Top

BMC Health Services Research

Published in:

Open Access 01-12-2024 | Carpal Tunnel Syndrome | Research

Patient experiences and perspectives of health service access for carpal tunnel syndrome in Aotearoa New Zealand: a normalisation process theory-informed qualitative study

Authors: Miranda Bűhler, Carol Atmore, Meredith Perry, Sue Crengle, Pauline Norris, G. David Baxter

Published in: BMC Health Services Research | Issue 1/2024

Abstract

Background

Early access to care for carpal tunnel syndrome (CTS) can avoid higher rates of surgery and permanent harm yet is often delayed, particularly for populations more likely to underutilise care.

Objective

We sought to explore patient experiences and perspectives of health service access for CTS to inform an equity-focussed co-design of a health service for improving early care access.

Methods

In this Normalisation Process Theory (NPT)-informed qualitative study we conducted semistructured in-depth interviews with 19 adults with experience of CTS. Recruitment prioritised New Zealand Māori, Pasifika, low-income, and rural populations. Data were analysed using deductive then inductive thematic analysis.

Results

We identified five major themes: (1) the ‘Significant Impact of CTS’ of the sense-making and relational work to understand the condition, deciding when to get care, compelling clinicians to provide care, and garnering help from others; (2) ‘Waiting and Paying for Care’– the enacting, relational, and appraising work to avoid long wait times unless paying privately, particularly where quality of care was low, employment relations poor, or injury compensation processes faltered; (3) circumstances of ‘Occupation and CTS Onset’ whereby the burden of proof to relate onset of CT symptoms to occupation created excessive relational and enacting work; (4) the ‘Information Scarcity’ of good information about CTS and the high relational and appraising work associated with using online resources; (5) ‘Negotiating Telehealth Perspectives’ where telehealth was valued if it meant earlier access for all despite the challenges it held for many.

Conclusion

Quality, culturally and linguistically responsive information and communication from clinicians and health services will improve equitable early access to CTS care including realising the potential of telehealth modes of care. Policy changes that reduce individual burden of proof in injury compensation claims processes, enable time off work to attend health appointments, and increase public funding for surgical resources would improve early access to CTS care particularly for Māori and Pacific populations and those in small and rural workplaces. NPT is valuable for understanding where opportunities lie to reduce inequitable delays to accessing care including the impact of racism, particularly for populations more likely to underutilise care.

Available only for authorised users

British Orthopaedic Association. Comissioning guide: Treatment of carpal tunnel syndrome. 2017. Accessed 2 Feb 2020. https://www.rcseng.ac.uk/-/media/files/rcs/standards-and-research/commissioning/boa--carpal-tunnel-syndrome-guide-2017.pdf

Erickson M, Lawrence M, Stegnik Jansen CW, Coker D, Amadio P, Cleary C. Hand pain and sensory deficits: carpal tunnel syndrome. J Orthop Sports Phys Therapy. 2019;49(5):CPG1–85. https://doi.org/10.2519/jospt.2019.0301

Padua L, Coraci D, Erra C, et al. Carpal tunnel syndrome: clinical features, diagnosis, and management. Lancet Neurol. 2016;15(12):1273–84. https://doi.org/10.1016/s1474-4422(16)30231-9CrossRefPubMed

Patel A, Culbertson MD, Patel A, et al. The negative effect of carpal tunnel syndrome on sleep quality. Sleep Disorders. 2014;2014:1–7. https://doi.org/10.1155/2014/962746CrossRef

Baldwin J, Briggs A, Bagg W, Larmer P. An osteoarthritis model of care should be a national priority for New Zealand. N Z Med J. 2017;130(1467):78–86.PubMed

Choojaturo S, Sindhu S, Utriyaprasit K, Viwatwongkasem C. Factors associated with access to health services and quality of life in knee osteoarthritis patients: a multilevel cross-sectional study. BMC Health Serv Res Oct. 2019;11(1):688. https://doi.org/10.1186/s12913-019-4441-2CrossRef

Ackerman IN, Livingston JA, Osborne RH. Personal perspectives on enablers and barriers to accessing care for hip and knee osteoarthritis. Phys Ther. 2016;96(1):26–36. https://doi.org/10.2522/ptj.20140357CrossRefPubMed

Goodyear-Smith F, Ashton T. New Zealand health system: universalism struggles with persisting inequities. Lancet. 2019;394(10196):432–42. https://doi.org/10.1016/s0140-6736(19)31238-3CrossRefPubMed

Jatrana S, Crampton P. Do financial barriers to access to primary health care increase the risk of poor health? Longitudinal evidence from New Zealand. Soc Sci Med. 2020;28:113255. https://doi.org/10.1016/j.socscimed.2020.113255CrossRef

10.

