Skip to main content
Top
Published in:

Open Access 01-12-2024 | Research

Enhancing patient-centred chiropractic care in Canada: identifying barriers, enablers, and strategies through a qualitative needs assessment

Authors: Daphne To, Danielle Southerst, Melissa Atkinson-Graham, Hainan Yu, Gaelan Connell, Crystal Draper, Carol Cancelliere

Published in: Chiropractic & Manual Therapies | Issue 1/2024

Login to get access

Abstract

Background

The Canadian Chiropractic Association (CCA) initiated a quality improvement project to develop best practices aimed at enhancing the patient experience.

Objectives

(1) Identify and prioritise the key moments in the new patient experience that could be improved by providing chiropractors with focused support and resources; (2) explore views, barriers, and enablers to implementing these best practices; and (3) develop recommendations to facilitate the adoption of these practices.

Methods

We conducted a qualitative needs assessment using a human-centred design approach, focused on understanding the needs and experiences of end-users to create tailored solutions. The Theoretical Domains Framework (TDF) was employed to explore chiropractors’ knowledge use and behaviour change, and TDF domains were mapped to Behaviour Change Techniques (BCTs) to develop targeted strategies for addressing identified barriers and enablers. Thirteen chiropractors from across Canada participated in semi-structured interviews and related activities.

Results

The key moments where participants felt they needed the most support were “treatment”, “report of findings”, “informed consent”, “physical examination”, and “before the appointment”. All participants agreed with the best practices seed statements. Key barriers included gaps in knowledge, communication skills, and resource availability, particularly in rural areas. Enablers included collaboration with other health professionals, mentorship, and access to practice tools. Recommendations include enhanced training in communication and treatment planning, increased access to resources in rural areas, and fostering collaborative relationships among health professionals.

