Implementing low-cost Capability, Opportunity Motivation and Behaviour (COM-B) interventions to increase bed-substitution rehabilitation referrals in acute stroke care

Purpose To explore barriers and enablers of referral to bed-substitution from acute stroke and neurology and evaluate the impact of theoretically-developed implementation strategies to improve referral rates.Methods An implementation study. Baseline auditing of referrals to bed-substitution was completed. Staff referral enablers and barriers were identified via a Theoretical Domains Framework (TDF) survey, mapped to the Capability, Opportunity, Motivation – Behaviour Change (COM-B) model and used to develop low-cost interventions with staff and consumers. The staff survey and audit were repeated after 12 months and differences were analysed via chi-squared tests and Mann-Whitney U tests.Results The pre-intervention survey (n = 19) indicated that staff lacked confidence, faced a cumbersome process and were unsure of their role in referral, despite understanding the referral need. Interventions included: education, information sheets, patient stories, staff simultaneously working across acute and bed-substitution, and changes to referral process to address Knowledge, Environmental context and resources, Belief about Consequences. Referrals to bed-substitution increased from 64 (5.6%) referrals to bed-substitution (n = 1146, median age 65 [interquartile range 50–77] years, 53% male) to n = 57, 9.6%, p = 0.002) post-implementation.Conclusions Following the theoretically-developed low-cost interventions there was an increase in referrals to our bed-substitution service from our acute stroke and neurology ward.