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. 2022 Jul;60(7):664-673.
doi: 10.1038/s41393-021-00743-0. Epub 2022 Jan 7.

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

Vera-Ellen M Lucci  1   2 , Rhyann C McKay  2   3 , Christopher B McBride  4 , Maureen S McGrath  1   2 , Rhonda Willms  2   5   6 , Heather L Gainforth  2   3 , Victoria E Claydon  7   8
Affiliations

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

Vera-Ellen M Lucci et al. Spinal Cord. 2022 Jul.

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.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Study protocol.
The study incorporated an integrated knowledge translation approach guided by the theoretical domains framework (TDF).
Fig. 2
Fig. 2. Proportion of total barriers and facilitators by TDF domain across all interviews.
Domains outlined in red reflect those included in the inductive analysis. TDF Theoretical Domains Framework.
Fig. 3
Fig. 3. Barriers and facilitators by TDF domain across all interviews.
A Proportion of barriers by TDF domains. B Proportion of facilitators by TDF domains. TDF Theoretical Domains Framework.
Fig. 4
Fig. 4. TDF domains and associated themes related to changing bowel care practices after SCI.
Red boxes represent TDF domains and blue boxes below represent domain-specific themes. TDF Theoretical Domains Framework.
See this image and copyright information in PMC

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