Conclusion

Understanding the barriers and enablers to implementing best practices can inform targeted strategies to improve patient-centred care in chiropractic practice across Canada.
Appendix
Available only for authorised users
Literature
1.
go back to reference Institute of Medicine Committee on Quality of Health Care in A. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US) Copyright 2001 by the National Academy of Sciences. All rights reserved.; 2001. Institute of Medicine Committee on Quality of Health Care in A. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington (DC): National Academies Press (US) Copyright 2001 by the National Academy of Sciences. All rights reserved.; 2001.
2.
go back to reference Rathert C, Wyrwich MD, Boren SA. Patient-centered care and outcomes: a systematic review of the literature. Med Care Res Rev. 2012;70(4):351–79.CrossRefPubMed Rathert C, Wyrwich MD, Boren SA. Patient-centered care and outcomes: a systematic review of the literature. Med Care Res Rev. 2012;70(4):351–79.CrossRefPubMed
3.
go back to reference Nundy S, Cooper LA, Mate KS. The quintuple aim for health care improvement: a new imperative to advance health equity. JAMA, J Am Med Assoc. 2022;327(6):521–2.CrossRef Nundy S, Cooper LA, Mate KS. The quintuple aim for health care improvement: a new imperative to advance health equity. JAMA, J Am Med Assoc. 2022;327(6):521–2.CrossRef
4.
6.
go back to reference Bertakis KD, Azari R. Patient-centered care is associated with decreased health care utilization. J Am Board Fam Med. 2011;24(3):229–39.CrossRefPubMed Bertakis KD, Azari R. Patient-centered care is associated with decreased health care utilization. J Am Board Fam Med. 2011;24(3):229–39.CrossRefPubMed
7.
go back to reference Shanafelt TD, Gorringe G, Menaker R, Storz KA, Reeves D, Buskirk SJ, et al. Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin Proc. 2015;90(4):432–40.CrossRefPubMed Shanafelt TD, Gorringe G, Menaker R, Storz KA, Reeves D, Buskirk SJ, et al. Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin Proc. 2015;90(4):432–40.CrossRefPubMed
8.
go back to reference Beliveau PJH, Wong JJ, Sutton DA, Simon NB, Bussières AE, Mior SA, et al. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropr Man Therap. 2017;25:35.CrossRefPubMedPubMedCentral Beliveau PJH, Wong JJ, Sutton DA, Simon NB, Bussières AE, Mior SA, et al. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropr Man Therap. 2017;25:35.CrossRefPubMedPubMedCentral
9.
go back to reference Ipsos. Canadian Chiropractic Association National Poll 2019. 2019. Ipsos. Canadian Chiropractic Association National Poll 2019. 2019.
10.
go back to reference Canadian Chiropractic Association. Consensus Statements on “Best Practices” for the Patient Experience. 2023. Canadian Chiropractic Association. Consensus Statements on “Best Practices” for the Patient Experience. 2023.
11.
go back to reference Birkhäuer J, Gaab J, Kossowsky J, Hasler S, Krummenacher P, Werner C, et al. Trust in the health care professional and health outcome: a meta-analysis. PLoS ONE. 2017;12(2): e0170988.CrossRefPubMedPubMedCentral Birkhäuer J, Gaab J, Kossowsky J, Hasler S, Krummenacher P, Werner C, et al. Trust in the health care professional and health outcome: a meta-analysis. PLoS ONE. 2017;12(2): e0170988.CrossRefPubMedPubMedCentral
12.
go back to reference Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR, Lazaro P, et al. RAND/UCLA appropriateness method user’s manual: RAND corporation Santa Monica, CA; 2000. Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR, Lazaro P, et al. RAND/UCLA appropriateness method user’s manual: RAND corporation Santa Monica, CA; 2000.
14.
go back to reference Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006;26(1):13–24.CrossRefPubMed Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, et al. Lost in knowledge translation: time for a map? J Contin Educ Health Prof. 2006;26(1):13–24.CrossRefPubMed
15.
go back to reference Knudsen SV, Laursen HVB, Johnsen SP, Bartels PD, Ehlers LH, Mainz J. Can quality improvement improve the quality of care? a systematic review of reported effects and methodological rigor in plan-do-study-act projects. BMC Health Serv Res. 2019;19(1):683.CrossRefPubMedPubMedCentral Knudsen SV, Laursen HVB, Johnsen SP, Bartels PD, Ehlers LH, Mainz J. Can quality improvement improve the quality of care? a systematic review of reported effects and methodological rigor in plan-do-study-act projects. BMC Health Serv Res. 2019;19(1):683.CrossRefPubMedPubMedCentral
16.
go back to reference Perla RJ, Provost LP, Parry GJ. Seven propositions of the science of improvement: exploring foundations. Qual Manag Health Care. 2013;22(3):170–86.CrossRefPubMed Perla RJ, Provost LP, Parry GJ. Seven propositions of the science of improvement: exploring foundations. Qual Manag Health Care. 2013;22(3):170–86.CrossRefPubMed
19.
go back to reference Blessing LTM, Chakrabarti A. DRM, a Design Research Methodology. 1st ed. 2009. ed. London: Springer London; 2009. Blessing LTM, Chakrabarti A. DRM, a Design Research Methodology. 1st ed. 2009. ed. London: Springer London; 2009.
20.
go back to reference Roberts JP, Fisher TR, Trowbridge MJ, Bent C. A design thinking framework for healthcare management and innovation. Healthcare. 2016;4(1):11–4.CrossRefPubMed Roberts JP, Fisher TR, Trowbridge MJ, Bent C. A design thinking framework for healthcare management and innovation. Healthcare. 2016;4(1):11–4.CrossRefPubMed
21.
