Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
International Collaboration on Repair and Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
Spinal Cord. 2022 Jul;60(7):664-673. doi: 10.1038/s41393-021-00743-0. Epub 2022 Jan 7.
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.
Using an integrated knowledge translation approach, we aimed to explore the barriers and facilitators to making changes to bowel care in individuals with SCI.
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.
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.
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.
改善自主功能，如膀胱、肠道和性功能，是脊髓损伤（SCI）患者的首要任务。肠道护理与高水平的不满和生活质量下降有关。尽管不满意，71%的人至少 5 年来没有改变他们的肠道护理常规，这突显了对肠道护理的不满与改变常规以优化肠道护理之间的脱节。
采用综合知识转化方法，探讨改变 SCI 患者肠道护理的障碍和促进因素。
我们的方法以行为改变轮为指导，并使用理论领域框架（TDF）。对 13 名 SCI 患者（平均年龄 48.6±13.1 岁）进行了半结构化访谈，并逐字记录（持续时间 31.9±7.1 分钟）。提取障碍和促进因素，使用 TDF 域进行演绎编码，并对域内主题进行归纳分析。
SCI 后改变肠道护理受到四个 TDF 域的强烈影响：环境背景和资源（工作场所的灵活性、机会或环境，以及资源的获取）；信念关于后果；社会影响（感知支持和同伴指导）；和知识（生理过程和肠道护理选项的知识）。所有干预功能和政策类别都被认为是可行的干预选择，人类（61%）和数字（33%）平台更受欢迎。
改变肠道护理是一种多因素行为。这些发现将支持系统地开发和实施未来的干预措施，使 SCI 患者能够改变他们的肠道护理，并促进肠道护理方法的优化。
