Consumers’ experiences of back pain in rural Western Australia: access to information and services, and self-management behaviours

Abstract

BackgroundCoordinated, interdisciplinary services, supported by self-management underpin effective management for chronic low back pain (CLBP). However, a combination of system, provider and consumer-based barriers exist which limit the implementation of such models into practice, particularly in rural areas where unique access issues exist. In order to improve health service delivery for consumers with CLBP, policymakers and service providers require a more in depth understanding of these issues. The objective of this qualitative study was to explore barriers experienced by consumers in rural settings in Western Australia (WA) to accessing information and services and implementing effective self-management behaviours for CLBP.MethodsFourteen consumers with a history of CLBP from three rural sites in WA participated. Maximum variation sampling was employed to ensure a range of experiences were captured. An interviewer, blinded to quantitative pain history data, conducted semi-structured telephone interviews using a standardised schedule to explore individuals’ access to information and services for CLBP, and self-management behaviours. Interviews were digitally recorded and transcribed verbatim. Inductive analysis techniques were used to derive and refine key themes.ResultsFive key themes were identified that affected individuals’ experiences of managing CLBP in a rural setting, including: 1) poor access to information and services in rural settings; 2) inadequate knowledge and skills among local practitioners; 3) feelings of isolation and frustration; 4) psychological burden associated with CLBP; and 5) competing lifestyle demands hindering effective self-management for CLBP.ConclusionsConsumers in rural WA experienced difficulties in knowing where to access relevant information for CLBP and expressed frustration with the lack of service delivery options to access interdisciplinary and specialist services for CLBP. Competing lifestyle demands such as work and family commitments were cited as key barriers to adopting regular self-management practices. Consumer expectations for improved health service coordination and a workforce skilled in pain management are relevant to future service planning, particularly in the contexts of workforce capacity, community health services, and enablers to effective service delivery in primary care.

“A life of living death”: the experiences of people living with chronic low back pain in rural Nigeria

“…The cyclical experience of CLBP increases distress when interpreted as unpredictable. [21,22,24] The negative perception of the Nigerian rural-urban disparity, [9] similar to findings in rural Western Australia [76] was associated with poor Nigerian rural health services. [16,17,19,20] This may compound the impact of CLBP when combined with an acute biomedically oriented urban health care services.…”

Implementing Evidence-Informed Policy into Practice for Health Care Professionals Managing People with Low Back Pain in Australian Rural Settings: A Preliminary Prospective Single-Cohort Study

“…Following the implementation of this educational intervention, primary care physicians in metropolitan Perth, Western Australia (WA) adopted more self‐reported evidence‐based attitudes, beliefs, and clinical behaviors regarding nsLBP [19]; however, this same implementation approach has not been trialled for care providers working in rural WA, an area with a unique system and service challenges. Given the recognized need for best practice care for consumers with nsLBP and the inequities in delivery of this care in rural WA [13], we expanded our education program beyond physicians to include the broader primary care health workforce. The aim of this preliminary study was to trial the implementation of this educational program and to evaluate the short‐term effectiveness in improving the self‐reported evidence‐based management of nsLBP by primary care providers in rural areas of WA.…”

Models of care for musculoskeletal health in Australia: now more than ever to drive evidence into health policy and practice

“…For example, it may be impractical to deliver services in some areas due to a lack of workforce volume and infrastructure capability, and thus e-health initiatives may be a preferable option. 13 Another important attribute of MoCs which more readily facilitates implementation than other health policies or guidelines is the contemporary manner in which they have been developed. Nowadays a network model and the rigorous use of evidence are critical components to MoC development.…”