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Barriers and facilitators to medical referral of people with Osteoarthritis to the Split.OA programme: a qualitative study
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Introdução: A osteoartrose da anca e do joelho (OAAJ) é uma condição prevalente, com elevado impacto individual e social. Contudo, a implementação de intervenções de primeira linha continua a ser insuficiente. O programa Split.OA é um modelo desenvolvido para melhorar a qualidade dos cuidados em Portugal, promovendo a prática regular de exercício através de estratégias de mudança comportamental em pessoas com OAAJ. Este estudo teve como objetivo explorar as barreiras e facilitadores que os médicos percecionam na referenciação de utentes para o programa Split.OA. Metodologia: Foi realizado um estudo qualitativo, seguindo um paradigma interpretativista. Realizaram-se entrevistas semiestruturadas por videoconferência, que foram gravadas, transcritas verbatim e analisadas dedutivamente. O guião da entrevista e a análise de dados basearam-se na Behaviour Change Wheel (BCW), incluindo o modelo Capability-Opportunity-Motivation Behaviour (COM-B) e o Theoretical Domains Framework (TDF). Foram entrevistados cinco médicos de família, quatro reumatologistas, três fisiatras e um ortopedista. Resultados: Foram identificadas 21 barreiras e 25 facilitadores distribuídos por 5 componentes do COM-B e 13 domínios do TDF, relacionados com a referenciação de pessoas com OAAJ para o programa Split.OA. Estes incluem fatores relacionados com os médicos (formação, competências de comunicação, estratégias de apoio à referenciação, relações e papéis profissionais), fatores relacionados com os utentes (desafios associados às características, crenças e necessidades) e fatores organizacionais (limitações do sistema de saúde, apoio organizacional e restrições no processo de referenciação). Conclusão: Este estudo identificou múltiplas barreiras e facilitadores que poderão ser usados para otimizar a referenciação de utentes para o programa Split.OA. Com recurso à BCW, investigação futura poderá associar este diagnóstico comportamental a estratégias de intervenção para suportar a implementação do Split.OA.
Background: Hip and knee osteoarthritis (HKOA) is a prevalent condition with substantial individual and societal burden. However, the delivery of first-line treatments remains suboptimal. The Split.OA programme is a care model designed to improve the quality of care in Portugal by promoting regular exercise through behaviour change in people with HKOA. This study aimed to explore the barriers and facilitators perceived by physicians in referring patients to the Split.OA. Methods: A qualitative study under an interpretivist paradigm was performed. Semi‐structured videoconference interviews were conducted, recorded, transcribed verbatim, and deductively analysed. The interview guide and data analysis were grounded in the Behaviour Change Wheel (BCW), including the Capability-Opportunity-Motivation Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). Five general practitioners, four rheumatologists, three physiatrists and one orthopaedic surgeon were interviewed. Results: Twenty-one barriers and twenty-five facilitators were identified within five COM-B components and thirteen TDF domains, related to referring people with HKOA to the Split.OA programme. These related to physician factors (training, communication skills, referral support strategies, professional relationships and roles), patient factors (challenges linked to patient characteristics, beliefs and needs), and organisational factors (health system limitations, organisational support and referral process constraints). Conclusions: This study identified multiple barriers and facilitators that could be targeted to optimise referrals to the Split.OA programme. Using the BCW, future research can link this behavioural diagnosis to intervention strategies to support the Split.OA implementation.
Background: Hip and knee osteoarthritis (HKOA) is a prevalent condition with substantial individual and societal burden. However, the delivery of first-line treatments remains suboptimal. The Split.OA programme is a care model designed to improve the quality of care in Portugal by promoting regular exercise through behaviour change in people with HKOA. This study aimed to explore the barriers and facilitators perceived by physicians in referring patients to the Split.OA. Methods: A qualitative study under an interpretivist paradigm was performed. Semi‐structured videoconference interviews were conducted, recorded, transcribed verbatim, and deductively analysed. The interview guide and data analysis were grounded in the Behaviour Change Wheel (BCW), including the Capability-Opportunity-Motivation Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). Five general practitioners, four rheumatologists, three physiatrists and one orthopaedic surgeon were interviewed. Results: Twenty-one barriers and twenty-five facilitators were identified within five COM-B components and thirteen TDF domains, related to referring people with HKOA to the Split.OA programme. These related to physician factors (training, communication skills, referral support strategies, professional relationships and roles), patient factors (challenges linked to patient characteristics, beliefs and needs), and organisational factors (health system limitations, organisational support and referral process constraints). Conclusions: This study identified multiple barriers and facilitators that could be targeted to optimise referrals to the Split.OA programme. Using the BCW, future research can link this behavioural diagnosis to intervention strategies to support the Split.OA implementation.
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Osteoartrose Referenciação Profissionais de saúde Investigação qualitativa Mudança comportamental Osteoarthritis Referral Healthcare professionals Qualitative research Behaviour change