Improving adoption of osteoarthritis management programs: Using co-design to prioritise and address barriers

Abstract

Purpose (the aim of the study): Substantial efforts have been made to improve access to best-evidence first-line care for osteoarthritis (OA) through developing and evaluating OA management programs. Continuous evaluation and refinement of these programs is needed to ensure they are up-to-date and deliver evidence-based care as intended. The OA Chronic Care Program (OACCP) was implemented in public hospitals across New South Wales, Australia, in 2011. The OACCP is a 9-12-month program delivered over several visits by a multidisciplinary team. It aims to reduce pain, increase function and improve the quality of life of people living with OA through the provision of tailored interventions. We previously identified barriers to OACCP adoption. This study used a stakeholder co-design framework to prioritise the barriers in order of perceived importance and to develop an action plan to address them. METHODS: The stakeholders consisted of OACCP staff, health managers, policy makers and people with OA, and were identified through Sydney Health Partners (SHP). SHP is a unique collaboration between five major Sydney local health districts, the University of Sydney, and 11 affiliated medical research institutes. We used the seven-step 'Co-design Framework for Public Service Design' (Trischler et al, 2019), which involved the following: Resourcing: semi-structured interviews and a survey from previous work identified 20 barriers and four facilitators to OACCP adoption. Planning: the reults of the interviews and survey informed the development of the design task and aims. Recruitment: we recruited stakeholders to engage as investigators. Sensitisation: we presented the previous results to the investigators for reflection and group discussions. The barriers were then ranked and prioritised in an online survey, and written documents reviewed by the investigators. Facilitation: five 60-minute online workshops were conducted over four months. The barriers were mapped to the Theoretical Domains Framework which was used to identify factors influencing health professional and patient behaviours. The investigators were invited to propose and discuss potential strategies to address the barriers. Reflecting: the barriers and potential strategies were compiled and presented to the investigators for further discussion. Building for change: a plan of strategies was circulated for review until all investigators approved the plan. RESULTS: We recruited six physiotherapists and one health manager across three large, diverse NSW local health districts. We also recruited one consumer with lived experience of OA and two NSW Agency for Clinical Innovation policy makers. The ten stakeholder investigators completed the survey. The two top-ranked barriers were related to the reduced capability of OACCP coordinators to support long-term behaviour change, and to set goals with OACCP participants. The top eight barriers to adopting the OACCP are shown in Table 1, the barriers considered to be related to each other were grouped. The proposed strategies to address the barriers were presented according to the target populations: participant, staff or health system level. The first barriers to be addressed will be reduced confidence of OACCP staff in supporting participants in achieving long-term behaviour change, goal setting and chronic disease management. We will also address participant fears and misconceptions about OA and unhelpful attitudes towards OA treatments. The strategies designed to address these barriers include staff education and training, participant educational materials and a shared decision-making tool. CONCLUSIONS: We used a data-driven approach and adopted a theory-informed co-design framework to interpret the results of our previous work, prioritise the barriers to the adoption of the OACCP and develop a plan of action with specific strategies to address the barriers.