Barriers and facilitators to postoperative pain management in Rwanda from the perspective of health care providers: A contextualization of the theory of planned behavior

Abstract

Methods: The theory of planned behavior (TPB) guided development of a questionnaire to measure intent to assess and treat postoperative pain. Focus groups and individual interviews were used to contextualize the final questionnaire and generate questions related to pain management practice. Health care providers from two Rwandan teaching hospitals involved in postoperative pain management completed the TPB questionnaire in May 2015. TPB subscale scores were analyzed to identify demographic and practice characteristics associated with intention to treat pain. The general linear model was used to test effect of attitudes, subjective norms, and perceived control on behavioral intent to treat pain. Results: Forty-six percent of participants (N = 131) had training in acute pain management, 56% used a pain protocol, and 74% used pain scales. Tramadol (78%), morphine (79%), and paracetamol (75%) were used most often to treat pain. Drug availability was the most frequently reported barrier to treating pain. Though intention to treat pain was high, only attitudes and perceived control about assessing pain were associated with intention to treat pain. The theme of fear of the adverse effects of pain medications was consistent across focus groups and interviews in both sites. Conclusions: System and knowledge barriers exist: interventions to address these barriers may lead to improved postoperative pain care. Further validation of the TPB questionnaire is required to address cultural and language factors specific to the Rwandan context. RÉSUMÉBut: Améliorer le transfert des connaissances en matière de prise en charge de la douleur postopératoire au Rwanda en étudiant les facteurs environnementaux et les facteurs liés aux cliniciens qui affectent cette pratique. Méthodes: La théorie du comportement planifié (TCP) a guidé l'élaboration d'un questionnaire visant à mesurer l'intention d'évaluer et de traiter la douleur postopératoire. Des groupes de discussion et des entrevues individuelles ont été utilisées afin de contextualiser le questionnaire final et formuler des questions portant sur les pratiques en matière de gestion de la douleur. Les prestataires de soins de deux hôpitaux universitaires rwandais impliqués dans la prise en charge de la douleur postopératoire ont répondu au questionnaire fondé sur la TCP en mai 2015. Les scores obtenus pour les sous-échelles ont été analysés afin de cerner les caractérisriques démographiques et les caractéristiques liées aux pratiques qui étaient associées à l'intention de traiter la douleur. Le modèle linéaire général a été utilisé afin de tester l'effet des attitudes, des normes subjectives et du contrôle perçu sur l'intention comportementale de traiter la douleur. Résultats: Quarante-six pour cent des participants (N = 131) avaient une formation en prise en charge de la douleur aigue, 56 % utilisaient un protocole de prise en charge de la douleur et 74 % utilisaient des échelles d'évaluation de la douleur. Le tranadol (78 %), la morphine (79 %) et le paracétamol (75 %) étaient le p...

The views of patients, healthcare professionals and hospital officials on barriers to and facilitators of quality pain management in Ethiopian hospitals: A qualitative study

“…However, patients were very comfortable throughout the interview and which might neutralize the possible bias. By using purposive and maximum variation sampling to include a diverse group of participants, however, we may have counteracted this limitation, as indicated by the fact that our findings are in line with previous reports [ 45 , 47 ]. Nevertheless, we cannot guarantee that by using these sampling techniques we included a wide enough variety of people to obtain information on all relevant barriers to and facilitators of QPM, i.e.…”

“…In addition, resource-based limitations, such as the lack of strong analgesics like opioids, prevents HCPs from delivering QPM. A very recent report from Rwanda also stated that the lack of resources was the most frequently identified barrier to adequate treatment of postoperative pain [ 47 ]. In Africa, a lack of resources has prevented the health care system from delivering QPM for several years [ 48 ].…”

Knowledge and associated factors towards post-operative pain management among nurses working at referral hospitals, Ethiopia

“…DOI: https://dx.doi.org/10.17352/ojpm.000023 [6]. Developing countries remain to face this impacts with establishing and maintaining effective programs for the enhancement of POP [8,9]. In Africa, the issue of pain has been visited principally in relative to AIDS and cancer.…”

Exploration of Barriers Perceived by Oncology Nurses Related to Cancer Pain Management

“…This lead to many complications such as anxiety and sleep disturbance and increase patient stay in hospital 4 . Despite of persistent work done on pain management and introduction of advance therapies only slight improvements have been achieved and still 45.6 % of the patients reported pain in early stage of cancer while 73.9 % of the patients reported severe pain in advanced stage of cancer in many settings 5 .…”

“…Oncology nurses are considered to have an obvious role in managing the pain of patients suffering from cancer. However, It is observed that nurses face multiple factors as barriers that cause them to inefficiently participate in assessment and management of pain [5][6][7] . These barriers are lack of pain management specialists in the health care team, improper nurse to patient ratio, religious and cultural misconception about the cancer pain 8 .…”