Wyeth EH, Samaranayaka A, Davie G, Derrett S. Prevalence and predictors of disability for Māori 24 months after injury. Aust Nz J Publ Heal Jun. 2017;41(3):262–8. https://doi.org/10.1111/1753-6405.12657CrossRef

11.

Sopoaga F, Parkin L, Gray A. A Pacific population’s access to and use of health services in Dunedin. N Z Med J. 2012;125(1364):27–36.PubMed

12.

Perry M. Musculoskeletal physiotherapy provided within a community health centre improves access. N Z J Physiotherapy. 2015;43(2). https://doi.org/10.15619/nzjp/43.2.03

13.

Treasury. Statistical Analysis of Ethnic Wage Gaps in New Zealand. 2018. March. Accessed 15 Jan 2021. https://www.treasury.govt.nz/sites/default/files/2018-08/ap18-03.pdf

14.

Singh R, Gamble G, Cundy T. Lifetime risk of symptomatic carpal tunnel syndrome in type 1 diabetes. Diabet Med. 2005;22:625–30.CrossRefPubMed

15.

Harwood M, Tipene-Leach D. Diabetes. In: Robson B, Harris R, editors. Hauora: Māori standards of Health IV A study of the years 2000–2005. Te Rōpū Rangahau Hauora a Eru Pōmare; 2007. Chap. 9.

16.

Teng A, Blakely T, Scott N, et al. What protects against pre-diabetes progressing to diabetes? Observational study of integrated health and social data. Diabetes Res Clin Pract Feb. 2019;148:119–29. https://doi.org/10.1016/j.diabres.2018.12.003CrossRef

17.

National Health Committee. Rural health: Challenges of distance, opportunities for innovation. 2010. https://www.moh.govt.nz

18.

New Zealand Council of Trade Unions. Under pressure: A detailed report into insecure work in New Zealand. 2013. October. Accessed 3 Nov 2021. www.union.org.nz/underpressure

19.

Te Whatu Ora Health NZ and Te Aka Whai Ora. Te Pae Tata interim New Zealand health plan. 2022. www.TeWhatuOra.govt.nz

20.

McGeoch G, Anderson I, Gibson J, Gullery C, Kerr D, Shand B. Consensus pathways: evidence into practice. N Z Med J. 2015;128(1408):86–96.PubMed

21.

bpacNZ better medicine. Referral of patients with features suggestive of bowel cancer: Ministry of Health guidance. Ministry of Health Cancer Control Agency. Accessed Jul 10. 2020. https://bpac.org.nz/2020/bowel-cancer.aspx

22.

Lee XJ, Blythe R, Choudhury AAK, Simmons T, Graves N, Kularatna S. Review of methods and study designs of evaluations related to clinical pathways. Aust Health Rev Aug. 2019;43(4):448–56. https://doi.org/10.1071/AH17276CrossRef

23.

Kenealy TW, SN F, Connolly MJ. HealthPathways website: making the right thing the easy thing to do? N Z Med J. 2015;128(1408):6–9.PubMed

24.

Wright-Chisem J, Trehan S. The hand and wrist examination for video telehealth encounters. HSS J Feb. 2021;17(1):70–4. https://doi.org/10.1177/1556331620975341CrossRef

25.

Lim AM, Pranata R. Letter to the editor regarding ‘the challenging battle of mankind against COVID-19 outbreak: is this global international biological catastrophe the beginning of a new era?’ - is telehealth the future of orthopaedic and rehabilitation in post-COVID-19 era? J Orthop Surg-Hong K. 2020;28(3):2309499020947840. https://doi.org/10.1177/2309499020947840CrossRef

26.

Greenhalgh T, Procter R, Wherton J, Sugarhood P, Shaw S. The organising vision for telehealth and telecare: discourse analysis. BMJ Open. 2012;2(4). https://doi.org/10.1136/bmjopen-2012-001574

27.

Gurney J, Fraser L, Ikihele A, Manderson J, Scott N, Robson B. February. Telehealth as a tool for equity: pros, cons and recommendations. N Z Med J. 2021;134(1530):111–115.

28.

Brix J, Krogstrup HK, Mortensen NM. Evaluating the effects of co-production initiatives in public service organizations. Presented at: the XVIII Nordic Political Science Congress; August 8–11 2017; Odense, Denmark.

29.

Areskoug Josefsson K, Andersson A-C, Lee A. The co-constructive processes in physiotherapy. Cogent Med. 2017;4(1). https://doi.org/10.1080/2331205x.2017.1290308

30.

May C, Finch T. Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology. 2009;43(3):535–54. https://doi.org/10.1177/0038038509103208CrossRef

31.

