Abstract
BackgroundClinical practice guidelines generally recommend clinicians use self-management support (SMS) when managing patients with spine pain. However, even within the educational setting, the implementation of SMS remains suboptimal. The objectives of this study were to 1) estimate the organizational readiness for change toward using SMS at the Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario from the perspective of directors and deans, 2) estimate the attitudes and self-reported behaviours towards using evidence-based practice (EBP), and beliefs about pain management among supervisory clinicians and chiropractic interns, 3) identify potential barriers and enablers to using SMS, and 4) design a theory-based tailored Knowledge Translation (KT) intervention to increase the use of SMS.MethodsMixed method design. We administered three self-administered questionnaires to assess clinicians’ and interns’ attitudes and behaviours toward EBP, beliefs about pain management, and practice style. In addition, we conducted 3 focus groups with clinicians and interns based on the Theoretical Domain Framework (TDF) to explore their beliefs about using SMS for patients with spine pain. Data were analysed using deductive thematic analysis by 2 independent assessors. A panel of 7 experts mapped behaviour change techniques to key barriers identified informing the design of a KT intervention.ResultsParticipants showed high level of EBP knowledge, positive attitude of EBP, and moderate frequency of EBP use. A number of barrier factors were identified from clinicians (N = 6) and interns (N = 16) corresponding to 7 TDF domains: Knowledge; Skills; Environmental context and resources; Emotion; Beliefs about Capabilities; Memory, attention & decision making; and Social Influence. To address these barriers, the expert panel proposed a multifaceted KT intervention composed of a webinar and online educational module on a SMS guided by the Brief Action Planning, clinical vignettes, training workshop, and opinion leader support.ConclusionSMS strategies can help maximizing the health care services for patients with spine pain. This may in turn optimize patients’ health. The proposed theory-based KT intervention may facilitate the implementation of SMS among clinicians and interns.
Highlights
Clinical practice guidelines generally recommend clinicians use self-management support (SMS) when managing patients with spine pain
The objectives of this study were to 1) estimate the organizational readiness for change toward using SMS at the Canadian Memorial Chiropractic College (CMCC), Toronto, Ontario from the perspective of Directors and Deans, 2) estimate the attitudes towards and self-reported use of evidence-based practice (EBP) behaviours, as well as beliefs about pain management among supervisory clinicians and chiropractic interns, 3) identify potential barriers and enablers to using SMS, and 4) design a theory-based tailored Knowledge Translation (KT) intervention to increase the use of SMS
Results from the Organizational readiness for implementing change (ORIC) showed that decision makers perceived that members of the CMCC were highly committed to, and confident about implementing SMS for patients with spine pain in CMCC outpatient teaching clinics, Fig. 1 A&B
Summary
Clinical practice guidelines generally recommend clinicians use self-management support (SMS) when managing patients with spine pain. Clinical practice guidelines (CPGs) generally recommend offering self-management support (SMS) strategies to individuals with spine pain [21,22,23,24,25,26,27,28] as these help reduce the associated individual and societal burden [29]. SMS strategies are designed to facilitate adoption of healthy lifestyle in people with a range of health issues including spine pain and related co-morbidities (e.g. heart disease, type 2 diabetes, depression) [30,31,32,33,34,35,36,37,38,39]. Barriers to implementing EBPs among chiropractors include: lack of time, lack of generalizability of guidelines, lack of compensation, time since graduation greater than 10 years, insufficient skills or confidence in using findings from the literature, predefined beliefs and a more narrowed scope of practice [43]
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