go back to reference Creswell JW, Poth CN. Qualitative inquiry & research design : choosing among five approaches. Fourth edition. ed. Thousand Oaks, California: SAGE; 2018. Creswell JW, Poth CN. Qualitative inquiry & research design : choosing among five approaches. Fourth edition. ed. Thousand Oaks, California: SAGE; 2018.
22.
go back to reference IDEO.org. The Field Guide to Human-Centered Design. Canada2015. IDEO.org. The Field Guide to Human-Centered Design. Canada2015.
25.
go back to reference Atkins L, Francis J, Islam R, O’Connor D, Patey A, Ivers N, et al. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12(1):77.CrossRefPubMedPubMedCentral Atkins L, Francis J, Islam R, O’Connor D, Patey A, Ivers N, et al. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12(1):77.CrossRefPubMedPubMedCentral
26.
go back to reference Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37.CrossRefPubMedPubMedCentral Cane J, O’Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37.CrossRefPubMedPubMedCentral
27.
go back to reference Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14(1):26–33.CrossRefPubMedPubMedCentral Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14(1):26–33.CrossRefPubMedPubMedCentral
28.
go back to reference Carey RN, Connell LE, Johnston M, Rothman AJ, de Bruin M, Kelly MP, et al. Behavior change techniques and their mechanisms of action: a synthesis of links described in published intervention literature. Ann Behav Med. 2019;53(8):693–707.PubMed Carey RN, Connell LE, Johnston M, Rothman AJ, de Bruin M, Kelly MP, et al. Behavior change techniques and their mechanisms of action: a synthesis of links described in published intervention literature. Ann Behav Med. 2019;53(8):693–707.PubMed
29.
go back to reference Michie S, Johnston M, Francis J, Hardeman W, Eccles M. From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol Int Rev. 2008;57(4):660–80.CrossRef Michie S, Johnston M, Francis J, Hardeman W, Eccles M. From theory to intervention: mapping theoretically derived behavioural determinants to behaviour change techniques. Appl Psychol Int Rev. 2008;57(4):660–80.CrossRef
30.
go back to reference Michie S, Wood CE, Johnston M, Abraham C, Francis JJ, Hardeman W. Behaviour change techniques: the development and evaluation of a taxonomic method for reporting and describing behaviour change interventions (a suite of five studies involving consensus methods, randomised controlled trials and analysis of qualitative data). Health Technol Assess. 2015;19(99):1–188.CrossRefPubMedPubMedCentral Michie S, Wood CE, Johnston M, Abraham C, Francis JJ, Hardeman W. Behaviour change techniques: the development and evaluation of a taxonomic method for reporting and describing behaviour change interventions (a suite of five studies involving consensus methods, randomised controlled trials and analysis of qualitative data). Health Technol Assess. 2015;19(99):1–188.CrossRefPubMedPubMedCentral
31.
go back to reference Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.CrossRefPubMed Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349–57.CrossRefPubMed
32.
go back to reference Braun V, Clarke V. Thematic analysis : a practical guide. London: SAGE; 2022.CrossRef Braun V, Clarke V. Thematic analysis : a practical guide. London: SAGE; 2022.CrossRef
33.
go back to reference Foy R, Sales A, Wensing M, Aarons GA, Flottorp S, Kent B, et al. Implementation science: a reappraisal of our journal mission and scope. Implement Sci. 2015;10(1):51.CrossRefPubMedPubMedCentral Foy R, Sales A, Wensing M, Aarons GA, Flottorp S, Kent B, et al. Implementation science: a reappraisal of our journal mission and scope. Implement Sci. 2015;10(1):51.CrossRefPubMedPubMedCentral
35.
go back to reference Michie S, Johnston M, Rothman AJ, de Bruin M, Kelly MP, Carey RN, et al. Developing an evidence-based online method of linking behaviour change techniques and theoretical mechanisms of action: a multiple methods study Health Services and Delivery Research. Southampton (UK): NIHR Journals Library Copyright © Queen’s Printer and Controller of HMSO 2021; 2021. Michie S, Johnston M, Rothman AJ, de Bruin M, Kelly MP, Carey RN, et al. Developing an evidence-based online method of linking behaviour change techniques and theoretical mechanisms of action: a multiple methods study Health Services and Delivery Research. Southampton (UK): NIHR Journals Library Copyright © Queen’s Printer and Controller of HMSO 2021; 2021.
36.
go back to reference Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81–95.CrossRefPubMed Michie S, Richardson M, Johnston M, Abraham C, Francis J, Hardeman W, et al. The behavior change technique taxonomy (v1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med. 2013;46(1):81–95.CrossRefPubMed
37.
go back to reference Johnston M, Carey RN, Connell Bohlen LE, Johnston DW, Rothman AJ, de Bruin M, et al. Development of an online tool for linking behavior change techniques and mechanisms of action based on triangulation of findings from literature synthesis and expert consensus. Transl Behav Med. 2021;11(5):1049–65.CrossRefPubMed Johnston M, Carey RN, Connell Bohlen LE, Johnston DW, Rothman AJ, de Bruin M, et al. Development of an online tool for linking behavior change techniques and mechanisms of action based on triangulation of findings from literature synthesis and expert consensus. Transl Behav Med. 2021;11(5):1049–65.CrossRefPubMed
39.
