The tensions between micro-, meso- and macro-levels: physiotherapists’ views of their role towards fall prevention in the community – a qualitative study

Abstract

Background: Falls are a global public health concern. Physiotherapists are a key resource in this context, but there is sparse knowledge about how they perceive their role in the primary care setting. Therefore, the purpose of the present study is to explore physical therapists' (PTs) view of how they experience and perceive their role working with fall prevention in a community care setting. Methods: Semi-structured interviews were conducted with 17 physiotherapists. Data were analysed using a qualitative thematic analysis. Results: The analysis resulted in a core theme and three subthemes. The core theme was 'capability to cope with the tensions between the micro-, meso-and macro-levels in fall, prevention', which indicated the importance of an evolving multifaceted, evidence based and innovative physiotherapy role. A key factor for this role is to take an integrative biopsychosocial approach based on how biological and psychosocial factors are uniquely related in fall prevention. The three themes were as follows: 1) always moving and changing: the competent explorative knowledge-hungry clinician's multifaceted role; 2) multiprofessionalbut in the end alone; 3) reaching outfrom the bottom to the top. Success in the role of physiotherapists in fall prevention depends on the empowering leadership and working culture, as well as on the time and multifaceted professional competence of the clinicians. Conclusion: Our findings indicate that the PTs' role reflects their abilities to change and improve their professional work in accordance with evidence based knowledge. To ensure good quality the PTs focused on the special needs of the patients, evidence-based fall prevention, interdisciplinary team work, good clinical competences, good skills in communication, and interpersonal relations. Attention should be placed on the importance of biopsychosocial perspective framing in the actual clinical and political context. The PTs saw the need for working at the micro-, meso-and macro-levels to succeed in the work of fall prevention.

Physiotherapists’ perceptions of challenges facing evidence-based practice and the importance of environmental empowerment in fall prevention in the municipality – a qualitative study

“…In line with findings from Cerderbom et al [ 38 ], the participants in our study described the ways in which politicians’ decisions influenced their clinical practice. However, as reported in our findings and in the study by Cerderbom et al [ 38 ], a positive policy environment at the macro-level is required to support the meso- and micro-levels of fall prevention; this includes leadership, financial support and human resources allocation.…”

“…This in line with Cerderbom et al [ 38 ], who stated that competent, experienced and skilful practitioners and physiotherapists in fall prevention had to cope with the interaction between the micro- (i.e., individual), meso- (i.e., organisational) and macro-levels (i.e., policy) in order to evolve their multifaceted, evidence-based and innovative physiotherapy practice. Furthermore, Cerderbom et al [ 38 ] emphasised the importance of having the capability to make changes and improve professional work in accordance with evidence-based knowledge and that successful fall prevention depends on an empowering leadership and working culture. In line with findings from Cerderbom et al [ 38 ], the participants in our study described the ways in which politicians’ decisions influenced their clinical practice.…”

“…Furthermore, Cerderbom et al [ 38 ] emphasised the importance of having the capability to make changes and improve professional work in accordance with evidence-based knowledge and that successful fall prevention depends on an empowering leadership and working culture. In line with findings from Cerderbom et al [ 38 ], the participants in our study described the ways in which politicians’ decisions influenced their clinical practice. However, as reported in our findings and in the study by Cerderbom et al [ 38 ], a positive policy environment at the macro-level is required to support the meso- and micro-levels of fall prevention; this includes leadership, financial support and human resources allocation.…”

“…Physiotherapists also play an important role in implementing fall-prevention programmes [ 37 ]. In a recent study, Cerderbom et al [ 38 ] explored physiotherapists’ views of how they experienced and perceived their role when working with fall prevention in the primary care setting. Their findings disclosed a multifaceted and innovative role that requires competent, experienced and skilful physiotherapists who can cope with the interaction between the micro- (i.e., individual), meso- (i.e., organisational) and macro-levels (i.e., policy).…”

“…They described how their multifaceted, evidence-based and innovative role means initiating and motivating, both on the individual level (i.e., with an older person) and with their team of colleagues and at the level of the organisation (i.e., policy, work culture). Last but not least, physiotherapists’ success in implementing fall-prevention programmes and interventions depend on empowering leadership and a working culture, along with time and multifaceted professional competence [ 38 ]. Furthermore, research indicate that clinicians’ experience might contribute to strategic priorities to improve patient experience and place patients at the centre of healthcare and decision-making [ 39 ].…”