Exploring Pain Management for People Living With Dementia in Acute Care Settings Using the COM-B Framework to Guide Baseline Data Gathering.

AIM: To establish a comprehensive pre-implementation baseline of pain management for people living with dementia (PLWD) in acute hospitals by exploring behavioural, contextual, organisational and clinical practice factors to inform the implementation of the DOTS approach. BACKGROUND: Pain is common yet frequently under-recognised and inconsistently managed in PLWD in acute care. Behaviour change frameworks, such as COM-B, may help identify determinants of practice and inform implementation strategies. DESIGN: Multiple-methods study, underpinned by the COM-B framework and guided by the Medical Research Council framework for developing and evaluating complex interventions. METHODS: The study was conducted across five wards in two acute hospitals in the United Kingdom. Healthcare staff (n = 148) completed an adapted 6-item COM-B self-evaluation scale (0-10). Semi-structured interviews with ward managers and a pain management specialist nurse (n = 6) were analysed using deductive thematic analysis. A retrospective review of patient documentation (n = 50) assessed compliance with the National Institute for Health and Care Excellence dementia guidelines. RESULTS: Staff reported high perceived capability, opportunity and motivation, suggesting strong self-reported readiness to deliver effective pain management. However, qualitative findings highlighted barriers across the COM-B domains, including knowledge gaps and inconsistent use of pain assessment tools. Documentation review highlighted deficits in recording acute pain, chronic pain history and usual pain management strategies. Only five patients received analgesia within 60 min of admission, despite many presenting with fractures or serious infections. CONCLUSION: A discrepancy exists between self-reported behavioural determinants and documented clinical practice, indicating inconsistent pain management for PLWD in acute care. IMPLICATIONS FOR CLINICAL PRACTICE: Interventions should prioritise strengthening healthcare staff's capability and embedding structured, system-level processes to support timely person-centred pain management. REPORTING METHODS: STROBE guidelines were followed. PATIENT OR PUBLIC CONTRIBUTION: A multidisciplinary steering group, including clinical leaders and dementia representatives, contributed to the study.