Experiences of health care access challenges for back pain care across the rural-urban continuum: A protocol paper (Preprint)

Abstract

BACKGROUND Back pain is a common and costly problem, with negative impacts on both individuals and the healthcare system. Rural, remote, and Indigenous populations are at greater risk of experiencing back pain compared to urban and non-Indigenous populations. Potential barriers to health care access among Canadians with chronic back pain (CBP) have been identified; however, no known study has used lived experiences of people with CBP to drive the selection, analysis, and interpretation of variables most meaningful to patients. OBJECTIVE 1) Engage with rural, remote, and urban Indigenous and non-Indigenous patients, health care providers, and health system decision makers to explore lived experiences of attempting to access health care among people with CBP in Saskatchewan, Canada; 2) Co-create meaningful indicators of CBP care access and effectiveness; 3) Identify program and policy recommendations to overcome access barriers to CBP care. METHODS Phase 1) One-on-one interviews with 30 people with current or past CBP and 10 health care providers residing or practicing in rural, remote, or urban Saskatchewan communities will be conducted. We will recruit Indigenous (10) and non-Indigenous (20) rural, remote and urban people. Phase 2) Findings from the interviews will inform development of a population-based telephone survey focused on access to health care barriers and facilitators among rural, remote and urban people; this survey will be administered to 383 residents with CBP across Saskatchewan. Phase 3) Phase 1 & 2 findings will be presented to provincial and national policy makers, health system decision makers, health care providers, rural, remote, and urban people with CBP and their communities, and other knowledge users at an interactive end-of-project knowledge translation event. A World Café method will be used to facilitate interactive dialogue designed to catalyse future patient-oriented research and pathways to improve access to CBP care. Patient engagement: People with lived experience of CBP, including Indigenous and non-Indigenous people from rural, remote, and urban communities (i.e. ‘patient partners’) are equal members of the research team for this patient-oriented project. Patient partners are engaged throughout the entire research process and will provide unique knowledge from the patient perspective to ensure more comprehensive collection of data, while shaping culturally appropriate messages and identifying target audiences and methods of sharing findings to knowledge users. RESULTS Participant recruitment began in January 2021. Final results are anticipated in late 2022. CONCLUSIONS This study will privilege CBP patient experiences to better understand current health care use and potential access challenges and facilitators among rural, remote, and urban people living with CBP in Saskatchewan. Our study aims to inform the development of comprehensive measures that will be sensitive to geographical location and relevant to culturally diverse people with CBP, ultimately leading to enhanced access to more patient-centred care for CBP.