From Insight to Action: Using the COM-B Model to Explore Behaviour Determinants in Pre-Diabetes Programs

Background: The global burden of diabetes is increasing, necessitating improved surveillance and prevention efforts. Evidence supports identifying high-risk individuals and implementing intervention programmes. Until recently, Wales lacked a nationwide, standardised support programme for individuals with pre-diabetes. Clinical data from a Welsh diabetes prevention pilot program, implemented in 2022, suggested that there was a decrease in average blood glucose levels (HbA1c) at 12-month follow-up appointments however there is limited qualitative evidence on experiences of patients identified with pre-diabetes. The aim of our study was to undertake a formative evaluation, exploring the views of adults enrolled in the two prevention programmes currently being run within one Welsh health board. Methods: This qualitative study, informed by the Capability, Opportunity, Motivation and Behaviour (COM-B) model, evaluated the experiences of participants who accessed the diabetes prevention programmes in CTM UHB. Different dimensions of experience including access to service, interactions with HCSWs and behaviour change were explored and mapped against their capability, opportunity, motivation and behaviour change. Service users were invited to take part in a focus group or one to one online or telephone interviews. There were 11 individual interviews and five focus group interviews with a total of 28 participants, from January to March 2024. Thematic analysis was used to analyse the data. The key findings, were mapped around the COM-B model. Results: The evaluation identified various factors influencing programme engagement and lifestyle changes. Psychological and physical capabilities, social and physical opportunities, and automatic and reflective motivation all played roles. Key elements included prior knowledge, supportive staff, health checks, personalised guidance, risk awareness, and personal responsibility. The findings revealed a complex interplay of factors affecting participant engagement and behaviour change. Conclusions: Based on our findings, we summarised a set of recommendations that might improve the current services being offered within the Welsh Diabetes Prevention Pilot Programmes, such as increased flexibility in delivery (out-of-hours), and availability (resources to be made available online out of hours), more frequent contact (e.g. monthly for the first 6 months), and regular health checks (e.g. HbA1c every 6 months), could improve initial uptake and sustained engagement in the programmes.