Background In 2011, World Spine Care (WSC) opened their pilot clinic at the Botswana Mahalapye District Hospital (MDH) aiming to develop a low-cost model of evidence-based spine care for underserved communities. Providing sustainable, integrated, evidence-based care will require buy-in from local healthcare providers (HCPs) and the communities served. The purpose of this project was to understand how MDH HCPs perceive WSC. Methods We used a qualitative descriptive methodology to conduct individual, semi-structured interviews with MDH HCPs who had some familiarity about WSC services. Interviews were conducted in English, audio-recorded, and transcribed verbatim. We used an iterative coding process for thematic content analysis and interpretations were regularly reviewed by all co-authors. Results In March 2017, interviews with 20 HCPs, from diverse disciplines with a range in years’ experience at MDH, revealed three overlapping themes: knowledge about WSC and spinal related disorders, perceived role of WSC, and challenges for WSC integration. Participants who attended WSC conferences or self-referred for care were more informed and, generally, held positive perceptions. Participants lacked knowledge about managing spinal-related disorders, asserted hospital protocols did not meet patient needs, and perceived WSC is ‘filling a gap’ to manage these conditions. There were mixed perceptions about care received as WSC patients; some ultimately obtained relief, while others reported the treatment painful and unfamiliar, discharging themselves from care. Challenges to integrate WSC into the healthcare system were: lack of knowledge about scope of practice and unclear referral pathways; reversing the isolated care WSC provides by increasing collaboration between WSC and hospital staff; and, high turnover of WSC clinicians that undermines program sustainability. Conclusions MDH healthcare providers had adequate general knowledge about World Spine Care and spinal-related disorders, but did not understand the WSC scope of practice nor referral pathways to and from providers. Participants advocated for greater collaboration between WSC and hospital staff to increase acceptance and integration to deliver spine care services and foster wider adoption of the WSC model, particularly if WSC expands services across Botswana. Future efforts that incorporate interviews with patients and government officials also can provide valuable perspectives to achieve sustainable, integrated, evidence-based spine care. Electronic supplementary material The online version of this article (10.1186/s12998-019-0250-2) contains supplementary material, which is available to authorized users.

Background: The World Spine Care (WSC) is a non-governmental organization that provides evidence-based spinal care to underserved communities around the world. The WSC opened a clinic in the Mahalapye District Hospital (MDH) in 2011 (Haldeman et al., 2015:2304). The WSC aims for long term presence in Botswana. They will require ‘buy in’ from the local community including the health care professionals of the region. Little is known about how WSC has been received by other health care professionals in the settings where they are present. Hence, this study aimed to determine the knowledge, attitudes and perceptions of health care professionals working at the MDH about the WSC. Method: A qualitative exploratory descriptive study was conducted using semi-structured interviews. Twenty health care professionals were interviewed at the Mahalapye District Hospital to ascertain their levels of knowledge, attitudes and perceptions. The interviews were semi- structured and conducted in English and later transcribed verbatim. The transcripts were then analyzed using the thematic analysis described by Graneheim and Lundman (2003:105). Thereafter codes, categories and themes were formed. Results: A variety of health care professionals from different departments were interviewed. Three overarching themes emerged from the data: knowledge of WSC and the management of spinal related disorders at the MDH, the perceived role of WSC, challenges to integration and possible solutions. The HCPs had varying levels of knowledge of the WSC depending on the amount of interaction they had with WSC. Some HCPs who had greater inter-professional interaction with WSC displayed more positive attitudes towards WSC. Many of the HCPs had a positive perception of the WSC though they were not confident in their knowledge of the WSC scope of practice which has limited referral by HCPs WSC. This is mainly due to an unclear referral pathway within the hospital and limited knowledge of WSC’s scope of practice. Increased awareness and an improved system of referral was a strong recommendation made. Many mentioned an unclear referral pathway for their patients. Those who had interacted with WSC generally had pleasant personal interactions with the WSC. Several of the HCPs had themselves been patients of the WSC. Most HCPs felt that WSC was beneficial to patients and made suggestions for WSC to expand to other centres across Botswana. Conclusion: Overall there was a positive perception of WSC however more effort to increase knowledge of what WSC offers and how it can be integrated into the hospital is necessary. Future studies should assess the perceptions of patients as well as knowledge and attitudes of HCPs towards WSC at other sites.