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Table 3 Themes and sub-themes mapped to the Theoretical Domains Framework. Solutions to address barriers to the implementation of GWG guidelines are mapped to the COM-B system for behaviour change (COM-B = Capability, Opportunity, Motivation - Behaviour)

From: ‘Weighty issues’ in GP-led antenatal care: a qualitative study

Themes and sub-themes Barrier ✗ Enabler TDF domain Possible solution
THEME 1: Despite low awareness of guidelines, GWG advice is provided
Sub-theme: Knowledge of guidelines is low
Sub-theme: Providing advice, but only to those who need it most
   Knowledge Capability:
Clear GWG guidelines
Effective dissemination of guidelines
Despite low awareness of GWG guidelines, GPs provide many women with advice and support regarding weight management in pregnancy.  
THEME 2: ‘I should do this more’    Social/professional role and identity
Beliefs about capabilities/ consequences
 
General Practitioners considered it their professional role to support women with weight management in pregnancy.  
Providing GWG advice is often deprioritised in busy consultations.  
Many GPs said that they would prioritise the provision of advice about this important topic in the future.  
THEME 3: Lack of everyday resources
Sub-theme: Lack of time
Sub-theme: Lack of resources
Sub-theme: Lack of clear guidance
   Skills
Environmental context and resources
Behavioural regulation
Capability:
Clear guidelines
Additional training
Opportunity:
Access to multidisciplinary team and/or practice nurses
Barriers to GPs providing women with weight management advice are national health policy and funding-based.  
THEME 4: Working ‘against the odds’ at times
Sub-theme: Meeting women where they are at
Sub-theme: Social environment
   Social influences
Reinforcement
Motivation:
Public health messages that promote the importance of weight management for pregnancy
Women’s motivation and perceptions of weight management in pregnancy, and the broader social environment can be barriers and/or enablers for the implementation of GWG guidelines.
THEME 5: Optimism and reality    Optimism
Environmental context and resources
Motivation:
Affirmation in role
General Practitioners generally believe that primary care is an ideal setting to provide GWG advice and that women respond well to the advice they receive.     
On the other hand, women’s capacity to put the advice they receive into practice is challenged by the broader physical and social environment.