Understanding Primary Care Dietitians' Experiences and Perspectives on Weight Management Practice Using the COM-B...

Weight management is a core area of dietetic primary practice. Understanding the behavioural drivers that influence dietitians' weight management practice is essential for gaining insight into how to better support dietitians in this area. This study used the Capability, Opportunity, Motivation-Behaviour (COM-B) model, a behavioural framework, to explore how dietitians' practice is influenced by their skills and knowledge (capability), environmental factors (opportunity) and professional desires and habits (motivation).

This qualitative descriptive study used an interpretivist approach guided by social constructionism. Primary care dietitians practising in Australia were recruited through purposive and snowball sampling for semi-structured interviews. Interviews were audio-recorded, transcribed verbatim, and analysed using content analysis. Constructed content categories were then mapped to the COM-B model to understand the behavioural factors shaping dietitians' weight management practice.

Fourteen primary care dietitians participated in the study; 13 were women, 11 were aged between 20 and 50 years, and 8 had over 9 years dietetic practice experience. Eight content categories were constructed and mapped against the COM-B components. Aligned with Capability, dietitians demonstrated comprehensive 'Understanding [of] Weight Management Complexity' and employed 'Holistic Practice Approaches' in their care delivery, though they found 'Navigating Clients' Psychosocial Needs' challenging. Opportunity was shaped by 'System Constraints' that influenced care provision, 'Multidisciplinary Care Environment[s]' that had varied impacts on collaborative care delivery, and 'Digital Solutions' that offered service delivery advantages. Motivation was characterised by dietitians exhibiting strong 'Professional Drive' and commitment to 'Client-centred Strategies'.

Supporting primary care dietitians requires targeted interventions across all COM-B components. Potential approaches include enhancing capability through behaviour change counselling training, improving opportunity with integration of digital technologies, and sustaining motivation through established clinical pathways that align with dietitians' client-centred values.