Barriers and facilitators to telerehabilitation adherence in young and middle-aged stroke survivors: a qualitative COM-B analysis.

Authors

Yiling Huang, Meilan Su, Yingying Chen, Sufang Hu

Published in

Frontiers in neurology. Volume 17. Pages 1885751. Epub Sep 28, 2026.

Abstract

To explore the barriers and facilitators to telerehabilitation adherence among young and middle-aged stroke survivors using the Capability, Opportunity, Motivation-Behavior (COM-B) model.
A qualitative descriptive study was conducted with 15 stroke survivors aged 18-60 years recruited from a tertiary hospital in China. Data were collected via one-on-one semi-structured interviews and analyzed using directed content analysis, with iterative mapping of codes to COM-B sub-domains.
Fourteen themes were identified across the six COM-B dimensions, comprising eight barriers and six facilitators. Capability barriers included post-stroke physical exhaustion and low digital confidence, while facilitators were perceived functional recovery and movement self-correction. Opportunity barriers encompassed physical space limitations, unstable internet connectivity, and social isolation; facilitators were family support and therapist supervision. Motivational barriers included efficacy skepticism, digital fatigue, and re-injury anxiety; facilitators were return-to-work aspiration and routine integration. Adherence was shaped by dynamic interactions among these factors rather than isolated determinants.
Telerehabilitation adherence in young and middle-aged stroke survivors is influenced by a complex interplay of physical, cognitive, environmental, social, and motivational factors. Multi-component interventions that simultaneously target capability, opportunity, and motivation-such as fatigue management, digital skills training, home environment optimisation, family involvement, vocational goal-setting, serious games, and peer support-are warranted to enhance engagement and improve long-term outcomes. The COM-B model provides a useful framework for designing such tailored strategies.

PMID:
42865559
Bibliographic data and abstract were imported from PubMed on 13 Oct 2026.

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