This paper, titled “Facilitators and barriers of reducing sedentary behavior in sedentary and non-sedentary older adults: a descriptive qualitative study based on the COM-B model and TDF” by Siqing Chen, Kaijie Yang, Albert Ko, Edward Giovannucci, Matthew Stults-Kolehmainen, and Lili Yang, provides crucial insights into a significant public health challenge. Prolonged sedentary behavior is identified as a critical health risk for older adults, with global surveys indicating they spend an average of 9.4 hours per day sedentary, accounting for 65-80% of their waking hours. This high level of inactivity is closely linked to an increased risk of various chronic diseases, including obesity, diabetes, cardiovascular diseases, cancer, dementia, accelerated aging, and higher all-cause mortality. Despite the growing awareness of these health risks and the release of international guidelines, such as the “2020 WHO Guidelines on Physical Activity and Sedentary Behavior” and the Canadian 24-hour Movement Guidelines (recommending ≤8 hours/day sedentary time for older adults), many older adults face persistent challenges in reducing their sedentary time. The underlying reasons for these difficulties are complex, encompassing various capabilities, environmental opportunities, and intrinsic and extrinsic motivations. However, little is known about the distinct barriers and facilitators experienced specifically by older adults who are sedentary versus those who are non-sedentary, making this understanding essential for designing effective behavior change interventions.
The primary purpose of this study was to systematically identify and categorize these specific barriers and facilitators to reducing sedentary behavior among both sedentary and non-sedentary older adults. To achieve this, the researchers utilized two established theoretical frameworks: the Capability, Opportunity, Motivation-Behavior (COM-B) model and the Theoretical Domains Framework (TDF). The COM-B model posits that human behavior results from the interaction of capability (physical and psychological capacity), opportunity (environmental and social resources), and motivation (reflective and automatic drivers). Building upon this, the TDF translates these COM-B components into 14 practical domains, offering a systematic approach to identifying and addressing behavioral determinants. The application of these frameworks provides a comprehensive perspective for examining the possibilities of behavior change through in-depth interviews and analysis.
For the methodology, a descriptive qualitative study design was employed to gain in-depth insights. Data were collected through semi-structured, face-to-face in-depth interviews with older adults. These interviews were conducted in two community hospitals in Hangzhou, Zhejiang Province, China, between July and September 2024. Participants were recruited using a purposive sampling method, with inclusion criteria requiring them to be aged 60 or older, able to communicate effectively in Mandarin or local dialect, and capable of providing informed consent. Participants were categorized as sedentary (>8 hours/day sitting time) or non-sedentary (≤8 hours/day) based on self-reported sitting time, consistent with the Canadian 24-Hour Movement Guidelines. The interview guide was systematically developed based on the COM-B model and TDF, specifically targeting older adults’ psychological and physical capabilities, social and physical opportunities, and reflective and autonomous motivations related to sedentary behavior. Interviews lasted 15 to 30 minutes, and audio recordings were transcribed verbatim within 24 hours, continuing until data saturation was achieved. Data analysis involved inductive thematic analysis by three coders, who synthesized initial codes into lower-order themes, which were then systematically organized into ten higher-order themes by mapping them onto the COM-B model and TDF. Ethical approval was obtained from the Ethics Committee of Zhejiang University, and all participants provided written informed consent.
The study included 29 older adults, comprising 19 sedentary (65.5%) and 10 non-sedentary (34.5%) individuals. The thematic analysis identified ten higher-order themes, encompassing both barriers and facilitators:
- Lack of Knowledge (and Limited Knowledge)
- Lack of Methods (and Available Methods)
- Sedentary Triggers (and Interruptions)
- Lack of Management (and Self-management)
- Lack of Social Support (and Available Social Support)
- Lack of Environmental Support (and Available Environment Support)
- Perceptions and Conflicts (and Importance and Effort)
- Lack of Confidence (and Confidence)
- Limited Belief (and Understanding Health Benefits)
- Limited Motivation (and Sufficient Motivation)
The findings revealed notable differences between the sedentary and non-sedentary older adults across various dimensions of capability, opportunity, and motivation.
In terms of Capability:
- Psychological Capability (Knowledge): Sedentary older adults exhibited a significant lack of knowledge about what sedentary behavior entailed, often providing vague or incomplete explanations. In contrast, non-sedentary older adults demonstrated a generally better understanding, with some even identifying specific health risks like impacts on energy flow.