May CR, Eton DT, Boehmer K et al. Rethinking the patient: using burden of treatment theory to understand the changing dynamics of illness. BMC Health Serv Res. 2014;14(281).

32.

Huddlestone L, Turner J, Eborall H, Hudson N, Davies M, Martin G. Application of normalisation process theory in understanding implementation processes in primary care settings in the UK: a systematic review. BMC Fam Pract Mar. 2020;16(1):52. https://doi.org/10.1186/s12875-020-01107-yCrossRef

33.

Boyd H, McKernon S, Old A. Health Service Co-design: Working with patients to improve healthcare services. 2010. 978-0-473-17835-2. Accessed 4 Mar 2020. www.healthcodesign.org.nz

34.

Friedberg MW, Edelen MO, Hirshman S, et al. Development and psychometric analysis of the revised patient perceptions of integrated care survey. Med Care Res Rev Apr. 2019;15:1077558719842951. https://doi.org/10.1177/1077558719842951CrossRef

35.

Health Quality and Safety Commission New Zealand. New Zealand patient experience adult primary care questionnaire. Wellington, NZ: New Zealand Government; 2020.

36.

Durie M. Whaiora: Māori health development. 2nd ed. Oxford University Press; 1998.

37.

Bryant KAP. He kiteka hauā i Murihiki. University of Otago; 2016.

38.

Perry B. Household incomes in New Zealand: Trends in indicators of inequality and hardship 1982 to 2018. 2019. Accessed 10 Dec 2020. https://www.msd.govt.nz/about-msd-and-our-work/publications-resources/monitoring/household-incomes/index.html

39.

Statistics New Zealand. Urban rural boundaries at 1 January 2020. 2020. Accessed 21 Jan 2021. https://datafinder.stats.govt.nz/layer/104269-urban-rural-2020-generalised/

40.

Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oaCrossRef

41.

Levine DW, Simmons BP, Koris MJ, et al. A self-administered questionnaire for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am. 1993;75A(11):1585–92.CrossRef

42.

Mehta SP, Weinstock-Zlotnick G, Akland KL, Hanna MM, Workman KJ. Using Carpal Tunnel Questionnaire in clinical practice: a systematic review of its measurement properties. J Hand Ther. 2020;33(4):493–506. https://doi.org/10.1016/j.jht.2019.12.011.

43.

Bakhsh H, Ibrahim I, Khan W, Smitham P, Goddard N. Assessment of validity, reliability, responsiveness and bias of three commonly used patient-reported outcome measures in carpal tunnel syndrome. Ortop Traumatol Rehabil Jul-Aug. 2012;14(4):335–40. https://doi.org/10.5604/15093492.1005085CrossRef

44.

Storey PA, Fakis A, Hilliam R, Bradley MJ, Lindau T, Burke FD, Levine-Katz (Boston) Questionnaire analysis, editors. means, medians or grouped totals? J Hand Surg-Eur Vol. 2009;34(6):810–2. https://doi.org/10.1177/1753193408104560

45.

Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099–104. https://doi.org/10.1016/S0140-6736(05)71146-6CrossRefPubMed

46.

Keene L, Dalton S. Closing the gaps: health equity by 2040. N Z Med J. 2021;134(1543):12–8.PubMed

47.

Ministry of Health. Health and Disability System Review - final report - Pūrongo Whakamutunga. 2020. March. www.systemreview.health.govt.nz/final-report

48.

World Health Organisation. A conceptual framework for action on the social determinants of health: social determinants of health discussion paper 2. 2010. https://www.who.int/publications/i/item/9789241500852

49.

Reeves JJ, Ayers JW, Longhurst CA. Telehealth in the COVID-19 era: a balancing act to avoid harm. J Med Internet Res Feb. 2021;1(2):e24785. https://doi.org/10.2196/24785CrossRef

50.

Imlach F, McKinlay E, Middleton L, et al. Telehealth consultations in general practice during a pandemic lockdown: survey and interviews on patient experiences and preferences. BMC Fam Pract Dec. 2020;13(1):269. https://doi.org/10.1186/s12875-020-01336-1CrossRef

51.

Lacey C, Huria T, Beckert L, Gilles M, Pitama S. The Hui process: a framework to enhance the doctor–patient relationship with Māori. N Z Med J. 2011;124(1347):72–8.PubMed

52.

Signal N, Martin T, Leys A, Maloney R, Bright F. Implementation of telerehabilitation in response to COVID-19: lessons learnt from neurorehabilitation clinical practice and education. N Z J Physiother. 2020;48(3):117–26. https://doi.org/10.15619/NZJP/48.3.03CrossRef

53.

Martin H. Patients’ health beliefs and adaptation to carpal tunnel syndrome based on duration of symptomatic presentation. J Hand Ther Jan-Mar. 2007;20(1):29–35. https://doi.org/10.1197/j.jht.2006.10.002. quiz 36.CrossRef

54.

