Barriers and enablers to health care providers assessment and treatment of knee osteoarthritis in persons with type 2 diabetes mellitus: A qualitative study using the Theoretical Domains Framework

Lauren K. King; Owen Krystia; Esther J. Waugh; Crystal MacKay; Ian Stanaitis; Jane Stretton; Alanna Weisman; Noah M. Ivers; Janet A. Parsons; Lorraine Lipscombe; Gillian A. Hawker

Osteoarthritis and Cartilage Open (Dec 2022)

Barriers and enablers to health care providers assessment and treatment of knee osteoarthritis in persons with type 2 diabetes mellitus: A qualitative study using the Theoretical Domains Framework

Lauren K. King,
Owen Krystia,
Esther J. Waugh,
Crystal MacKay,
Ian Stanaitis,
Jane Stretton,
Alanna Weisman,
Noah M. Ivers,
Janet A. Parsons,
Lorraine Lipscombe,
Gillian A. Hawker

Affiliations

Lauren K. King: Department of Medicine, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Corresponding author. Department of Medicine, University of Toronto, Women's College Research Institute, 6307 - 76 Grenville Street, Toronto, Toronto, ON, M5S 1B2, Canada.
Owen Krystia: Department of Medicine, University of Toronto, Toronto, ON, Canada
Esther J. Waugh: Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
Crystal MacKay: Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
Ian Stanaitis: Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
Jane Stretton: Patient Research Partner, Toronto, ON, Canada
Alanna Weisman: Department of Medicine, University of Toronto, Toronto, ON, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
Noah M. Ivers: Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Department of Community and Family Medicine, University of Toronto, Toronto, ON, Canada
Janet A. Parsons: Department of Physical Therapy, University of Toronto, Toronto, ON, Canada; Applied Health Research Centre and Li Ka Shing Knowledge Institute, St. Michael's Hospital – Unity Health Toronto, Toronto, ON, Canada
Lorraine Lipscombe: Department of Medicine, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
Gillian A. Hawker: Department of Medicine, University of Toronto, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada

Journal volume & issue: Vol. 4, no. 4
p. 100299

Abstract

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Objectives: Symptomatic knee osteoarthritis (OA) commonly co-exists in persons with Type 2 diabetes (T2DM) and may impede diabetes self-management. Yet, OA is often underdiagnosed and undertreated due to competing health care demands. We sought to determine healthcare providers' (HCPs’) perceptions of the barriers and enablers to assessing and treating knee OA in persons with T2DM. Design: We conducted 18 semi-structured telephone interviews with HCPs who manage persons with T2DM (family physicians, endocrinologists, diabetes educators). Interviews were analyzed deductively using Theoretical Domains Framework (TDF), a framework developed to comprehensively identify behavioural determinants. Within relevant domains, data were thematically analyzed to generate belief statements, and these were compared across the different HCP disciplines. Results: Six TDF domains influenced HCPs behaviour to assess and treat knee OA in persons with T2DM. For all HCPs, important barriers included not seeing assessment/treatment of joint pain as a priority for their patients (intention), and insufficient access to required resources such as physiotherapy to treat OA (environmental context and resources). Endocrinologists and diabetes educators perceived having insufficient knowledge and skills to identify and manage OA (knowledge, skills), did not consider it within their professional role to do so (professional role and identity), and perceived other physicians would not want to receive a referral for OA care (social influences). Conclusions: We identified barriers and enablers encountered by diabetes HCPs to assessing and treating knee OA in persons with T2DM involving multiple domains of the TDF. These will help inform development of a complex intervention to improve health outcomes.

Published in Osteoarthritis and Cartilage Open

ISSN: 2665-9131 (Online)
Publisher: Elsevier
Country of publisher: United Kingdom
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the musculoskeletal system
Website: https://www.journals.elsevier.com/osteoarthritis-and-cartilage-open/

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