Barriers and Facilitators Towards Physiotherapists' Use of Behaviour Change Techniques (BCTs) to Improve Patients' Adherence to Treatment

Abstract

Purpose: Patient adherence to physiotherapy treatment recommendations is less than optimal. This can lead to poor outcomes across a range of clinical and service level measures including patient satisfaction, long-term morbidity and increased prevalence of long-term conditions. Physiotherapists have been found to only use a small number of behaviour change techniques (BCTs) in consultations, despite evidence that these can help to improve outcomes in a range of domains including adherence. The study aimed to explore physiotherapists perceived barriers and facilitators to utilising BCTs in clinical practice.

Methods: Fourteen qualified physiotherapists recruited from a higher education institution and a national healthcare provider participated in semi-structured interviews and reflexive thematic analysis was conducted thereafter.

Results: Three key themes were identified: (1) A Lack of Training and Support; (2) Organisational Culture and Practices; (3) Individual Differences During the Consultation, which had two subthemes: (i) Patient Attitudes and Expectations; (ii) Clinician Attitudes and Approach. Findings suggest that physiotherapists believe that their use of BCTs is restricted by a lack of capability, due to limited training. Furthermore, the opportunity to effectively utilise BCTs is restricted by organisational environment, resources and effective clinical supervision.

Conclusions: Improving physiotherapists' capabilities by enhancing BCT training and psychology led clinical supervision is required. Furthermore, organisational change is recommended to create the opportunity for clinicians to effectively utilise BCTs. Specifically, organisations should devote necessary resources, backed by effective implementation strategies, to enhance such opportunity.

Keywords: behaviour change; chronic pain; health psychology; qualitative.