Barriers and facilitators perceived by healthcare professionals for implementing lifestyle interventions in patients with osteoarthritis: a scoping review

Abstract

ObjectiveTo provide an overview of barriers and facilitators that healthcare professionals (HCPs) perceive regarding the implementation of lifestyle interventions (LIs) in patients with hip and/or knee osteoarthritis (OA).DesignScoping review.Data sourcesThe databases PubMed, Embase, CINAHL, PsycINFO and the Cochrane Library were searched from inception up to January 2021.Eligibility criteriaPrimary research articles with a quantitative, qualitative or mixed-methods design were eligible for inclusion if they reported: (1) perceptions of primary and/or secondary HCPs (population); (2) on implementing LIs with physical activity and/or weight management as key components (concept) and (3) on conservative management of hip and/or knee OA (context). Articles not published in English, German or Dutch were excluded.Data extraction and synthesisBarriers and facilitators were extracted by two researchers independently. Subsequently, the extracted factors were linked to a framework based on the Tailored Implementation for Chronic Diseases checklist.ResultsThirty-six articles were included. In total, 809 factors were extracted and subdivided into nine domains. The extracted barriers were mostly related to non-optimal interdisciplinary collaboration, patients’ negative attitude towards LIs, patients’ low health literacy and HCPs’ lack of knowledge and skills around LIs or promoting behavioural change. The extracted facilitators were mostly related to good interdisciplinary collaboration, a positive perception of HCPs’ own role in implementing LIs, the content or structure of LIs and HCPs’ positive attitude towards LIs.ConclusionsMultiple individual and environmental factors influence the implementation of LIs by HCPs in patients with hip and/or knee OA. The resulting overview of barriers and facilitators can guide future research on the implementation of LIs within OA care. To investigate whether factor frequency is related to the relevance of each domain, further research should assess the relative importance of the identified factors involving all relevant disciplines of primary and secondary HCPs.PROSPERO registration numberCRD42019129348.

Exploring barriers and enablers to the delivery of Making Every Contact Count brief behavioural interventions in Ireland: A cross‐sectional survey study

“…‘Professional role’ was also an important enabler of MECC delivery in our study, as has been identified in previous research (Bouma et al, 2022; Keyworth et al, 2019; Yamada et al, 2015). Those who considered the delivery of MECC interventions as consistent with their health care professional role, were more likely to deliver MECC interventions and delivered them more frequently.…”

Osteoarthritis Literacy and Equity Issues: A Post COVID-19 Analysis and Update

“…However, with few definitive longitudinal studies designed to examine to what degree older adults receive understandable and actionable instructions that are found to ably foster a comprehension of what they may need to do and why their participation and behaviours are likely to affect their health status and outcomes, providers themselves may not be aware of all the possible salient impacts of poor health literacy and its importance in securing the potential utility of a host of possible essential osteoarthritis self-management strategies [8]. By contrast, those providers sensitized to the probable impacts of low health literacy in developing their recommendations, and which groups this may be most likely to apply to, may yet be able to render those cases who could otherwise be challenged and confused about the disease and their personal behavioural responsibilities and actions in this regard, as well as their treatment options quite suitably.…”

“…Since there is increasing evidence that the rates of disability produced by osteoarthritis are not inevitable, but that lifestyles and behaviours are highly influential as well, the objective of this brief was to review the concept of health literacy that might be implicated and considered in efforts to tailor educational approaches and others designed to mitigate or moderate pain and functional disability, as well as prevent future excess impairments [8]. It was believed that insightful efforts to help the older adult meet the challenges of late life osteoarthritis and that may help needy adults to understand and disentangle oftentimes highly technical terms and osteoarthritis intervention associated instructions and approaches, along with efforts to appreciate possible educational limitations, as well as diminished feelings of confidence and empowerment due to a history of discrimination and structural inequities may surely help to reduce the burgeoning health costs of failing to do so [8,9].…”

A survey of patient and medical professional perspectives on implementing osteoarthritis management programs for hip and knee osteoarthritis

“…Multiple factors known to negatively impact programme implementation include accessibility issues (e.g., prohibitive cost with limited reimbursement models, complex referral processes and limited session availability), clinician‐specific factors such as limited interdisciplinary collaboration and skills, and patient‐specific factors such as inadequate motivation and low health literacy (Bouma et al., 2022). Clinician trustworthiness, positive perceptions towards the intervention and flexible session times have been shown to have a positive impact (Bouma et al., 2022; Wallis et al., 2020).…”

“…Multiple factors known to negatively impact programme implementation include accessibility issues (e.g., prohibitive cost with limited reimbursement models, complex referral processes and limited session availability), clinician‐specific factors such as limited interdisciplinary collaboration and skills, and patient‐specific factors such as inadequate motivation and low health literacy (Bouma et al., 2022). Clinician trustworthiness, positive perceptions towards the intervention and flexible session times have been shown to have a positive impact (Bouma et al., 2022; Wallis et al., 2020). While some qualitative research has already been conducted investigating the perspective of patients and medical professionals around implementation of OA management programs in clinical practice, a mixed‐methods approach including quantitative survey methods enables the capture of data from a larger sample to confirm and extend our understanding of the key themes arising from qualitative interviews.…”