“Physical activity allows people to actually live their life, not just live in a hospital.” A qualitative study assessing the barriers and facilitators experienced by hospital staff when promoting physical activity in patients with acquired brain injury

Patients with acquired brain injuries (ABIs) are less physically active and more sedentary than the general population, despite physical activity being an important component of inpatient rehabilitation. As hospital staff play a central role in supporting activity during admission, this study explored the barriers and facilitators they experience in promoting physical activity in this context. A qualitative study was conducted using individual semi-structured interviews and focus groups. Ten staff members (5 female), with a mean of 7.9 years of clinical experience, from an ABI inpatient rehabilitation unit were interviewed via videoconferencing. Data were analysed using reflexive thematic analysis informed by descriptive phenomenology. Themes were then mapped to the Capability, Opportunity, Motivation and Behaviour (COM-B) model and the Behaviour Change Wheel to identify staff-focused behavioural targets for intervention. Nine themes were generated, highlighting barriers and facilitators to physical activity promotion. Barriers related to limited staff knowledge and confidence, alongside a perceived lack of organizational prioritization of physical activity. Facilitators included staff members' own experiences of being active and their belief that physical activity is integral to patient recovery and wellbeing. Findings suggest future interventions should include role-specific training, practical education, and support for rapport-building, behaviour change communication, and creative activity planning.