Barriers and facilitators of integrating physiotherapy into primary health care settings: A systematic scoping review of qualitative research

Shabnam ShahAli; Saeed Shahabi; Manal Etemadi; Maryam Hedayati; Barth Cornelia Anne; Parviz Mojgani; Masoud Behzadifar; Kamran Bagheri Lankarani

doi:10.1016/j.heliyon.2023.e20736

Barriers and facilitators of integrating physiotherapy into primary health care settings: A systematic scoping review of qualitative research

Shabnam ShahAli
, Saeed Shahabi^*
, Manal Etemadi
, Maryam Hedayati
, Barth Cornelia Anne
, Parviz Mojgani
, Masoud Behzadifar
, Kamran Bagheri Lankarani

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

24 Citations (Scopus)

Abstract

Purpose: This scoping review investigated the barriers and facilitators to integrating physiotherapy into primary health care (PHC). Materials and methods: PubMed, Scopus, Web of Science, Embase, ProQuest, and REHABDATA were searched. Two independent reviewers were involved in screening, selecting, and extracting data. Data were synthesized using thematic analysis. Results: Of the 483 screened documents, 44 qualitative studies, primarily from high-income countries, were included. All of the studies had good methodological quality. Barriers and facilitators of integrating physiotherapy into PHC were extracted within the WHO six building blocks framework. In total, 41 items were identified as barriers to the integration process. The studies included 49 recommendations to facilitate integrating physiotherapy services into PHC. Conclusion: Integrating physiotherapy services into PHC faces many barriers. The most commonly suggested potential barriers are poor knowledge of physicians about physiotherapy, ineffective teamwork, physiotherapists’ time constraints/workload, a lack of clarity over the role and knowledge of physiotherapists, unawareness of physiotherapy users about these services, and lack of intra- and inter-professional collaborations. The most commonly suggested recommendations to facilitate the integration process include: Clarifying the role of involved professionals, strengthening teamwork, improving intra- and inter-professional collaborations, and providing comprehensive training programs for physiotherapists.

Original language	English
Article number	e20736
Journal	Heliyon
Volume	9
Issue number	10
DOIs	https://doi.org/10.1016/j.heliyon.2023.e20736
Publication status	Published - Oct 2023

Bibliographical note

Funding Information:
As part of PHC, healthcare education needs to be reoriented towards empowering the client, consumer partnerships and participation, self-care, supporting the person to achieve their health goals, as well as teamwork and community collaboration [22]. Universities should encourage graduates not only to think and practice in their chosen field and discipline but can also to develop beyond those defined abilities. Physiotherapy education must be reimagined to meet workforce demands and address these expectations [17,23]. Knowing the barriers and facilitators for integrating physiotherapy into primary health care settings can facilitate decisions regarding needed changes in the curriculum content and teaching methods.Table 4 [Table Presented] demonstrates the suggested facilitators for integrating physiotherapy into PHC. Regarding the stewardship dimension, 1) improving intra- and inter-professional collaborations [20,31,32,40,41,43,51,61,65,66]; 2) strengthening teamwork [32,33,35,37,39,48,51,57–59,67–70]; 3) effective communication among PHC team members [20,33,34,45,52,57,68,70]; and 4) enhancing patients’ awareness [35,47,49,61,69] were among the most common facilitators provided by the participants in the included studies. Furthermore, some studies stated that employing effective advocacy strategies [20,23,40,45,57,60], gaining political support [51], and increasing the awareness of policymakers [51,69] were necessary prerequisites for the effective integration of physiotherapy services into PHC. Participants in one study [51] believed that the participation of physiotherapists in relevant policymaking processes should be greater. Identifying and involving community engagement [40,51,60], effective communication [20,33,34,45,52,57,68,70], patient-centered planning [45,53,66,68], strengthening scientific evidence [41,50,51,69], and involving the private sector [65,69] were other identified solutions regarding the stewardship component.Four qualitative studies [20,51,58,68] also stated solutions related to financing to smooth the integration of physiotherapy services, which included increasing financial resources, developing a package of rehabilitation services including physiotherapy in PHC, considering competitive payment mechanisms to create incentives, and reducing out-of-pocket. Regarding human resources, participants stated that considering a comprehensive training program for physiotherapists [32,36,40,54,56,57,60,65–67,69], as well as facilitating their personal and professional development [35,48,51,58,60,67], and providing management and mentorship support [32,35–37,57,59,70], can significantly improve their participation and performance in PHC. In addition to increasing the awareness of physiotherapists regarding PHC [20,57,69], they need to learn the necessary administrative skills [20,32] and have the ability to work in a flexible manner [20,32,57]. Specifically, in one of the studies, participants stated that staff rotation can be used to familiarize physiotherapists with different clinical environments [40]. Some studies also emphasized the importance of enhancing the confidence of physiotherapists to perform effectively in PHC [34,35,37,45,58,70].The integration of physiotherapy services into PHC faces many barriers, including a lack of intra- and inter-professional collaboration, ineffective teamwork, time constraints, and workloads, lack of clarity over the role and knowledge of physiotherapists, poor knowledge of GPs about physiotherapy, undesirable referral mechanisms, inadequate funding resources, educational challenges, and inadequate equipment. However, there are several facilitators for integrating these services into PHC, including employing effective advocacy strategies, empowering the leadership, improving intra- and inter-professional collaborations, strengthening teamwork, enhancing patients’ awareness about physiotherapy, improving the working culture, creating a desirable referral system, effectively communicating between patients and physiotherapists, clarifying the roles of involved professionals, increasing funding resources, providing comprehensive training, facilitating personal and professional development, providing management and mentorship support, organizing an electronic information system, and applying new technological innovations.

