An Interpretive Phenomenological Analysis Of Physiotherapy In Mental Health: Exploring Barriers And Facilitators To Care

Abstract

Background/Aims Current literature identifies decreased life expectancy and increased physical health complaints for service users with mental health diagnosis. However, research also highlights increased challenges for this population when accessing physical health care services. Physiotherapy is one such service shown to be of benefit for those with co-morbid physical and mental health needs. However, research is currently lacking on experiences and access to physiotherapy for this population. This study aimed to explore lived experiences of physiotherapeutic care for those with co-morbid physical and mental health complaint and identify barriers and facilitators for those attempting to access this service. Methods Semi-structured interviews were carried out with service users (n=8) with long-standing physiotherapeutic and severe and enduring psychiatric complaints. Focus groups were completed with physiotherapists working within the field of mental health care. Verbatim transcripts of the interviews and focus groups were analysed using Interpretive Phenomenological Analysis in order to obtain in depth insight into participant experiences. The study was designed to enhance quality through use of methodological and investigator triangulation, negative case analysis, reflexivity, secondary coding and a clear audit trail. Results Data was analysed systematically following the structure: individual case analysis, emergence of themes, cross case analysis, validation of themes and ideas. This analysis produced five master themes: (1) Communication with health care provider; (2) holistic care from physiotherapist; (3) perceived benefit of physiotherapy; (4) health care politics and interaction between services; (5) patient activation and motivation to comply with physiotherapy. These factors were seen to be of high importance for patient experience and, when lacking, were identified as barriers to quality physiotherapeutic care. Conclusions Results were found to be consistent with current literature around physical health care. This study identifies the need for greater integrated care between physical and mental health services and improved awareness of mental health and use of the biopsychosocial model within physiotherapy practice in order to promote holistic care. Results also highlight the need for positive experience of physiotherapy for those with severe mental illness in order to increase patient activation and motivation to attend and comply with services.