Barriers and facilitators of adherence to awake prone positioning: a qualitative study using the COM-B model

Abstract

Background Awake prone positioning (APP) is a recommended therapy for non-intubated ARDS patients, but adherence can be challenging. Understanding the barriers and facilitators of adherence to APP is essential to increase the adherence of therapy and improve patient outcomes. The objective of this study was to explore the barriers and facilitators of adherence to awake prone ventilation using a qualitative approach and the Capability, Opportunity, Motivation-Behavior (COM-B) model. Methods Semi-structured, in-depth interviews were conducted with patients involved in awake prone ventilation. Data were analyzed using an adapted inductive thematical approach and mapped onto the COM-B model to identify barriers and facilitators to adherence of APP. Results Nineteen patients were interviewed (aged 55–92 years). Fifteen themes were identified and mapped directly on to the six COM-B constructs, with “physical challenges” related to physical capability being the primary barrier. These COM-B sub-items reflected five other barriers, including low self-efficacy(M), treatment environment(O), availability of time(O), misconceptions about the treatment(C), and insufficient knowledge(C). Key facilitators in adhering to APP were ability to identify and overcome obstacles(C), availability and affordability of treatment(O), family influences(O), beliefs and trust in treatment(M), fear about the disease(M), and perceived benefits(M). In addition, three factors played the role of both facilitator and barrier, such as media influences(O), healthcare influences(O), and behavioral habits(M). Conclusion The COM-B model was proved to be a useful framework for identifying the barriers and facilitators of adherence to awake prone ventilation. The findings suggest that adherence behavior is a dynamic and balanced process and interventions aimed at improving adherence to APP should address the barriers related to capability, opportunity, and motivation. Healthcare providers should focus on providing proper guidance and training, creating a comfortable environment, and offering social support to improve patients’ capability and opportunity. Additionally, promoting patients’ positive beliefs and attitudes towards the treatment and addressing misconceptions and fears can further enhance patients’ motivation to adhere to the treatment plan.

A Comprehensive Review of Prone Ventilation in the Intensive Care Unit: Challenges and Solutions

“…Leadership support is crucial in championing the adoption of prone ventilation, emphasizing its potential impact on patient outcomes and the overall quality of care. Collaborative decision-making involving all relevant stakeholders can help address concerns and build consensus [ 43 ].…”

“…Informed and engaged patients are more likely to understand the rationale behind prone positioning, actively participate in their care, and contribute to a positive healthcare experience. Patient and family education programs should emphasize clear communication, address concerns, and empower individuals to partner in their healthcare journey [ 43 ].…”

Ventilatory Management of Patients with Acute Respiratory Distress Syndrome Due to SARS-CoV-2

“…Second, what level of hypoxaemia should trigger implementation of prone positioning, and third, how can we maximize patient comfort and promote adherence with this manoeuvre? Indeed, patient comfort seems to be a key issue, as investigated in a qualitative study by Zhu et al [78] among 19 patients to identify barriers to and facilitators of adherence to awake prone positioning. Among the key facilitators identified by these authors were availability and affordability of treatment, family influences and perceived benefits.…”

Awake prone positioning effectiveness in moderate to severe COVID-19 a randomized controlled trial

“…More severely ill patients are more likely to be cared for in settings with greater access to staff for support in turning and maintaining APP, whereas patients with lower oxygen requirements, cared for in less intensive environments, are more able to move themselves to a position of their choice. Studies in the UK, Pakistan and China which have examined acceptability from patient perspectives suggest overall negative attitudes to APP related to discomfort, physical consequences and social factors which may influence patients' willingness to self-prone (15)(16)(17). Concurrent patient perspectives from randomised controlled trials remains lacking.…”