Publisher Copyright:
© 2023

Research Groups and Themes

HEHP@Bristol
NIHR ARC West

Keywords

Physiotherapy
Primary care
Primary health care
Qualitative evidence
Rehabilitation
Scoping review

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10.1016/j.heliyon.2023.e20736

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Cite this

@article{7db7944051be460c9e13ff64779b3e4c,

title = "Barriers and facilitators of integrating physiotherapy into primary health care settings: A systematic scoping review of qualitative research",

abstract = "Purpose: This scoping review investigated the barriers and facilitators to integrating physiotherapy into primary health care (PHC). Materials and methods: PubMed, Scopus, Web of Science, Embase, ProQuest, and REHABDATA were searched. Two independent reviewers were involved in screening, selecting, and extracting data. Data were synthesized using thematic analysis. Results: Of the 483 screened documents, 44 qualitative studies, primarily from high-income countries, were included. All of the studies had good methodological quality. Barriers and facilitators of integrating physiotherapy into PHC were extracted within the WHO six building blocks framework. In total, 41 items were identified as barriers to the integration process. The studies included 49 recommendations to facilitate integrating physiotherapy services into PHC. Conclusion: Integrating physiotherapy services into PHC faces many barriers. The most commonly suggested potential barriers are poor knowledge of physicians about physiotherapy, ineffective teamwork, physiotherapists{\textquoteright} time constraints/workload, a lack of clarity over the role and knowledge of physiotherapists, unawareness of physiotherapy users about these services, and lack of intra- and inter-professional collaborations. The most commonly suggested recommendations to facilitate the integration process include: Clarifying the role of involved professionals, strengthening teamwork, improving intra- and inter-professional collaborations, and providing comprehensive training programs for physiotherapists.",

keywords = "Physiotherapy, Primary care, Primary health care, Qualitative evidence, Rehabilitation, Scoping review",

author = "Shabnam ShahAli and Saeed Shahabi and Manal Etemadi and Maryam Hedayati and Anne, \{Barth Cornelia\} and Parviz Mojgani and Masoud Behzadifar and Lankarani, \{Kamran Bagheri\}",

