Table 3 Mapping quality of life and HF management to the COM-B framework
COM-B components | Theme | Illustrative quote |
|---|---|---|
Capability | ||
Physical (Skills, abilities acquired through practice) | Environment/competing demands for HF management | “I used to have one client in Beverly Hills who I would help clean their home once a week and I really like that they like me, I like them and I did a very nice, thorough obsessive–compulsive job of cleaning their place but I can’t do it any longer because there’s too much bending down.”—ptid51 |
Psychological (Knowledge, memory, attention, decision process, behavioral regulation) | Mental health barriers | “Nobody focus about what is a relation between my psychiatry and my illness, and I know my psychiatry caused the damage in me because I have a lot of sadness. A lot of psychiatry problem damaged my head, caused me—I feel the pain when I am sad more than when my diabetes is high or cholesterol is a high.”—ptid327 “If you’re not in tune with yourself mentally and you’re getting down upon yourself, there’s no way you’re going to stick to a medical regimen. Most of them (health care providers) do understand it but a lot of them haven’t tied the two in together yet, that there’s a physical aspect and there’s also a mental aspect to it.”—ptid350 “Anxiety is one thing also that has affected me. I mean, anxiety has a major impact on my life, but now since I have a heart failure, it’s even more.”—ptid395 |
Opportunity | ||
Physical (Environment context and resources) | Environment/competing demands for HF management | “I’m living in a place where it’s not secured. I’m seeing all this drug addiction around me and seeing all the stuff around me, and it—I stay in line, and it’s just—this is not like how I used to see it. This is getting really, really bad to where you go outside and all you see is feces on the ground. People don’t use the bathroom. People selling drugs. I mean, this is like an open market to do that you want to do now. Everybody who’s crazy is down there. It’s like for mental people with problems. Everybody down there got mental problems and they know where they’re putting them. They put them in this one area and anybody can come there. They come from all over the world. They come down to you, and you get down there and you can get stuff easy, and I’m trying my best because I was addict for about 30 years and I got like—going on 11 years now—clean and sober.”—ptid129 “Well, it’s San Francisco, you have three stories. Here is a one flat in Oakland but they built everything upwards instead of outwards, so yes, it limits me because walking up and down the flights of stairs. Whoever designed my home is an idiot because there’s no rest room on the first floor, so you have to go to the second and third to use the bathroom. Yes, doing household chores, we’re going to go with severely limited because the kitchen is also on the second. Whoever designed that was a complete buffoon, so I’m just going to leave it at that. You put the dining room and the kitchen on the second floor, you put a living room and a family room on the first and you put all the bedrooms upstairs. I didn’t design it but I’m just leaving it at that. [Laughter] It limits me because I have a hard time walking up and down the stairs. It limits me from being in certain parts of the house. ”—ptid350 “And ever since the fires, I haven’t been able to exercise but I did take up walking and—and, you know, very [Unintelligible] jogging like power walking, really fast walking but I haven’t been able to exercise since the fires.”—ptid264 |
Social (Influences such as social pressure, norms, conformity and social comparisons) | Social support | “There are friends that’ll hear me out and give me their opinion about things. I’m glad I have networks of people that I can basically talk to. You need to talk somebody about it.”—ptid375 “I can't do any house work, so I have someone to come to do that for me.”—ptid190 “My girlfriend, she helps me with like managing my salt and my food because I’m a salt person.”—ptid133 “I’m now able to do like one-tenth of what I was able to do before, so the other nine-tenths, I’ve had to create, delegate, reassign all the those things that I used to do, and then the same goes for me in that I now have someone that comes in to help me to do those—that nine-tenth that I can’t do, and then the visiting family and friends, that’s pretty much gone out the window coupled by the COVID quarantine.”—ptid400 |
Motivation | ||
Automatic (Emotions, reinforcement, such as rewards, incentives and punishment) | Environment/competing demands for HF management | “See, my dad had died from mesothelioma in 2011. He worked in a shipyard and I worked in the shipyard also about 12 years, and I used to work around all that stuff, the asbestos and stuff. I’m scared I might have some of that, not from my dad, but I worked in the same spots he did, and that kind of scared me because I know few people that I grew up with that worked with me, they’re dead now. And my dad died and all his friends died, and they all worked together.”—ptid129 “You know what, I—one thing that I—it really hurts me a lot, but it’s like I’m unable to work as before. It really affects me. That’s one main thing that I—I’m like, “Wow, that’s”—not being able to be the same person like before, like……able to work.”—ptid395 “Because I’m very involved with various community organizations. I provide consultancies to everything from Mission Language and Vocational School to the economic development and social services, mental health and everybody else that I’ve been involved with for several years now. So, I’ve had to curtail all of that. So, my answer in number one, extremely limited my enjoyment of life, yes, because I can no longer participate the way that I used to.” ptid400 “I’m a carpenter by trade. I can’t even do that a little bit now.”—ptid45 |
Mental health: barriers | “It’s important for health care providers to understand that the physical toll is very great and lays heavy on a person, but as the emotional part of it is even harder to deal with.”—ptid107 “Emotionally, [heart disease] can—not all the time, but there are days when [heart disease] makes me depressed and scared, pensive, worried, anxious, afraid, angry.”—ptid107 | |
Reflective (Beliefs about capabilities and consequences, roles, identity, intentions, goals, and optimism) | Mental health: resiliency | “Having just a doctor look you in your eye and telling you, “You have heart disease,” is very—excuse my word, disheartening. It’s hard. It’s very hard. I could see how some can throw in the white flag, but for me it motivated me to keep my head even higher.”—ptid375 “And now, you know, I’m—before, it was really hard for me to accept it that I’m having a heart failure and I was like, ‘Wow, I never thought this could happen to me.’ So, now those questions, it’s like now I look forward because I do try to answer, and I do—it doesn’t bother no more, but at first it would bother me because I didn’t wanna believe that I have a heart problem. I didn’t want to, you know, talk about it because it really bothered me. Like, I didn’t—now it doesn’t bother me at all. Now I won’t say I’m happy with this thing, but I’m learning to deal with this thing and then be more comfortable about it because before, it just put me more in the bag, more worries and things, now I’m learning day by day about my illness. I think I—I feel it’s something that I really like, especially with—talk—I talk with my doctors about it that I’m doing my best. I’m doing my best because it’s really had a major impact in my life and it’s—I have to continue. You know, I don’t want to—I wanna live. I wanna live. I know it’s not gonna be a normal life, a regular life, but I—I still…I’m trying as hard as I can to be…”—ptid395 “They don’t impact my life anymore. I’ve learned to let it go. Yes, I had a bout with depression when I first got diagnosed with this disease, but we don’t live like that anymore. I’ve learned to just let things just go into one ear and out the other, and not dwell on them, because if you sit there and you dwell on it it’s going to impact your heart way more than worrying about a little small, minute problem.”—ptid350 “I got my whole family—I haven’t seen nobody in my family in 3 years. My daughter don’t to speak to me. I’m all alone. So, this strength—the things I went through really taught me how to just be grateful and just pray on. But the Lord knows my heart, what I’m going through, and He’s been blessing me every day. So many good things happening to me now, and I’m just grateful that I turned my life around, and it just strengthened me, got me feeling better about myself.”—ptid129 “I had a change of lifestyle and I try to think differently and act differently too and try to push through whatever I think tries to limit me.”—ptid264 |