Platform Presentation The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Understanding Barriers and Enablers to Delivering Vocational Rehabilitation Interventions with Adults with Stroke using the Theoretical Domains Framework (#85)

Natasha A Lannin 1 2 , Sophie O'Keefe 3 , Jade Kettlewell 4 , Sandra Reeder 1 , Kate Radford 4
  1. Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
  2. Alfred Health, Melbourne, Victoria, Australia
  3. Occupational Therapy, Monash University, Melbourne, Victoria, Australia
  4. Faculty of Medicine & Health Sciences, The University of Nottingham, Nottingham, UK

Background: Despite acknowledging the important role that vocational rehabilitation programs play in supporting people to return to working after stroke, there are gaps in the literature regarding how to best support clinicians to deliver vocational rehabilitation as part of a comprehensive stroke rehabilitation program. To address this gap, we sought to understand the implementation behaviours of clinicians who are currently delivering vocational rehabilitation within this context.

Aims: To identify the factors influencing delivery of vocational rehabilitation in clinical rehabilitation using the Theoretical Domains Framework (TDF) to inform development of a behaviour change intervention.

Methods: We administered the Theoretical Domains Framework Questionnaire (TDFQ) online to 17 allied health professionals who had a role providing vocational rehabilitation within government-funded, clinical rehabilitation settings in Victoria. All responding clinicians were experienced in stroke rehabilitation.

Results: On average, clinicians reported 30% (5-100%) of their caseload involved vocational rehabilitation. All theoretical domains were identified as being relevant to supporting clinicians to deliver vocational rehabilitation with personal ratings varying across clinicians. There was an overall high level of belief in the value of vocational rehabilitation for supporting return-to-work after stroke, and strong beliefs that providing vocational rehabilitation interventions formed an important part of the rehabilitation clinician role. While ‘Motivation’ for delivering vocational rehabilitation was high, significant ‘Capability’ and ‘Opportunity’ issues were identified. Respondents identified both knowledge and skill concerns. And, the ability to deliver vocational rehabilitation interventions was seen to be limited by availability of resources, lack of support from management, insufficient time, and lack of opportunity for training.

Conclusion:  Implementation supports should be tailored to address Capability and Opportunity issues that influence delivery of vocational rehabilitation interventions within the clinical setting. Using the TDF allowed for the identification of a range of factors influencing clinicians that could be targeted in a future education and training intervention.