Barriers and enablers to health care providers assessment and treatment of knee osteoarthritis in persons with type 2 diabetes mellitus: A qualitative study using the Theoretical Domains Framework

King, Lauren; Krystia, Owen; Waugh, Esther J.; MacKay, Crystal; Stanaitis, I.; Stretton, Jane; Weisman, Alanna; Ivers, Noah; Parsons, Janet; Lipscombe, Lorraine; Hawker, Gillian

doi:10.1016/j.ocarto.2022.100299

Cited by 2 publications

(2 citation statements)

References 42 publications

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“…We conducted qualitative interviews with 18 persons with T2DM and knee OA, 18 HPs who treat persons with T2DM (8 endocrinologists, 7 family physicians, 3 diabetes educators) and 18 ATs. These studies, reported elsewhere [ 53 – 55 ], are summarized below, and we list the TDF domains that we identified as relevant in parentheses.…”

Section: Resultsmentioning

confidence: 99%

“…We undertook qualitative studies in three stakeholder groups (patients; diabetes HPs, including family physicians, endocrinologists and diabetes educators; and AREP arthritis therapists [ATs]), to identify the barriers and enablers to the target behaviours [ 53 – 55 ]. Semi-structured telephone interviews, conducted between September 2020 and January 2021, comprehensively explored the behaviours of interest for each group, guided by the Theoretical Domains Framework (TDF) [ 56 ].…”

Section: Methodsmentioning

confidence: 99%

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Improving diagnosis and treatment of knee osteoarthritis in persons with type 2 diabetes: development of a complex intervention

King

Ivers

Waugh

et al. 2023

Implement Sci Commun

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Background Symptomatic knee osteoarthritis (OA) commonly co-occurs in people with type 2 diabetes (T2DM) and increases the risk for diabetes complications, yet uptake of evidence-based treatment is low. We combined theory, stakeholder involvement and existing evidence to develop a multifaceted intervention to improve OA care in persons with T2DM. This was done in partnership with Arthritis Society Canada to leverage the existing infrastructure and provincial funding for community arthritis care. Methods Each step was informed by a User Advisory Panel of stakeholder representatives, including persons with lived experience. First, we identified the target groups and behaviours through consulting stakeholders and current literature. Second, we interviewed persons living with T2DM and knee OA (n = 18), health professionals (HPs) who treat people with T2DM (n = 18) and arthritis therapists (ATs, n = 18) to identify the determinants of seeking and engaging in OA care (patients), assessing and treating OA (HPs) and considering T2DM in OA treatment (ATs), using the Theoretical Domains Framework (TDF). We mapped the content to behavioural change techniques (BCTs) to identify the potential intervention components. Third, we conducted stakeholder meetings to ascertain the acceptability and feasibility of intervention components, including content and modes of delivery. Fourth, we selected intervention components informed by prior steps and constructed a programme theory to inform the implementation of the intervention and its evaluation. Results We identified the barriers and enablers to target behaviours across a number of TDF domains. All stakeholders identified insufficient access to resources to support OA care in people with T2DM. Core intervention components, incorporating a range of BCTs at the patient, HP and AT level, sought to identify persons with knee OA within T2DM care and refer to Arthritis Society Canada for delivery of evidence-based longitudinal OA management. Diverse stakeholder input throughout development allowed the co-creation of an intervention that appears feasible and acceptable to target users. Conclusions We integrated theory, evidence and stakeholder involvement to develop a multifaceted intervention to increase the identification of knee OA in persons with T2DM within diabetes care and improve the uptake and engagement in evidence-based OA management. Our partnership with Arthritis Society Canada supports future spread, scalability and sustainability. We will formally assess the intervention feasibility in a randomized pilot trial.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Improving diagnosis and treatment of knee osteoarthritis in persons with type 2 diabetes: development of a complex intervention

King

Ivers

Waugh

et al. 2023

Implement Sci Commun

Self Cite

View full text Add to dashboard Cite

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Surgeon Alignment With Clinical Practice Guidelines: A Qualitative Analysis of Treatment of Distal Radius Fractures

Schultz,

Eppler,

Shapiro

et al. 2024

Hand (New York, N,Y.)

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Background: Clinical practice guidelines (CPGs) are developed to guide physicians in providing consistent high-quality care. Despite availability of evidence-based guidelines for the treatment of distal radius fractures, prior work suggests many patients receive treatment that is misaligned with the CPG. We sought to explore barriers and facilitators of guideline-aligned care for distal radius fractures. Methods: We conducted semistructured interviews of a purposive sample of surgeons who treat distal radius fractures. Our interview guide was based on the Theoretical Domains Framework (TDF). Interviews were transcribed and coded using a deductive analytical approach within the 14 TDF domains. Belief statements underlying similar codes were developed to describe barriers and facilitators of guideline-aligned care. A content analysis was performed to count the frequency of each TDF domain. Results: We interviewed 14 surgeons. The most common TDF domains were beliefs about consequences (110), knowledge (49), and social influences (29). Belief statements representative of barriers of concordance to the CPGs included, “I am more likely to deviate from the CPGs when the CPGs differ from my professional opinion,” which was coded under beliefs about consequences. Similar belief statements were created for each theme within TDF domains. Conclusion: Decision-making for patients with distal radius fractures is driven by beliefs about consequences, knowledge, and social influences. Strategies to address these beliefs in other fields such as including patient factors in a further structured shared decision-making process, developing implementation toolkits as part of the CPG development process, and implementing payment programs may improve CPG alignment.

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Barriers and enablers to health care providers assessment and treatment of knee osteoarthritis in persons with type 2 diabetes mellitus: A qualitative study using the Theoretical Domains Framework

Cited by 2 publications

References 42 publications

Improving diagnosis and treatment of knee osteoarthritis in persons with type 2 diabetes: development of a complex intervention

Improving diagnosis and treatment of knee osteoarthritis in persons with type 2 diabetes: development of a complex intervention

Surgeon Alignment With Clinical Practice Guidelines: A Qualitative Analysis of Treatment of Distal Radius Fractures

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