Jerosch-Herold C, Mason R, Chojnowski AJ. A qualitative study of the experiences and expectations of surgery in patients with carpal tunnel syndrome. J Hand Ther Jan-Mar. 2008;21(1):54–61. https://doi.org/10.1197/j.jht.2007.09.001. quiz 62.CrossRef

55.

Levesque J-F, Harris MF, Russell G. Patient-centred access to health care: conceptualising access at the interface of health systems and populations. Int J Equity Health. 2013;12(18). https://doi.org/10.1186/1475-9276-12-18

56.

Hamed S, Bradby H, Ahlberg BM, Thapar-Björkert S. Racism in healthcare: a scoping review. BMC Public Health. 2022;22(1):988–988. https://doi.org/10.1186/s12889-022-13122-yCrossRefPubMedPubMedCentral

57.

Harris RB, Stanley J, Cormack DM. Racism and health in New Zealand: prevalence over time and associations between recent experience of racism and health and wellbeing measures using national survey data. PLoS ONE. 2018;13(5):e0196476–0196476. https://doi.org/10.1371/journal.pone.0196476CrossRefPubMedPubMedCentral

58.

Palmer SC, Gray H, Huria T, Lacey C, Beckert L, Pitama SG. Reported Māori consumer experiences of health systems and programs in qualitative research: a systematic review with meta-synthesis. Int J Equity Health Oct. 2019;28(1):163. https://doi.org/10.1186/s12939-019-1057-4CrossRef

59.

Graham R, Masters-Awatere B. Experiences of Māori of Aotearoa New Zealand’s public health system: a systematic review of two decades of published qualitative research. Aust N Z J Public Health Jun. 2020;44(3):193–200. https://doi.org/10.1111/1753-6405.12971CrossRef

60.

Houkamau CA, Stronge S, Sibley CG. The prevalence and impact of racism toward indigenous Māori in New Zealand. Int Perspect Psychol: Res Pract Consultation. 2017;6(2):61–80. https://doi.org/10.1037/ipp0000070CrossRef

61.

Te Karu L, Harwood M, Arroll B, Bryant L, Kenealy T. The inequity of access to health: a case study of patients with gout in one general practice. N Z Med J. 2021;134(1543):51–8.

62.

Signal L, Martin J, Cram F, Robson B. The Health Equity Assessment Tool: A user’s guide. 2008. Accessed 10 Aug 2021. http://www.moh.govt.nz

63.

Health Quality and Safety Commission New Zealand. A window on the quality of Aotearoa New Zealand’s health care 2019. 2019. May. https://www.hqsc.govt.nz/assets/Health-Quality-Evaluation/PR/Window_2019_web_final.pdf

64.

Curtis E, Jones R, Tipene-Leach D, et al. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. Int J Equity Health Nov. 2019;14(1):174. https://doi.org/10.1186/s12939-019-1082-3CrossRef

65.

May CR, Finch TL, Cornford J, et al. Integrating telecare for chronic disease management in the community: what needs to be done? BMC Health Serv Res. 2011;11:131. https://doi.org/10.1186/1472-6963-11-131CrossRef

66.

McEvoy R, Ballini L, Maltoni S, O’Donnell CA, Mair FS, MacFarlane A. A qualitative systematic review of studies using the normalization process theory to research implementation processes. Implement Sci. 2014;9(2). https://doi.org/10.1186/1748-5908-9-2

Title: Patient experiences and perspectives of health service access for carpal tunnel syndrome in Aotearoa New Zealand: a normalisation process theory-informed qualitative study
Authors: Miranda Bűhler
Carol Atmore
Meredith Perry
Sue Crengle
Pauline Norris
G. David Baxter
Publication date: 01-12-2024
Publisher: BioMed Central
Keywords: Carpal Tunnel Syndrome
Carpal Tunnel Syndrome
Telemedicine
Published in: BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-024-10871-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Patient experiences and perspectives of health service access for carpal tunnel syndrome in Aotearoa New Zealand: a normalisation process theory-informed qualitative study

Abstract

Background

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

Spatio-temporal modelling of referrals to outpatient respiratory clinics in the integrated care system of the Morecambe Bay area, England

Hospital length of stay and readmission after elective surgery: a comparison of current and former smokers with non-smokers

Applying the UTAUT2 framework to patients’ attitudes toward healthcare task shifting with artificial intelligence

The implementation of a perioperative medicine for older people undergoing surgery service: a qualitative case study

Implementing a new living concept for persons with dementia in long-term care: evaluation of a quality improvement process

Effect of social capital on enrolment of informal sector occupational groups in the national health insurance scheme in Ghana: a cross-sectional survey