背景:物理治疗提供非侵入性和非药物干预治疗,康复和预防目的。物理治疗也是健康促进的中心提供者。随着非传染性疾病和慢性健康状况的全球负担不断增加,理疗服务的重要性增加。不幸的是,低收入和中等收入国家(LMICs)的理疗服务通常不能令人满意.在尼泊尔,2015年的地震和COVID大流行清楚地说明了物理治疗的重要性。
目的:这项定性研究旨在确定不同系统级别的障碍和促进因素,以加强尼泊尔的理疗服务。
方法:对不同的医疗服务提供者进行了40次半结构化个体访谈。转录访谈通过主题分析进行评估。五级社会生态框架概念化了障碍和促进者的多级决定因素。
结果:该研究揭示了五个不同层次的潜在障碍和促进因素,即个人(带头,需要倡导),人际关系(缺乏认可和自主性,转介和协调的网络),社区(缺乏知识和意识,社会和家庭支持),组织(可访问性,工作场所和临床实践,教育机会,组织和康复中心的作用),和公共政策层面(政策和方案的规划和实施,医疗霸权,优先事项)。政府官员,当地领导人,和临床医生,其中一半是物理治疗师,在许多相同的问题上达成一致,在那里,缺乏对物理治疗的认识和对物理治疗师做什么的知识是核心。
结论:结果通过指出需要注意的关键要素,为物理治疗的发展提供了信息。我们广泛而结构化的调查策略适用于其他人,以全面分析理疗服务的障碍和促进者。
BACKGROUND: Physiotherapy provides non-invasive and non-pharmaceutical intervention for curative, rehabilitation and preventative purposes. Physiotherapy is also a central provider of health promotion. As the global burden of non-communicable diseases and chronic health conditions is rising, the importance of physiotherapy services increases. Unfortunately, physiotherapy services in low- and middle-income countries (LMICs) are generally unsatisfactory. In Nepal, the earthquake in 2015 and the COVID pandemic have clearly illuminated the importance of physiotherapy.
OBJECTIVE: This qualitative study aimed to identify barriers and facilitators at different system levels for strengthening physiotherapy services in Nepal.
METHODS: Forty semi-structured individual interviews were performed with different health providers. Transcribed interviews were assessed with thematic analysis. A five-level socioecological framework conceptualised multilevel determinants of barriers and facilitators.
RESULTS: The study revealed various factors that were potential barriers and facilitators across five different levels, namely individual (taking the lead, need for advocacy), interpersonal (lack of recognition and autonomy, networking for referrals and coordination), community (lack of knowledge and awareness, social and family support), organisational (accessibility, workplace and clinical practice, educational opportunities, role of organisations and rehabilitation centres), and public policy level (planning and implementation of policies and programs, medical hegemony, priorities). Government officials, local leaders, and clinicians, half of whom were physiotherapists, agreed on many of the same issues, where a lack of awareness of what physiotherapy is and knowledge about what physiotherapists do was central.
CONCLUSIONS: The results provide information for the development of physiotherapy by pointing out key elements that need attention. Our broad and structured investigation strategy is applicable to others for a comprehensive analysis of barriers and facilitators for physiotherapy services.