Exploring barriers and facilitators to healthcare professional implementation of a stroke physical activity behaviour change intervention to inform targeted strategies: a qualitative study

Purpose
Physical activity improves outcomes after stroke, but barriers exist to healthcare professionals promoting physical activity in this population. This study explored barriers and facilitators to healthcare professional implementation of a stroke physical activity behaviour change intervention, Physical Activity Routines After Stroke (PARAS), to inform targeted implementation strategies.

Methods
UK stroke rehabilitation teams participated in one-hour workshops discussing PARAS implementation. Transcripts were analysed inductively and deductively using the Theoretical Domains Framework (TDF), facilitating the mapping of behaviour change techniques (BCTs) (Behaviour Change Techniques Taxonomy V1) and implementation strategies (Expert Recommendations for Implementing Change compilation).

Results
Five teams (35 healthcare professionals, predominantly physiotherapists) participated. Key themes included system and resource constraints, stakeholder and stroke survivor engagement, intervention adaptation, and knowledge and skills. Nine TDF domains were identified as central to implementation behaviour. Fifteen BCTs and 14 implementation strategies were mapped, with operationalisation methods including training, stakeholder engagement, identifying local determinants, audit, and resource adaptation.

Conclusions
This is the first study applying the TDF to understand healthcare professionals’ experiences implementing a physical activity behaviour change intervention post-stroke. Using the TDF enabled systematic mapping of tailored strategies supporting implementation. Findings offer practical solutions for PARAS implementation, with broader applicability across stroke rehabilitation contexts.