, and motivation model for behavior change in people with asthma: protocol for a cross-sectional study

Alice Munns, Laura Wiffen, Thomas Brown, Alessandra Fasulo, Milan Chauhan, Leon D'cruz, Daphne Kaklamanou, Anoop j Chauhan

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Background: Asthma is a common lung condition that cannot be cured, but it can usually be effectively managed using available treatments. Despite this, it is widely acknowledged that 70% of patients do not adhere to their asthma treatment. Personalizing treatment by providing the most appropriate interventions based on the patient’s psychological or behavioral needs produces successful behavior change. However, health care providers have limited available resources to deliver a patient-centered approach for their psychological or behavioral needs, resulting in a current one-size-fits-all strategy due to the nonfeasible nature of existing surveys. The solution would be to provide health care professionals with a clinically feasible questionnaire that identifies the patient’s personal psychological and behavioral factors related to adherence.

Objective: We aim to apply the capability, opportunity, and motivation model of behavior change (COM-B) questionnaire to detect a patient’s perceived psychological and behavioral barriers to adherence. Additionally, we aim to explore the key psychological and behavioral barriers indicated by the COM-B questionnaire and adherence to treatment in patients with confirmed asthma with heterogeneous severity. Exploratory objectives will include a focus on the associations between the COM-B questionnaire responses and asthma phenotype, including clinical, biological, psychosocial, and behavioral components.

Methods: In a single visit, participants visiting Portsmouth Hospital’s asthma clinic with a diagnosis of asthma will be asked to complete a 20-minute questionnaire on an iPad about their psychological and behavioral barriers following the theoretical domains framework and capability, opportunity, and motivation model. Participants’ data are routinely collected, including demographics, asthma characteristics, asthma control, asthma quality of life, and medication regime, which will be recorded on an electronic data capture form.

Results: The study is already underway, and it is anticipated that the results will be available by early 2023.

Conclusions: The COM-B asthma study will investigate an easily accessible theory-based tool (a questionnaire) for identifying psychological and behavioral barriers in patients with asthma who are not adhering to their treatment. This will provide useful information on the behavioral barriers to asthma adherence and whether or not a questionnaire can be used to identify these needs. The highlighted barriers will improve health care professionals’ knowledge of this important subject, and participants will benefit from the study by removing their barriers. Overall, this will enable health care professionals to use effective individualized interventions to support improved medication adherence while also recognizing and meeting the psychological needs of patients with asthma.

Trial Registration: NCT05643924;

International Registered Report Identifier (IRRID): DERR1-10.2196/44710
Original languageEnglish
Article numbere44710
Number of pages10
JournalJMIR Research Protocols
Publication statusPublished - 23 Jul 2023


  • adherence
  • asthma
  • behavioral barriers
  • psychological barriers
  • capability, opportunity, and motivation model of behavior change
  • COM-B
  • medication
  • theoretical domains framework
  • UKRI
  • ESRC
  • ES/P000673/1

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