- Behavioral Regulation and Management: Sedentary older adults reported a lack of effective methods to interrupt sedentary behavior, relying primarily on hunger, urgent tasks, or physiological responses. They did not report using electronic prompts. Non-sedentary older adults, however, tended to interrupt sedentary behavior through spontaneous actions, daily walking routines, and the use of smart devices to prompt breaks and encourage movement. Sedentary older adults also regarded behavioral counseling for sedentary reduction as unnecessary or inaccessible, while non-sedentary older adults had mixed attitudes, some feeling self-reminders were sufficient.
- Memory, Attention, and Decision Processes: Prolonged sitting among sedentary older adults was primarily attributed to leisure activities like playing mahjong, watching television, or handicrafts, as well as work demands, ingrained habits, physical limitations, and aging. A significant barrier for them was the absence of structured reminders or external prompts. Non-sedentary older adults showed a more balanced approach, with leisure activities occasionally leading to sitting but typically for shorter periods, and some relying on phone reminders as effective aids.
Regarding Opportunity:
- Social Opportunity: Sedentary older adults often experienced limitations in social support, with some lacking clear encouragement or receiving only occasional reminders. Many reported no social interaction or support. Non-sedentary older adults, conversely, exhibited more positive characteristics regarding social support, frequently referencing explicit encouragement from family members or companions to avoid prolonged sitting or engage in social activities.
- Physical Opportunity (Environmental and Resource Factors): Sedentary older adults noted that work and environmental conditions made it challenging to interrupt sedentary behavior, such as work requiring prolonged sitting or home environments reinforcing sitting habits. Non-sedentary older adults demonstrated greater adaptability to external conditions, finding ways to interrupt sedentary behavior through daily tasks, household chores, or outdoor activities, and often leveraging retirement as an opportunity for physical activity.
Pertaining to Motivation:
- Reflective Motivation (Perceptions/Conflicts, Confidence, Belief in Consequences): Many sedentary older adults acknowledged the importance of reducing prolonged sitting for health but were unsure of its full impact and struggled to change due to ingrained habits. They often lacked confidence in their ability to reduce sedentary behavior. Non-sedentary older adults, however, showed higher levels of motivation and confidence, recognizing the importance of maintaining activity for overall health and citing specific benefits such as improved overall health and relief from constipation.
- Automatic Motivation (Optimism, Intention, Goals, Reinforcement, Emotions): Sedentary older adults generally lacked confidence in achieving positive outcomes from reducing sedentary behavior, and while most expressed willingness to change, a few preferred the comfort of prolonged sitting and lacked clear improvement plans. Non-sedentary older adults exhibited higher levels of confidence and optimism about the benefits, firmly believing changes could substantially improve physical health. They consistently expressed a strong willingness to adopt and maintain behavioral improvements with clearly defined goals, often driven by internal needs and reinforced by active habits.
The study emphasizes that these detailed insights are crucial for developing future tailored mobile health (mHealth) interventions. Recognizing that focusing on overcoming barriers is more beneficial for intervention effectiveness, the researchers propose integrating various Behavior Change Techniques (BCTs). For psychological capability, mHealth platforms can provide knowledge about health outcomes and strategies, implement prompts/cues, enable self-monitoring, and set behavioral goals. For physical capability, behavioral modeling and instruction on how to perform behaviors can be offered. To address social and physical opportunities, mHealth platforms can incorporate interactive social support features (e.g., sharing activity logs, exchanging encouraging messages), suggest group activities, and offer indoor exercise options for bad weather. To enhance reflective and automatic motivation, BCTs like commitment can be used, encouraging older adults to reaffirm their dedication. Positive reinforcement mechanisms, such as financial rewards or real-time feedback (e.g., step counts), and credible sources (e.g., healthcare professional videos) can also be employed. Furthermore, action planning and goal review features can assist users in scheduling and adjusting their efforts. The study also notes the potential for BCTs to reduce negative emotions related to autonomy-related motivation, especially for older adults with anxiety or depression.
The study concludes that, despite some limitations such as its focus on the Chinese context and lack of healthcare professional input, it is the first to systematically explore these barriers and facilitators using the COM-B model and TDF among both sedentary and non-sedentary older adults, offering comparative insights critical for tailoring interventions. The findings highlight the need for personalized and scientifically tailored mHealth intervention tools for older adults, focusing on their unique characteristics and specific sedentary activities, and evaluating their long-term effectiveness, sustainability, and scalability. By developing scientifically grounded and technology-driven interventions, it will be possible to provide systematic solutions for managing sedentary behavior in older adults.
Reference: Chen, S., Yang, K., Ko, A., Giovannucci, E., Stults-Kolehmainen, M., & Yang, L. (2025). Facilitators and barriers of reducing sedentary behavior in sedentary and non-sedentary older adults: a descriptive qualitative study based on the COM-B model and TDF. BMC Public Health, 25(2472). https://doi.org/10.1186/s12889-025-23613-3
