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Table 2 Identified facilitators and barriers and possible interventions informed by the literature, COM-B [17] and TDF [18]

From: Facilitators and barriers for harm reduction after first use of novel nicotine delivery devices: a qualitative investigation of cigarette smokers

COM-B sub-components   Facilitators and barriers identified TDF Intervention function Possible intervention
1. Psychological capability a* Health knowledge confusion over harm-reduction and need to have factual evidence that NNDDs are safer than cigarettes Knowledge and beliefs about consequences Increase availability of knowledge of comparative health implications ‘Try before you buy’ outlet with face to face trained staff
Disseminate evidence of harm reduction Explanatory email/leaflet/library/TV advert on harm reduction [27,28,29]
  b Satisfaction Emotion (positive affect) Trial to experience sensations Hygiene safe trial and report site [30]
   Good sensations similar to cigarette smoking    
2. Physical capability a* Cost Beliefs about capabilities Make current cost details available to enable goal planning Helpline—email link. A link with monthly updated information since prices are going downward [17, 31, 32]
  b* Availability/access Self confidence/self efficacy Easy access to reduce self-consciousness Universal retail outlet—High St. easy access; trained staff [25, 33, 34]
  c Duration Need provision to increase length of smoking time for the HTP
Include a limitation on E-cigs
Modification of design Longer tobacco sticks for HTP trial and time limiter on E-cigs [35]
3. Opportunity social a* Social acceptability Social influences (norms and conformity) To reinforce idea of being with the in crowd?? Modelling Self-experienced
Encouragement as self-perception improves—no bad smell. Others moving on to this form of NNDD Social/professional role and identity Progressing toward perceived desired identity Share experiences
Desired non-smoker identity [19, 36]
4. Opportunity physical a Convenience
Possibility of short period using an NNDD for a specific number of puffs (E-cigs)
Environmental context and resources Modelling convenience use—short burst of NNDD nearby as allowed. Disgruntled cigarette smoker returning from a lesser further away place Separate NNDD users from cigarette smokers and have some nicer place for NNDD users [18, 37]
5. Motivation reflective a* Renewed optimism
Simply by coming into contact with the products. Learning of their existence
Goals and Intentions (implementation intention/intrinsic motivation) Facilitate experience
Hear about others’ experience
More information points for guidance for cigarette smokers to trial such products [21]
6. Motivation automatic a Intention to continue smoking cigarettes Beliefs about consequences Negative health consequence feedback Education and information sharing of health consequences
  Health derogation Absence of social influence to change behaviour New interest; social expansion—identity modelling Promotion of an interest combining social-interaction [38, 39]
  1. *Key themes