note = "Funding Information: As part of PHC, healthcare education needs to be reoriented towards empowering the client, consumer partnerships and participation, self-care, supporting the person to achieve their health goals, as well as teamwork and community collaboration [22]. Universities should encourage graduates not only to think and practice in their chosen field and discipline but can also to develop beyond those defined abilities. Physiotherapy education must be reimagined to meet workforce demands and address these expectations [17,23]. Knowing the barriers and facilitators for integrating physiotherapy into primary health care settings can facilitate decisions regarding needed changes in the curriculum content and teaching methods.Table 4 [Table Presented] demonstrates the suggested facilitators for integrating physiotherapy into PHC. Regarding the stewardship dimension, 1) improving intra- and inter-professional collaborations [20,31,32,40,41,43,51,61,65,66]; 2) strengthening teamwork [32,33,35,37,39,48,51,57–59,67–70]; 3) effective communication among PHC team members [20,33,34,45,52,57,68,70]; and 4) enhancing patients{\textquoteright} awareness [35,47,49,61,69] were among the most common facilitators provided by the participants in the included studies. Furthermore, some studies stated that employing effective advocacy strategies [20,23,40,45,57,60], gaining political support [51], and increasing the awareness of policymakers [51,69] were necessary prerequisites for the effective integration of physiotherapy services into PHC. Participants in one study [51] believed that the participation of physiotherapists in relevant policymaking processes should be greater. Identifying and involving community engagement [40,51,60], effective communication [20,33,34,45,52,57,68,70], patient-centered planning [45,53,66,68], strengthening scientific evidence [41,50,51,69], and involving the private sector [65,69] were other identified solutions regarding the stewardship component.Four qualitative studies [20,51,58,68] also stated solutions related to financing to smooth the integration of physiotherapy services, which included increasing financial resources, developing a package of rehabilitation services including physiotherapy in PHC, considering competitive payment mechanisms to create incentives, and reducing out-of-pocket. Regarding human resources, participants stated that considering a comprehensive training program for physiotherapists [32,36,40,54,56,57,60,65–67,69], as well as facilitating their personal and professional development [35,48,51,58,60,67], and providing management and mentorship support [32,35–37,57,59,70], can significantly improve their participation and performance in PHC. In addition to increasing the awareness of physiotherapists regarding PHC [20,57,69], they need to learn the necessary administrative skills [20,32] and have the ability to work in a flexible manner [20,32,57]. Specifically, in one of the studies, participants stated that staff rotation can be used to familiarize physiotherapists with different clinical environments [40]. Some studies also emphasized the importance of enhancing the confidence of physiotherapists to perform effectively in PHC [34,35,37,45,58,70].The integration of physiotherapy services into PHC faces many barriers, including a lack of intra- and inter-professional collaboration, ineffective teamwork, time constraints, and workloads, lack of clarity over the role and knowledge of physiotherapists, poor knowledge of GPs about physiotherapy, undesirable referral mechanisms, inadequate funding resources, educational challenges, and inadequate equipment. However, there are several facilitators for integrating these services into PHC, including employing effective advocacy strategies, empowering the leadership, improving intra- and inter-professional collaborations, strengthening teamwork, enhancing patients{\textquoteright} awareness about physiotherapy, improving the working culture, creating a desirable referral system, effectively communicating between patients and physiotherapists, clarifying the roles of involved professionals, increasing funding resources, providing comprehensive training, facilitating personal and professional development, providing management and mentorship support, organizing an electronic information system, and applying new technological innovations. Publisher Copyright: {\textcopyright} 2023",

year = "2023",

month = oct,

doi = "10.1016/j.heliyon.2023.e20736",

language = "English",

volume = "9",

journal = "Heliyon",

issn = "2405-8440",

publisher = "Elsevier Limited",

number = "10",

}

TY - JOUR

T1 - Barriers and facilitators of integrating physiotherapy into primary health care settings

T2 - A systematic scoping review of qualitative research

AU - ShahAli, Shabnam

AU - Shahabi, Saeed

AU - Etemadi, Manal

AU - Hedayati, Maryam

AU - Anne, Barth Cornelia

AU - Mojgani, Parviz

AU - Behzadifar, Masoud

AU - Lankarani, Kamran Bagheri

N1 - Funding Information: As part of PHC, healthcare education needs to be reoriented towards empowering the client, consumer partnerships and participation, self-care, supporting the person to achieve their health goals, as well as teamwork and community collaboration [22]. Universities should encourage graduates not only to think and practice in their chosen field and discipline but can also to develop beyond those defined abilities. Physiotherapy education must be reimagined to meet workforce demands and address these expectations [17,23]. Knowing the barriers and facilitators for integrating physiotherapy into primary health care settings can facilitate decisions regarding needed changes in the curriculum content and teaching methods.Table 4 [Table Presented] demonstrates the suggested facilitators for integrating physiotherapy into PHC. Regarding the stewardship dimension, 1) improving intra- and inter-professional collaborations [20,31,32,40,41,43,51,61,65,66]; 2) strengthening teamwork [32,33,35,37,39,48,51,57–59,67–70]; 3) effective communication among PHC team members [20,33,34,45,52,57,68,70]; and 4) enhancing patients’ awareness [35,47,49,61,69] were among the most common facilitators provided by the participants in the included studies. Furthermore, some studies stated that employing effective advocacy strategies [20,23,40,45,57,60], gaining political support [51], and increasing the awareness of policymakers [51,69] were necessary prerequisites for the effective integration of physiotherapy services into PHC. Participants in one study [51] believed that the participation of physiotherapists in relevant policymaking processes should be greater. Identifying and involving community engagement [40,51,60], effective communication [20,33,34,45,52,57,68,70], patient-centered planning [45,53,66,68], strengthening scientific evidence [41,50,51,69], and involving the private sector [65,69] were other identified solutions regarding the stewardship component.Four qualitative studies [20,51,58,68] also stated solutions related to financing to smooth the integration of physiotherapy services, which included increasing financial resources, developing a package of rehabilitation services including physiotherapy in PHC, considering competitive payment mechanisms to create incentives, and reducing out-of-pocket. Regarding human resources, participants stated that considering a comprehensive training program for physiotherapists [32,36,40,54,56,57,60,65–67,69], as well as facilitating their personal and professional development [35,48,51,58,60,67], and providing management and mentorship support [32,35–37,57,59,70], can significantly improve their participation and performance in PHC. In addition to increasing the awareness of physiotherapists regarding PHC [20,57,69], they need to learn the necessary administrative skills [20,32] and have the ability to work in a flexible manner [20,32,57]. Specifically, in one of the studies, participants stated that staff rotation can be used to familiarize physiotherapists with different clinical environments [40]. Some studies also emphasized the importance of enhancing the confidence of physiotherapists to perform effectively in PHC [34,35,37,45,58,70].The integration of physiotherapy services into PHC faces many barriers, including a lack of intra- and inter-professional collaboration, ineffective teamwork, time constraints, and workloads, lack of clarity over the role and knowledge of physiotherapists, poor knowledge of GPs about physiotherapy, undesirable referral mechanisms, inadequate funding resources, educational challenges, and inadequate equipment. However, there are several facilitators for integrating these services into PHC, including employing effective advocacy strategies, empowering the leadership, improving intra- and inter-professional collaborations, strengthening teamwork, enhancing patients’ awareness about physiotherapy, improving the working culture, creating a desirable referral system, effectively communicating between patients and physiotherapists, clarifying the roles of involved professionals, increasing funding resources, providing comprehensive training, facilitating personal and professional development, providing management and mentorship support, organizing an electronic information system, and applying new technological innovations. Publisher Copyright: © 2023

