The acceptability of trauma-focused interventions

Introduction and Aim: Previous systematic reviews have explored the barriers and facilitators to the implementation of evidence-based trauma-focused interventions (TFIs). However, ambivalence with TFIs continue to be reported by clinicians and service users, and it remains underutilised as well as having higher dropout rates compared to other psychological therapies. The present review aimed to synthesise both clinicians’ and service users’ experiences and perspectives of the barriers and facilitators to the uptake and deliveryof TFIs, and map the identified factors to the Theoretical Domains Framework (TDF) to better inform implementation strategies.

Method: A systematic literature search was conducted by searching three databases. Nineteen qualitative and mixed-method studies were selected for review and analysed using thematic synthesis. The identified subthemes were then mapped to the TDF domains.

Key Findings: Four themes were generated from the data: Core elements needed to heal from trauma, readiness, therapeutic processes, and factors outside of therapy. The associated subthemes were mapped to 13 of the TDF domains, most of which were salient for both groups. Some unique factors were identified for each group, such as training and supervision for clinicians, and service users reporting the need to strengthen their resilience in engaging with TFIs.

Discussion: The interpretation of the findings in the context of previous literature, study limitations, research and clinical implications are discussed. Future studies should simultaneously explore clinicians’ and service users’ experiences with TFIs to allow a direct comparison of the key barriers and facilitators to maximise effective implementation and delivery.