Author:
Shakya Nishchal Ratna,Emén Amanda,Webb Gillian,Myezwa Hellen,Karmacharya Biraj Man,Stensdotter Ann-Katrin
Abstract
Abstract
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.
Funder
Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
Publisher
Springer Science and Business Media LLC
Reference76 articles.
1. Ghimire U, Shrestha N, Adhikari B, Mehata S, Pokharel Y, Mishra SR. Health system’s readiness to provide cardiovascular, diabetes and chronic respiratory disease related services in Nepal: analysis using 2015 health facility survey. BMC Public Health. 2020;20(1):1163.
2. Nepal Health Update. NHPC registered professionals [18 March, 2024]. https://publichealthupdate.com/nepal-health-professional-council-nhpc/.
3. Dean E, Al-Obaidi S, De Andrade AD, Gosselink R, Umerah G, Al-Abdelwahab S, et al. The First Physical Therapy Summit on Global Health: implications and recommendations for the 21st century. Physiother Theory Pract. 2011;27(8):531–47.
4. Escorpizo R, Bemis-Dougherty A. Introduction to Special Issue: a review of the International classification of Functioning, disability and health and physical therapy over the years. Physiother Res Int. 2015;20(4):200–9.
5. World Health Organisation (WHO). A Practical Manual for using the International Classification of Functioning, Disability and Health (ICF) 2013 [18 March, 2024]. https://www.who.int/publications/m/item/how-to-use-the-icf---a-practical-manual-for-using-the-international-classification-of-functioning-disability-and-health.