Implementation barriers and facilitators to a vocational rehabilitation intervention after traumatic injury (ROWTATE) in the UK: qualitative interviews with key stakeholders.

Abstract

To explore barriers and facilitators to implementing the ROWTATE vocational rehabilitation intervention and identify lessons for future service delivery. Qualitative interview implementation study embedded within the development and evaluation of a complex health intervention, guided by the UK Medical Research Council framework. National Health Service (NHS) major trauma services in England. The ROWTATE intervention included early vocational assessment lasting up to 12 months, case management, employer engagement and coordinated multidisciplinary support between occupational therapists and clinical psychologists. The intervention was delivered via hybrid models following COVID-19 adaptations. Purposively sampled stakeholders including patients, therapists, mentors, employers, carers, commissioners and primary care practitioners. 80 semistructured interviews were conducted remotely between March 2023 and June 2025 using topic guides informed by the Consolidated Framework for Implementation Research and the Theoretical Framework of Acceptability. Data were analysed using framework coding followed by reflexive thematic analysis to generate cross-cutting themes and implementation-focused recommendations. Implementation was shaped by six cross-cutting themes that acted as both barriers and facilitators depending on context. Stakeholders highlighted the importance of addressing diverse patient needs and outcomes through early, personalised support and case management. Remote delivery improved accessibility and flexibility but was most effective when combined with face-to-face contact to strengthen relationships and contextual understanding. Multidisciplinary occupational therapy and clinical psychology collaboration enabled holistic care, though required structured processes to overcome communication challenges. Mentoring provided essential professional development and mitigated isolation in remote roles, while employer engagement facilitated workplace adjustments and retention but was constrained by patients' reluctance to involve employers and by variable occupational health provision. Strategic buy-in from commissioners and clinical leaders was critical, with emphasis on robust outcome data and economic evidence to support sustainability. Findings inform strategies for embedding vocational rehabilitation within integrated care models and identify core components that should be protected to support implementation when scaling hybrid delivery (eg, mentoring and structured multidisciplinary team processes). The study also outlines scalable approaches to hybrid service delivery, workforce development and employer engagement, offering transferable lessons for health systems seeking to reduce economic inactivity and address post-trauma inequalities. ISRCTN43115471.