The ABCs of hearing and vision care in long-term care communities: a systematic review and behavioral systems map of Actors, Behaviors, and COM-B factors

BACKGROUND AND OBJECTIVES: Despite the high prevalence of hearing and vision impairment among people living in long-term care (LTC) and their impact on quality of life, these sensory challenges are often disregarded. Hence, this systematic review aims to identify the actors and factors influencing hearing and vision care behavior in LTC and construct a literature informed behavioral systems map to demonstrate this complex system. RESEARCH DESIGN AND METHODS: A systematic review across five databases yielded 23 articles from 3,644 screened (January 2013-September 2024). Data on sensory care behaviors in LTC (screening, referring, receiving care, device use, and communication adaptation) were extracted, coded, and mapped to the COM-B (Capability, Opportunity, and Motivation-Behavior) framework with associated actors. A behavioral systems mapping prototype was developed with the synthesized data. RESULTS: Actors included residents, family members, care staff, LTC management, and hearing and vision professionals. Analysis revealed 31 factors across the COM-B framework related to the five sensory care behaviors. Eighteen factors affected multiple behaviors. Most salient among the interconnecting factors were collaborative care, family engagement, infrastructure, and perception of value. The synthesized behavioral systems map revealed ten feedback loops driving sensory care behaviors. DISCUSSION AND IMPLICATIONS: The behavioral systems map provides crucial groundwork for developing comprehensive solutions to enhance hearing and vision care across LTC settings globally. It reveals that hearing and vision care involves multiple stakeholder groups and interconnected COM-B factors, whose components of capability, opportunity and motivation collectively influence care through feedback dynamics, creating emergent, self-organizing behaviors requiring multifaceted approaches.