Applicability of the TDF and COM-B in understanding barriers and facilitators to the implementation of infection prevention and control guidelines during COVID-19

<b>Objective:</b> To identify and compare the barriers and facilitators to the implementation of infection prevention and control (IPC) guidelines among nurses in Nepal and Scotland during the COVID-19 pandemic. <br/><br/><b>Design:</b> This study employed a generic qualitative research design combined with a case-oriented, cross national comparative approach. The Capability, Opportunity, and Motivation (COM-B) model, along with the Theoretical Domains Framework (TDF), were adopted as the theoretical frameworks.<br/><br/><b>Methods:</b> Online interviews were conducted with 22 registered nurses, 12 from Nepal and 10 from Scotland. The interviews were carried out in participants’ native languages (English and Nepali), with those conducted in Nepali translated into English. Data were inductively analysed using Reflexive Thematic Analysis, and NVivo 20 software was used for data management and coding.<br/><br/><b>Results:</b> This study identified five key themes from Nepal and four from Scotland, which were deductively mapped to the TDF and then linked to the COM-B model. The Nepal data identified factors corresponding to 11 of the 14 TDF domains as barriers or facilitators to the implementation of IPC guidelines, while the Scottish data identified factors corresponding to 10 of the 14 domains. <br/>Additionally, all components of the COM-B model, Capability (psychological), Opportunity (physical and social), and Motivation (reflective and automatic) were found to influence the implementation of IPC guidelines among nurses in both Nepal and Scotland.<br/><br/><b>Conclusions:</b> This study provides a theoretical understanding of how behavioural, organisational, and environmental factors influenced the capability, opportunity, and motivation of nurses in Nepal and Scotland to implement IPC guidelines and the findings offer a foundation for future IPC interventions<br/><br/><br/>