Applying the COM-B Model to Identify Facilitators and Barriers to the Implementation of Primary Healthcare Initiatives in Ontario, Canada
: A Retrospective Analysis

  • Joanne Amanda Permaul

Student thesis: Doctoral Thesis


Initiatives in primary healthcare have been implemented to increase access to care, and to improve the quality of healthcare, health outcomes and health equity. Interventions that are designed to influence health behaviours may encourage individuals to make lifestyle or medical changes and may involve community-level health education and screening programmes, or national information campaigns.
The aim of this analytical commentary was to retrospectively apply the COM-B model and Behaviour Change Wheel to eight of my published studies, to examine the facilitators and barriers to the successful implementation of a prenatal screening programme, a new model of care, and educational interventions in genetics. The COM-B model was selected because of its applicability to most behaviour settings, and it provides a structured method for identifying facilitators and barriers to behaviour change.
A lack of knowledge, inaccessibility to services, lack of culturally appropriate patient education materials, providers’ personal beliefs, patients’ fears of screening procedures, and a lack of trust in their healthcare providers were found to be barriers. The development of innovative educational tools for patients and providers, providing after-hours and virtual care options, consulting with community members, investing in infrastructure, and building relationships with patients, could counterbalance these barriers to facilitate the implementation of new initiatives.
Future research should focus on designing and evaluating innovative health information resources and evidence-based point-of-care tools, creating a multifaceted approach to build trust in the physician-patient relationship, assessing the perceptions of new immigrants on healthcare in Canada, and strategies for consulting and collaborating with marginalised communities.
Date of Award19 Jan 2024
Original languageEnglish
SupervisorMiznah Al-Abbadey (Supervisor)

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