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. 2021 May 28;6(1):24.
doi: 10.1186/s41256-021-00201-7.

The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants

Andrew M Briggs  1 , Joanne E Jordan  2 , Deborah Kopansky-Giles  3   4 , Saurab Sharma  5 , Lyn March  6   7 , Carmen Huckel Schneider  8 , Swatee Mishrra  7 , James J Young  3   9 , Helen Slater  10
Affiliations

The need for adaptable global guidance in health systems strengthening for musculoskeletal health: a qualitative study of international key informants

Andrew M Briggs et al. Glob Health Res Policy. .

Abstract

Background: Musculoskeletal (MSK) conditions, MSK pain and MSK injury/trauma are the largest contributors to the global burden of disability, yet global guidance to arrest the rising disability burden is lacking. We aimed to explore contemporary context, challenges and opportunities at a global level and relevant to health systems strengthening for MSK health, as identified by international key informants (KIs) to inform a global MSK health strategic response.

Methods: An in-depth qualitative study was undertaken with international KIs, purposively sampled across high-income and low and middle-income countries (LMICs). KIs identified as representatives of peak global and international organisations (clinical/professional, advocacy, national government and the World Health Organization), thought leaders, and people with lived experience in advocacy roles. Verbatim transcripts of individual semi-structured interviews were analysed inductively using a grounded theory method. Data were organised into categories describing 1) contemporary context; 2) goals; 3) guiding principles; 4) accelerators for action; and 5) strategic priority areas (pillars), to build a data-driven logic model. Here, we report on categories 1-4 of the logic model.

Results: Thirty-one KIs from 20 countries (40% LMICs) affiliated with 25 organisations participated. Six themes described contemporary context (category 1): 1) MSK health is afforded relatively lower priority status compared with other health conditions and is poorly legitimised; 2) improving MSK health is more than just healthcare; 3) global guidance for country-level system strengthening is needed; 4) impact of COVID-19 on MSK health; 5) multiple inequities associated with MSK health; and 6) complexity in health service delivery for MSK health. Five guiding principles (category 3) focussed on adaptability; inclusiveness through co-design; prevention and reducing disability; a lifecourse approach; and equity and value-based care. Goals (category 2) and seven accelerators for action (category 4) were also derived.

Conclusion: KIs strongly supported the creation of an adaptable global strategy to catalyse and steward country-level health systems strengthening responses for MSK health. The data-driven logic model provides a blueprint for global agencies and countries to initiate appropriate whole-of-health system reforms to improve population-level prevention and management of MSK health. Contextual considerations about MSK health and accelerators for action should be considered in reform activities.

Keywords: Disability; Global health; Musculoskeletal; Rehabilitation; Strategy; Systems strengthening.

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Conflict of interest statement

  1. Dr. Briggs reports grants from Bone and Joint Decade Foundation, during the conduct of the study.

  2. Dr. Jordan reports personal fees from Curtin University, during the conduct of the study.

  3. Dr. March reports personal fees from Lilly Pty Ltd., personal fees from Pfizer Ltd., personal fees from Abbvie Pty Ltd., grants from Janssen Pty Ltd., outside the submitted work; March is an Executive member of OMERACT which receives funding from 30 different companies.

  4. Dr. Huckel Schneider reports grants from Curtin University, during the conduct of the study.

  5. Ms. Mishrra reports grants from Curtin University, during the conduct of the study.

  6. Dr. Young reports grants from Danish Foundation for Chiropractic Research and Post-graduate Education, grants from Canadian Memorial Chiropractic College, grants from Ontario Chiropractic Association, grants from National Chiropractic Mutual Insurance Company Foundation, grants from University of Southern Denmark Faculty Scholarship, outside the submitted work.

  7. Dr. Slater reports grants from Bone and Joint Decade Foundation, during the conduct of the study; personal fees from AbbVie Pty Ltd., outside the submitted work.

Figures

Fig. 1
Fig. 1
Distribution of the sample across sampling categories (left panel) and geographies (middle panel). Organisations represented are listed in the right panel. While KIs identified as representing these organisations, the views expressed are not necessarily official statements from the organisations
Fig. 2
Fig. 2
Empirically derived logic model for a global strategy for musculoskeletal health. The focus of this paper is on contemporary and contextual factors relevant to MSK health globally, guiding principles and accelerators. The pillars for health systems strengthening for MSK health are described in an aligned manuscript [47]. Terminologies are aligned with those described by Menear et al. [39] for leaning health systems
See this image and copyright information in PMC

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