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Table 1 Summary of COM-B Themes classified as Mechanisms, Enablers and Barriers for Children

From: Identifying mechanisms of change in a magic-themed hand-arm bimanual intensive therapy programme for children with unilateral spastic cerebral palsy: a qualitative study using behaviour change theory

COM-B component Identified Theme Mechanism/
(n transcripts)
Interviewees (Parents/Child, n) Described as important
Sample Quote
Physical Capability Breathe Magic enables children to independently perform physical day-to-day tasks Mechanism 25 Child (15)
Parents (10)
No Six months ago, I couldn’t tie a shoelace, now I can. Six months ago, I couldn’t even flap my hand. Now I can. (Child)
  Breathe Magic improves function in children’s affected hand Mechanism 12 Child (7)
Parents (5)
No I can do pinch and I can move my hand more, and I’ve got this exercise I do. And then hold it for 30 s. (Child)
  Participating in Breathe Magic can be exhausting for children and parents Barrier 2 Parent (2) No We would get some challenges sometimes and she would be fatigued and I was exhausted. (Parents)
Psychological Capability Breathe Magic develops children’s independence Mechanism 1 Parents (1) No He′s calmer in himself and will just sit there, maybe not ask for help. (Parents)
  Breathe Magic makes children to become capable of regulating emotion Mechanism 1 Child (1) No I just used to go up to my bedroom sometimes every once in a while and just cry. I sometimes do that now, but I know how to get it better and stuff. Yeah. (Child)
Physical Opportunity Weekend session is not favoured by children Barrier 1 Child (1) No The thing I don’t like, it’s on a Saturday, it’s when I do my football. (Child)
  Breath Magic has two weeks back-to-back intense practice Enabler 1 Parents (1) No and the fact that it is two weeks back-to-back, that works because it’s just so intense, it’s all about the two handed and I know you won’t (Parents)
Social Opportunity Breathe Magic creates opportunity to form new friendships Mechanism 17 Child (15)
Parents (2)
No I’ve made a lot of new friends and loads of friends and stuff. And I get to socialise a lot, because at school I don’t really socialise. I’m a bit shy. (Child)
  The Breathe magic team, magicians and mentors provide good learning environment Mechanism 6 Child (1)
Parents (5)
No I like the teachers, the magic trainers. Especially Ed. … … … ..They give you enough time to do the trick, and if you get stuck they can help you. (Child)
  Breathe Magic creates a team spirit for children Mechanism 4 Parents (4) Yes It was about a bunch of kids coming together for magic tricks … because they were, like you said, they were all in the same boat. (Parents)
  Social environment makes children feel that they are not alone Mechanism 4 Child (2)
Parents (2)
No It gives them that little boost that I’m not on my own, I′ not the only person who’s got hemi.”. That helped them to see that socially, it’s kind of like you’re not alone. (Parents)
  Breathe Magic provides environment where children help each other Mechanism 1 Child
No Q. What was the favourite thing about the camp. Ans. I like how people help people at different difficult times. Say if someone was stuck on something, some people might help them. (Child)
  Breathe Magic creates opportunity to see old friends Enabler 1 Child (1) No Favourite thing about the camp - Ans. Probably seeing old friends again. (Child)
  Breath Magic improves integration with other children in mainstream schooling Mechanism 2 Parents (2) No So she is, now, entirely immersed in mainstream education, whereas since nursery, she’s had an education plan and we’ve had to go in and targets and all that sort of stuff but she’s completely
  The holistic experience of Breathe Magic provides an engaging environment Mechanism 3 Child (1) Parents (2) Yes And in terms of the best thing about the camp, I genuinely can’t think of anything that you could do to improve it. It’s the total sum of the different things, it’s the activities, it’s the people, it’s the environment, it’s everything (Parents)
Reflective Motivation Breathe Magic increases children’s self-confidence Mechanism 18 Child (2)
No The confidence for Alex from the first day 10 days later is just through the roof (Parents)
  Breathe Magic makes children determined Mechanism 13 Child (8)
Parents (5)
No That I can at least come away thinking it’s not like a terrible, terrible thing. You know I can try and I can try. I might not get it, but I can still give it a go. (Child)
  Breathe Magic increases children’s self-motivation Mechanism 7 Parents (7) No she kind of became really confident and motivated with that side of it as well, which is good. (Parents)
  Breathe Magic increases children’s self-esteem Mechanism 5 Child (1)
Parents (4)
Yes the best thing to come out of the camp is Erin’s self-esteem. (Parents)
  Children who participated in Breathe Magic would recommend participating the intervention to others Enabler 4 Child (4) No Q. What would you say to somebody who was thinking about coming on this camp, someone else with USCP? Ans. Yes I would probably say something nice like just about coming in to the camp. (Child)
  Breathe Magic enables children to feel comfortable talking about their condition with others Mechanism 3 Parents (3) Yes One of the ground-breaking things for her was that she was the confident to tell people about her USCP (Parents)
  Breathe Magic increases children’s willingness to try new things Mechanism 2 Parents (2) No he was much more willing to give everything a go. (Paremts)
  Breathe Magic increase children’s self-awareness that they need to improve Mechanism 2 Parents (2) No this is the self awareness that he should try (Parents)
  Breathe Magic increases child agency Mechanism 1 Parents (1) No Q. it sounds like a lot of you have found that it was more self driven during those two weeks? Ans. Yes” (Child)
  Breathe Magic makes children to become optimistic about the future Mechanism 1 Parents (1) No And then start looking negatively at herself and not wanting to be here, it’s quite hard for us because it’s been a very, very positive thing up until now … ..she, up to a few weeks ago, looked to the future with great optimism (Parents)
Automatic Motivation Breathe Magic reinforces children’s positive feeling about themselves Enabler 10 Child (9)
Parents (1)
No They (Magic Camp) won’t do stuff for you. You have to do it all by yourself. Because they push you to feel good about yourself. (Child)
  Magic is a fun skill for children to learn Mechanism 8 Child (7) Parents (1) No I guess just … This might seem a bit obvious, but just learning the magic and just practise it, practising, and trying and just learning new tricks. I like it all really. It’s a nice feeling just doing magic and, yeah, and just have magic, yes. (Child)
  Breathe Magic makes children to feel proud of their achievement Mechanism 6 Children (5) Parents (1) Yes Proud, to be honest. Like it was a sense of ... but at the same time it was kind of like, “Oh I can do this now.” It was kind of surreal because I was just like slowly progressing and I was watching myself do it (Child)
  Breathe Magic makes children become less frustrated Mechanism 4 Parents (4) No The frustration was reduced. (Parents)
  Breathe Magic is not seen as therapy but fun practice to learn Magic Mechanism 2 Parent (2) Yes that’s the important thing, isn’t it, that it’s therapy without being therapy (Parents)
  Breathe Magic makes children feel more independent Mechanism 1 Child (1) No It makes me feel more independent. (Child)
  Breathe Magic helps children discontinue self-punishing behaviours Mechanism 1 Child (1) No Alex had some quite negative physical behaviours towards himself because of how he felt before the camp. He′d sort of bite himself, hit himself, call himself ridiculous, directly because of the USCP and what he couldn’t do at any given time and I haven’t actually seen any of that, which is marvellous (Parents)
  Breathe Magic makes children feel helpful Mechanism 1 Child (1) No It’s good to be able to feel like I can help in some way I guess. (Child)