Barriers and facilitators to changing bowel care practices after spinal cord injury: a Theoretical Domains Framework approach

Abstract

Background Improvement to autonomic processes such as bladder, bowel and sexual function are prioritised by individuals with spinal cord injury (SCI). Bowel care is associated with high levels of dissatisfaction and decreased quality of life. Despite dissatisfaction, 71% of individuals have not changed their bowel care routine for at least 5 years, highlighting a disconnect between dissatisfaction with bowel care and changing routines to optimise bowel care. Objective Using an integrated knowledge translation approach, we aimed to explore the barriers and facilitators to making changes to bowel care in individuals with SCI. Methods Our approach was guided by the Behaviour Change Wheel and used the Theoretical Domains Framework (TDF). Semi-structured interviews were conducted with individuals with SCI (n = 13, mean age 48.6 ± 13.1 years) and transcribed verbatim (duration 31.9 ± 7.1 min). Barriers and facilitators were extracted, deductively coded using TDF domains and inductively analysed for themes within domains. Results Changing bowel care after SCI was heavily influenced by four TDF domains: environmental context and resources (workplace flexibility, opportunity or circumstance, and access to resources); beliefs about consequences; social influences (perceived support and peer mentorship); and knowledge (knowledge of physiological processes and bowel care options). All intervention functions and policy categories were considered viable intervention options, with human (61%) and digital (33%) platforms preferred. Conclusions Modifying bowel care is a multi-factorial behaviour. These findings will support the systematic development and implementation of future interventions to both enable individuals with SCI to change their bowel care and to facilitate the optimisation of bowel care approaches.

Perceived Barriers and Facilitators to a Healthy Diet among Cancer Survivors: A Qualitative Exploration Using the TDF and COM-B

“…The main limitation of this study, as with most qualitative research, is that the sample size is relatively small. However, it is in line with other COM-B [28,49] and dietary studies [50][51][52], and greater than several [53][54][55]. This study was mainly conducted with female breast cancer survivors; at the same time, this is reflective of many studies on cancer survivors.…”

A data extraction template for the behaviour change intervention ontology

“…BCIO annotations were identified in 14 papers; their details are shown in Table 1, with all 14 papers using the Mode of Delivery Ontology ( Encantado et al , 2022 ; Giroux et al , 2021 ; Jackson et al , 2022 ; Keller et al , 2023 ; Kenny et al , 2021 ; Lucci et al , 2022 ; McClatchey et al , 2024 ; McMahon et al , 2023 ; Osborne & Norris, 2022 ; Shwed et al , 2023 ; Silva et al , 2022 ; St Quinton et al , 2022 ; Umaefulam et al , 2023 ; Wuerstl et al , 2023 ), six papers using the Intervention Setting Ontology ( Jackson et al , 2022 ; McMahon et al , 2023 ; Osborne & Norris, 2022 ; Silva et al , 2022 ; Umaefulam et al , 2023 ; Wuerstl et al , 2023 ; and four papers using the Intervention Source Ontology ( Jackson et al , 2022 ; Osborne & Norris, 2022 ; Silva et al , 2022 ; Wuerstl et al , 2023 ). No papers were identified using the Mechanisms of Action, BCT and Style of Delivery ontologies.…”

Coping with Bowel and Bladder Dysfunction After SCI: A Comparison between India and Canada

“…Unaccounted for differences in patient and caregiver education could also impact results. Providing patients with clear and ongoing education about managing their bowel is critical for minimizing complications and maintaining QOL [24]. In India, bowel and bladder management were identi ed as speci c areas where care had been lacking [25].…”