Barriers and facilitators to resuming meaningful daily activities among critical illness survivors in the UK: a qualitative content analysis

Abstract

ObjectiveTo identify critical illness survivors’ perceived barriers and facilitators to resuming performance of meaningful activities when transitioning from hospital to home.DesignSecondary content analysis of semistructured interviews about patients’ experiences of intensive care (primary analysis disseminated on the patient-facing websitewww.healthtalk.org). Two coders characterised patient-perceived barriers and facilitators to resuming meaningful activities. To facilitate clinical application, we mapped the codes onto the Person-Task-Environment model of performance, a patient-centred rehabilitation model that characterises complex interactions among the person, task and environment when performing activities.SettingUnited Kingdom, 2005–2006.Participants39 adult critical illness survivors, sampled for variation among demographics and illness experiences.ResultsPerson-related barriersincluded negative mood or affect, perceived setbacks; weakness or limited endurance; pain or discomfort; inadequate nutrition or hydration; poor concentration/confusion; disordered sleep/hallucinations/nightmares; mistrust of people or information; and altered appearance.Task-related barriersincluded miscommunication and managing conflicting priorities.Environment-related barriersincluded non-supportive health services and policies; challenging social attitudes; incompatible patient–family coping (emotional trauma and physical disability); equipment problems; overstimulation; understimulation; and environmental inaccessibility.Person-related facilitatorsincluded motivation or attitude; experiencing progress; and religion or spirituality.Task-related facilitatorsincluded communication.Environment-related facilitatorsincluded support from family, friends or healthcare providers; supportive health services and policies; equipment; community resources; medications; and accessible housing. Barriers decreased and facilitators increased over time. Six barrier–facilitator domains dominated based on frequency and emphasis across all performance goals: mood/motivation, setbacks/progress, fatiguability/strength; mis/communication; lack/community support; lack/health services and policies.ConclusionsCritical illness survivors described a comprehensive inventory of 18 barriers and 11 facilitators that align with the Person-Task-Environment model of performance. Six dominant barrier–facilitator domains seem strong targets for impactful interventions. These results verify previous knowledge and offer novel opportunities for optimising patient-centred care and reducing disability after critical illness.