# Application of the behavior change wheel in supporting self-management among colorectal cancer survivors: A scoping review

## TL;DR

This review explores how the Behavior Change Wheel can support self-management in colorectal cancer survivors, highlighting its potential for improving care outcomes.

## Contribution

The study is the first to comprehensively map the application of the Behavior Change Wheel in colorectal cancer self-management.

## Key findings

- Ten studies applied the BCW framework to CRC self-management, targeting behaviors like screening and recovery.
- Education, Enablement, and Persuasion were commonly used intervention functions to improve self-care and motivation.
- Qualitative findings revealed contextual factors influencing CRC-related self-management behaviors.

## Abstract

Self-management is a cornerstone of colorectal cancer (CRC) care; however, many interventions lack explicit grounding in behavioral theory. The Behavior Change Wheel (BCW), underpinned by the Capability–Opportunity–Motivation Behavior (COM-B) model, provides a systematic framework for designing and evaluating behavior change interventions, yet its application in CRC self-management has not been comprehensively mapped. This scoping review aimed to synthesise the existing evidence on BCW-informed studies addressing CRC self-management and screening behaviors, and to identify implications for nursing practice and future research.

This scoping review was conducted in accordance with the Joanna Briggs Institute methodology and the PRISMA-ScR guideline. PubMed, Web of Science, Google Scholar, CNKI, and Wanfang were searched for studies published between April 2011 and April 2025 that applied the BCW framework (including COM-B) to CRC-related self-management or screening behaviors. Peer-reviewed articles and relevant grey literature were eligible. Study selection and data extraction were performed independently by two reviewers using a standardized form. Data were synthesised descriptively and thematically, with intervention components mapped to COM-B determinants and BCW intervention functions.

Ten studies met the inclusion criteria, comprising six intervention studies and four qualitative studies. These studies addressed behaviors across the CRC care continuum, including screening participation, perioperative self-care, postoperative recovery, and survivorship. Education, Enablement, and Persuasion were incorporated in all intervention studies (n = 6), often in combination with additional BCW functions and targeting multiple COM-B components, particularly psychological capability and reflective motivation. Qualitative findings further elucidated contextual barriers and facilitators influencing CRC-related self-management and screening behaviors. Reported outcomes included improvements in self-care ability, self-efficacy, adherence, symptom management, emotional adjustment, and screening participation.

BCW-informed approaches show potential for strengthening key behavioral determinants and supporting patient-centered outcomes across the CRC care continuum. Integrating explicit behavioral theory into nursing interventions may enhance their conceptual rigor, transparency, and effectiveness. Further robust, theory-driven studies are warranted to refine the application of the BCW and to evaluate its impact across diverse populations and health care settings.