院前卒中护理中与第一目击者反应潜在相关的行为决定因素：基于COM-B的范围界定综述
Behavioral Determinants Potentially Relevant to First-Witness Responses in Prehospital Stroke Care: A COM-B-Based Scoping Review.
摘要(中文译文)
院前卒中救治的延迟往往受到第一目击者（如家属、旁观者）行为的影响。然而，关于其应对行为形成因素的证据仍较为零散。本范围综述对这些因素进行综合，并将其映射至能力-机会-动机-行为（COM-B）模型。遵循PRISMA-ScR指南，检索了八个国际及中文数据库，纳入2019年至2024年间发表的研究。两名评审员独立筛选文献并提取数据。由于没有符合条件的研究直接招募第一目击者，所有纳入研究均聚焦于卒中患者或公众。因此，我们采取了保守的解释性方法：提取在专业救援人员接触之前发生于卒中现场的因素，并在存在逻辑上低推断性关联时，解释其与第一目击者行为的潜在相关性。随后将这些经解释的决定因素映射至COM-B框架。共纳入48项研究，涉及来自20多个国家的约257,000名参与者。文献中识别的因素涵盖了COM-B框架的所有领域。物理机会是最常被编码的领域（33/134条编码，24.6%），其次为心理能力（26/134，19.4%）和反思性动机（22/134，16.4%）。主要障碍包括卒中知识不足、紧急服务可及性有限，以及因紧迫感感知薄弱而导致的决策延迟。本范围综述基于患者和公众证据，识别了可能与第一目击者应对行为相关的行为因素。研究结果表明，院前卒中延迟可能与能力有限、机会受限和动机不足的共同存在有关。这些障碍往往并存并可能相互影响，凸显了基于行为的策略在改善院前卒中应对和减少延迟方面的潜在价值。
Abstract
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. 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. 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. 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.
如何引用
AMA
Keying Xu, Chengxia Wei, Hui Ni, Xinhao Chen, Gendi Lu. Behavioral Determinants Potentially Relevant to First-Witness Responses in Prehospital Stroke Care: A COM-B-Based Scoping Review.. Healthcare (Basel, Switzerland). 2026; doi:10.3390/healthcare14132000.
APA
Keying Xu, Chengxia Wei, Hui Ni, Xinhao Chen, Gendi Lu (2026). Behavioral Determinants Potentially Relevant to First-Witness Responses in Prehospital Stroke Care: A COM-B-Based Scoping Review.. Healthcare (Basel, Switzerland). https://doi.org/10.3390/healthcare14132000
GB/T 7714
Keying Xu, Chengxia Wei, Hui Ni, Xinhao Chen, Gendi Lu. Behavioral Determinants Potentially Relevant to First-Witness Responses in Prehospital Stroke Care: A COM-B-Based Scoping Review.[J]. Healthcare (Basel, Switzerland), 2026 doi:10.3390/healthcare14132000.
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