Table 2 Barriers to delivering the outdo orjourney intervention with examples ^

   From people with stroke: Some people are more focussed on getting their arm to work again 'I just want my arm to work'... [so] trying to identify goals different from that can be hard. Usually they've been told 'We're referring you for upper limb therapy' and they become very focussed on that 'I want to move my arm again'...they don't want to ....look at ...getting out and about. (OT1)

Belief about capabilities: Unhelpful, pessimistic or ambivalent beliefs and attitudes about the capability of an individual professional, family member, or the team to provide the outdoor journey intervention.

   ...there's concern about [therapy assistants] having the skills to assess and analyse the situation.....Would everything [ie problem areas] be picked up by somebody who's not trained? Can we have somebody who's not fully trained doing interventions and sessions? (OTM1)

   Maybe [it's] partly to do with not having done this before...for people... gosh ...(thinks)...how do I get people on buses? And time wise.... [how do I manage]? (OT2)

Knowledge and skills: Knowledge and skills which professionals felt they lacked, which related to; (i) the intervention itself; (ii) return to driving, (iii) motorised scooters and (iv) local transport options.

   One thing that the staff felt they wanted was information...around driving and what the guidelines say. Where can we access information to help them [people with stroke] for the knowledge part of the driving assessment? [Staff] awareness of what actually happens in an occupational therapy driving assessment is limited....how that's separate from the RTA [Roads and Traffic Authority] test, and sitting at a computer... and going out with a driving instructor? (OT3)

Professional role identity: Unhelpful attitudes and beliefs about professional roles, and routines which presented a barrier to delivery of the intervention. Includes professionals who were pessimistic or ambivalent about role change.

   I think a lot more people COULD benefit from [this type of] occupational therapy than actually have it. That's the first barrier. We as non-occupational therapists wouldn't normally think to refer to [them] for this aspect of care.... much of the role seems to have been about upper limb training and maybe some cognitive training. (PT1)

Resources: The absence of resources, limited resources or unpredictable resources on which the intervention depended. There were four categories of resources: (i) staff; (ii); time; (ii) information technology; and (iv) vehicles.

   Information technology: To get a bus timetable and transport information ...I'm lucky now I have access to the internet, but before I didn't, and you'd have to get someone else to log you on, which can make it difficult (OT1)

   Vehicles: Getting cars has been a huge issue in the past. We don't have a [dedicated] car for that position. If there [wasn't] a car...it [would require] a bit more planning and approval (OTM1)

Memory and attention: Failure or difficulty remembering to ask about, assess, document or address outdoor mobility and travel because of current systems, procedures or habits.

   Sometimes I might bring it [driving referral] up in discussion but I might forget when it comes time to document (OT1).

Emotions: Negative or uncomfortable emotions when thinking about, or delivering the intervention.

   If I'm out with a client for three hours or so, there will be a feeling of guilt...it's a bit like a social outing...I know we're training community access but perhaps a feeling of guilt that you're gone for so long, with one person and you're out in the community (OT2)