Behavioral Determinants Potentially Relevant to First-Witness Responses in Prehospital Stroke Care: A COM-B-Based Scoping Review.
Healthcare (Basel, Switzerland) · 2026-07-06 · Scoping review
Abstract
Objective: Delays in prehospital stroke care are often influenced by the actions of first witnesses (e.g., family, bystanders). However, evidence on what shapes their responses remains fragmented. This scoping review synthesizes these factors and maps them onto the Capability-Opportunity-Motivation-Behavior (COM-B) model. Methods: Following the PRISMA-ScR guidelines, eight international and Chinese databases were searched for studies published between 2019 and 2024. Two reviewers independently screened records and charted data. Because no eligible study directly recruited first witnesses, all included studies focused on stroke patients or the general public. We therefore adopted a conservative interpretive approach: we extracted factors occurring at the stroke scene before professional contact and, where a logical low-inference link existed, interpreted their potential relevance to first-witness behavior. These interpreted determinants were then mapped onto the COM-B framework. Results: Forty-eight studies involving approximately 257,000 participants from more than 20 countries were included. Factors identified across the literature covered all domains of the COM-B framework. Physical opportunity was the most frequently coded domain (33/134 codings, 24.6%), followed by psychological capability (26/134, 19.4%) and reflective motivation (22/134, 16.4%). Key barriers included insufficient stroke knowledge, limited access to emergency services, and delayed decision-making due to weak urgency perception. Conclusions: This scoping review identified behavioral factors potentially relevant to first-witness response, as interpreted from patient and public evidence. The findings suggest that prehospital stroke delays may be associated with the co-occurrence of limited capability, constrained opportunity, and insufficient motivation. These barriers often coexist and may interact with one another, highlighting the potential value of behavior-informed strategies for improving prehospital stroke response and reducing delay.
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