Perspectives on supporting social connection and participation following acquired brain injury: A qualitative study of service providers across health and community settings.

Social isolation is a prevalent consequence of acquired brain injury (ABI) that has notable impacts on wellbeing. Although social connection is recognized as central to recovery, little is known about how service providers understand and promote it. This study explored how services foster social connection post-ABI, the barriers and enablers encountered, how success is understood and what could strengthen future provision. Six online focus groups were conducted with 19 individuals working or volunteering across ABI services in the UK, USA, Australia and New Zealand. Data were analysed using reflective thematic analysis from a critical realist perspective, allowing attention to both participants' experiences and the organizational and structural conditions influencing service delivery. Two themes were developed: (1) Groups as psychosocial lifelines: safety, identity and providing the conditions for recovery, capturing the role of group spaces in rebuilding connection, identity, confidence and belonging and (2) Visible impact, invisible labour: plugging gaps in a precarious system, highlighting the undervalued relational work of the workforce in resource-constrained systems and how unstable funding and inequalities shape access to support. These findings demonstrate the psychosocial value of group-based initiatives and reveal the structural mechanisms that shape their development, sustainability and accessibility.