Barriers and facilitators to patient-to-provider messaging using the COM-B model and theoretical domains framework: a rapid umbrella review
Bibliographic record
Abstract
Abstract Background Virtual patient-to-provider messaging systems such as text messaging have the potential to improve healthcare access; however, little research has used theory to understand the barriers and facilitators impacting uptake of these systems by patients and healthcare providers. This review uses the Capability-Opportunity-Motivation-Behaviour (COM-B) model and the Theoretical Domains Framework (TDF) to explore barriers and facilitators of patient-to-provider messaging. Methods A rapid umbrella review method was followed. Medline and CINAHL were searched for review articles that examined patient-to-provider implementation barriers and facilitators by patients or healthcare providers. Two coders extracted implementation barriers and facilitators, and one coder mapped these barriers and facilitators on to the COM-B and TDF. Results Fifty-nine unique barriers and facilitators were extracted. Regarding healthcare provider oriented barriers and facilitators, the most frequently identified COM-B components included Reflective Motivation (identified in 42% of provider barriers and facilitators), Psychological Capability (19%) and Physical Opportunity (19%) and TDF domains included Beliefs about Consequences (identified in 28% of provider barriers and facilitators), Environmental Context and Resources (19%), and Social Influences (17%). Regarding patient oriented barriers and facilitators, the most frequently identified COM-B components included Reflective Motivation (identified in 55% of patient barriers and facilitators), Psychological Capability (16%), and Physical Opportunity (16%) and TDF domains included Beliefs about Consequences (identified in 30% of patient barriers and facilitators), Environmental Context and Resources (16%), and Beliefs about Capabilities (11%). Conclusions Both patients and healthcare providers experience barriers to implementing patient-to-provider messaging systems. By conducting a COM-B and TDF-based analysis of the implementation barriers and facilitators, this review highlights several theoretical domains for researchers, healthcare systems, and policy-makers to focus on when designing interventions that can effectively target these issues and enhance the impact and reach of virtual messaging systems in the future.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.002 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".