Box 1.

Factors affecting practitioners’ work to support older people to make healthier decisions in their alcohol use identified in participant narratives and described in reported themes; categorised into COM-B components27

COM-B componentFactors, including theme where issue is described
Physical capability (the physical strength, skills, and stamina to perform the behaviour)n/a
Psychological capability (the knowledge and psychological skills, strength, and stamina to perform the behaviour)Knowledge of general health recommendations, risks, and guidelines for alcohol use (Theme 3)
Awareness of prevalence of hazardous alcohol use among older population (Theme 1)
Knowledge of specific risks of drinking in old age (Theme 3)
Knowledge of potential positive contributions of alcohol use to older people’s wellbeing (Theme 1)
Interpersonal skills to raise potentially sensitive topic of alcohol with older people, and ask about intake (Themes 1 & 3)
Intervention skills to give older people advice about their alcohol use, and motivate healthier decisions (Theme 3)
Physical opportunity (what the environment allows or facilitates in terms of time, triggers, resources, locations, and physical barriers, for example)(Dedicated) time to raise the topic of alcohol use (Themes 2 & 3)
Available alcohol use risk screening resources (Theme 2)
Reminders, cues, and awareness campaigns to raise alcohol use with older people (Theme 2)
Clear signposting options for additional support with alcohol (Theme 2)
Social opportunity (a social environment conducive for the behaviour to occur, that is, socially acceptable; encompassing interpersonal influences, social cues, and cultural norms)Perceived sensitivities associated with discussing alcohol use, where ‘problematic’ use is stigmatised, but use is a cultural norm and viewed to be the older person’s prerogative (Theme 1)
Rapport with patients increases acceptance of alcohol-related discussion (Theme 1)
Alcohol-related discussion as a clear component of standard care increases acceptability of alcohol-related discussion (Theme 2)
Links between alcohol use and care concerns (Theme 2)
Reflective motivation (self-conscious planning and evaluations to perform the behaviour; evaluations about the behaviour, that is, beliefs about what is good or bad)Perception of specific professional roles for addressing older people’s alcohol use — where alcohol use was prioritised above other care tasks (Theme 3)
Belief in capability to discuss alcohol use with older people, and provide intervention where appropriate (Theme 3)
Expectations about older people’s receptivity to discussion and intervention (Theme 1)
Automatic motivation (processes such as wants and needs, desires, impulses, and reflex responses)Empathy for the older person’s motivations to use alcohol, for example, loneliness and coping with stresses (Theme 1)
  • n/a = not applicable. Theme 1 = Perceptions about how receptive older people are to alcohol-related intervention. Theme 2 = Processes and practicalities of addressing alcohol use. Theme 3 = Professional remit and addressing older people’s alcohol use.