PY - 2023/10

Y1 - 2023/10

N2 - Purpose: This scoping review investigated the barriers and facilitators to integrating physiotherapy into primary health care (PHC). Materials and methods: PubMed, Scopus, Web of Science, Embase, ProQuest, and REHABDATA were searched. Two independent reviewers were involved in screening, selecting, and extracting data. Data were synthesized using thematic analysis. Results: Of the 483 screened documents, 44 qualitative studies, primarily from high-income countries, were included. All of the studies had good methodological quality. Barriers and facilitators of integrating physiotherapy into PHC were extracted within the WHO six building blocks framework. In total, 41 items were identified as barriers to the integration process. The studies included 49 recommendations to facilitate integrating physiotherapy services into PHC. Conclusion: Integrating physiotherapy services into PHC faces many barriers. The most commonly suggested potential barriers are poor knowledge of physicians about physiotherapy, ineffective teamwork, physiotherapists’ time constraints/workload, a lack of clarity over the role and knowledge of physiotherapists, unawareness of physiotherapy users about these services, and lack of intra- and inter-professional collaborations. The most commonly suggested recommendations to facilitate the integration process include: Clarifying the role of involved professionals, strengthening teamwork, improving intra- and inter-professional collaborations, and providing comprehensive training programs for physiotherapists.

AB - Purpose: This scoping review investigated the barriers and facilitators to integrating physiotherapy into primary health care (PHC). Materials and methods: PubMed, Scopus, Web of Science, Embase, ProQuest, and REHABDATA were searched. Two independent reviewers were involved in screening, selecting, and extracting data. Data were synthesized using thematic analysis. Results: Of the 483 screened documents, 44 qualitative studies, primarily from high-income countries, were included. All of the studies had good methodological quality. Barriers and facilitators of integrating physiotherapy into PHC were extracted within the WHO six building blocks framework. In total, 41 items were identified as barriers to the integration process. The studies included 49 recommendations to facilitate integrating physiotherapy services into PHC. Conclusion: Integrating physiotherapy services into PHC faces many barriers. The most commonly suggested potential barriers are poor knowledge of physicians about physiotherapy, ineffective teamwork, physiotherapists’ time constraints/workload, a lack of clarity over the role and knowledge of physiotherapists, unawareness of physiotherapy users about these services, and lack of intra- and inter-professional collaborations. The most commonly suggested recommendations to facilitate the integration process include: Clarifying the role of involved professionals, strengthening teamwork, improving intra- and inter-professional collaborations, and providing comprehensive training programs for physiotherapists.

KW - Physiotherapy

KW - Primary care

KW - Primary health care

KW - Qualitative evidence

KW - Rehabilitation

KW - Scoping review

UR - https://www.scopus.com/pages/publications/85173788623

U2 - 10.1016/j.heliyon.2023.e20736

DO - 10.1016/j.heliyon.2023.e20736

M3 - Article (Academic Journal)

C2 - 37860510

AN - SCOPUS:85173788623

SN - 2405-8440

VL - 9

JO - Heliyon

JF - Heliyon

IS - 10

M1 - e20736

ER -

Barriers and facilitators of integrating physiotherapy into primary health care settings: A systematic scoping review of qualitative research

Abstract

Bibliographical note

Research Groups and Themes

Keywords

Access to Document

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