Understanding factors that influence goal setting in rehabilitation for paediatric acquired brain injury: a qualitative study using the Theoretical Domains Framework

Sarah Knight; Jill Rodda; Emma Tavender; Vicki Anderson; Natasha A. Lannin; Adam Scheinberg

doi:10.1071/IB23103

RESEARCH ARTICLE (Open Access)

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Understanding factors that influence goal setting in rehabilitation for paediatric acquired brain injury: a qualitative study using the Theoretical Domains Framework

Sarah Knight

^A ^B ^C ^D ^* , Jill Rodda ^A , Emma Tavender ^A , Vicki Anderson ^A ^B ^C , Natasha A. Lannin

^E ^F and Adam Scheinberg ^A ^C ^D ^E

+ Author Affiliations

- Author Affiliations

^A Clinical Sciences, Murdoch Children’s Research Institute, Melbourne, Vic., Australia.

^B Melbourne School of Psychological Sciences, The University of Melbourne, Vic., Australia.

^C Department of Paediatrics, The University of Melbourne, Vic., Australia.

^D Victorian Paediatric Rehabilitation Service, The Royal Children’s Hospital Melbourne, Vic., Australia.

^E Department of Neuroscience, Monash University, Melbourne, Vic., Australia.

^F Alfred Health, Melbourne, Vic., Australia.

^* Correspondence to: sarah.knight@unimelb.edu.au

Handling Editor: Sharon Kramer

Brain Impairment 25, IB23103 https://doi.org/10.1071/IB23103

Submitted: 23 September 2023 Accepted: 14 March 2024 Published: 4 April 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of the Australasian Society for the Study of Brain Impairment. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

While goal setting with children and their families is considered best practice during rehabilitation following acquired brain injury, its successful implementation in an interdisciplinary team is not straightforward. This paper describes the application of a theoretical framework to understand factors influencing goal setting with children and their families in a large interdisciplinary rehabilitation team.

Methods

A semi-structured focus group was conducted with rehabilitation clinicians and those with lived experience of paediatric acquired brain injury (ABI). The 90-min focus group was audio-recorded and transcribed verbatim. Data were thematically coded and mapped against the Theoretical Domains Framework (TDF) to understand influencing factors, which were then linked to the Capability, Opportunity, Motivation – Behaviour (COM-B) model.

Results

A total of 11 participants (nine paediatric rehabilitation clinicians, one parent and one young person with lived experience of paediatric ABI) participated in the focus group. Factors influencing collaborative goal setting mapped to the COM-B and six domains of the TDF: Capabilities (Skills, Knowledge, Beliefs about capabilities, and Behavioural regulation), Opportunities (Environmental context and resources), and Motivation (Social/professional role and identity). Results suggest that a multifaceted intervention is needed to enhance rehabilitation clinicians’ and families’ skills and knowledge of goal setting, restructure the goal communication processes, and clarify the roles clinicians play in goal setting within the interdisciplinary team.

Conclusion

The use of the TDF and COM-B enabled a systematic approach to understanding the factors influencing goal setting for children with acquired brain injury in a large interdisciplinary rehabilitation team, and develop a targeted, multifaceted intervention for clinical use. These represent important considerations for the improvement of collaborative goal setting in paediatric rehabilitation services to ensure that best practice approaches to goal setting are implemented effectively in clinical practice.

Keywords: acquired brain injury, behavioural change, children, family-centred care, goal setting, implementation science, integrated knowledge translation, rehabilitation.

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