go back to reference Santana MJ, Manalili K, Jolley RJ, Zelinsky S, Quan H, Lu M. How to practice person-centred care: a conceptual framework. Health Expect. 2018;21(2):429–40.CrossRefPubMed Santana MJ, Manalili K, Jolley RJ, Zelinsky S, Quan H, Lu M. How to practice person-centred care: a conceptual framework. Health Expect. 2018;21(2):429–40.CrossRefPubMed
40.
go back to reference Hutting N, Caneiro JP, Ong’wen OM, Miciak M, Roberts L. Person-centered care for musculoskeletal pain: putting principles into practice. Musculoskelet Sci Pract. 2022;62: 102663.CrossRefPubMed Hutting N, Caneiro JP, Ong’wen OM, Miciak M, Roberts L. Person-centered care for musculoskeletal pain: putting principles into practice. Musculoskelet Sci Pract. 2022;62: 102663.CrossRefPubMed
41.
go back to reference Unsgaard-Tøndel M, Søderstrøm S. Building therapeutic alliances with patients in treatment for low back pain: a focus group study. Physiother Res Int. 2022;27(1): e1932.CrossRefPubMed Unsgaard-Tøndel M, Søderstrøm S. Building therapeutic alliances with patients in treatment for low back pain: a focus group study. Physiother Res Int. 2022;27(1): e1932.CrossRefPubMed
42.
go back to reference Moore L, Britten N, Lydahl D, Naldemirci Ö, Elam M, Wolf A. Barriers and facilitators to the implementation of person-centred care in different healthcare contexts. Scand J Caring Sci. 2017;31(4):662–73.CrossRefPubMed Moore L, Britten N, Lydahl D, Naldemirci Ö, Elam M, Wolf A. Barriers and facilitators to the implementation of person-centred care in different healthcare contexts. Scand J Caring Sci. 2017;31(4):662–73.CrossRefPubMed
43.
go back to reference King LK, Waugh EJ, MacKay C, Stanaitis I, Krystia O, Stretton J, et al. Formulating knee osteoarthritis management plans taking type 2 diabetes into account: qualitative study of arthritis therapists using theoretical domains framework. J Rheumatol. 2022;49(12):1365–71.CrossRefPubMed King LK, Waugh EJ, MacKay C, Stanaitis I, Krystia O, Stretton J, et al. Formulating knee osteoarthritis management plans taking type 2 diabetes into account: qualitative study of arthritis therapists using theoretical domains framework. J Rheumatol. 2022;49(12):1365–71.CrossRefPubMed
44.
go back to reference Stilwell P, Hayden JA, Des Rosiers P, Harman K, French SD, Curran JA, et al. A qualitative study of doctors of chiropractic in a nova scotian practice-based research network: barriers and facilitators to the screening and management of psychosocial factors for patients with low back pain. J Manip Physiol Ther. 2018;41(1):25–33.CrossRef Stilwell P, Hayden JA, Des Rosiers P, Harman K, French SD, Curran JA, et al. A qualitative study of doctors of chiropractic in a nova scotian practice-based research network: barriers and facilitators to the screening and management of psychosocial factors for patients with low back pain. J Manip Physiol Ther. 2018;41(1):25–33.CrossRef
45.
go back to reference To D, Hall A, Bussières A, French SD, Lawrence R, Pike A, et al. Exploring factors influencing chiropractors’ adherence to radiographic guidelines for low back pain using the theoretical domains framework. Chiropr Man Therap. 2022;30(1):23.CrossRefPubMedPubMedCentral To D, Hall A, Bussières A, French SD, Lawrence R, Pike A, et al. Exploring factors influencing chiropractors’ adherence to radiographic guidelines for low back pain using the theoretical domains framework. Chiropr Man Therap. 2022;30(1):23.CrossRefPubMedPubMedCentral
46.
go back to reference Younas A, Inayat S, Masih S. Nurses’ perceived barriers to the delivery of person-centred care to complex patients: a qualitative study using theoretical domains framework. J Clin Nurs. 2023;32(3–4):368–81.CrossRefPubMed Younas A, Inayat S, Masih S. Nurses’ perceived barriers to the delivery of person-centred care to complex patients: a qualitative study using theoretical domains framework. J Clin Nurs. 2023;32(3–4):368–81.CrossRefPubMed
47.
go back to reference Beres LK, Simbeza S, Holmes CB, Mwamba C, Mukamba N, Sharma A, et al. Human-centered design lessons for implementation science: improving the implementation of a patient-centered care intervention. J Acquir Immune Defic Syndr. 2019;82:S230–43.CrossRefPubMedPubMedCentral Beres LK, Simbeza S, Holmes CB, Mwamba C, Mukamba N, Sharma A, et al. Human-centered design lessons for implementation science: improving the implementation of a patient-centered care intervention. J Acquir Immune Defic Syndr. 2019;82:S230–43.CrossRefPubMedPubMedCentral
48.
go back to reference Tzortziou Brown V, Underwood M, Westwood OM, Morrissey D. Improving the management of musculoskeletal conditions: can an alternative approach to referral management underpinned by quality improvement and behavioural change theories offer a solution and a better patient experience? a mixed-methods study. BMJ Open. 2019;9(2): e024710.CrossRefPubMedPubMedCentral Tzortziou Brown V, Underwood M, Westwood OM, Morrissey D. Improving the management of musculoskeletal conditions: can an alternative approach to referral management underpinned by quality improvement and behavioural change theories offer a solution and a better patient experience? a mixed-methods study. BMJ Open. 2019;9(2): e024710.CrossRefPubMedPubMedCentral
Metadata
Title
Enhancing patient-centred chiropractic care in Canada: identifying barriers, enablers, and strategies through a qualitative needs assessment
Authors
Daphne To
Danielle Southerst
Melissa Atkinson-Graham
Hainan Yu
Gaelan Connell
Crystal Draper
Carol Cancelliere
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Chiropractic & Manual Therapies / Issue 1/2024
Electronic ISSN: 2045-709X
DOI
https://doi.org/10.1186/s12998-024-00560-1