Exploring the barriers and facilitators experienced by physiotherapists and patients with musculoskeletal conditions when using digital health interventions as a self-management approach in Saudi Arabia: a sequential explanatory mixed method study.

Abstract

Background: Musculoskeletal (MSK) conditions constitute a significant public health challenge due to their increasing incidence and potential severe negative impact on patients' quality of life. One recommended treatment is self-management, endorsed in MSK management guidelines, including the National Institute for Health and Care Excellence guideline (2021). Self-management for MSKs can be delivered via digital health interventions (DHIs), which is the term referred to as the delivery of healthcare and the translation of information, knowledge, and communication via digital technologies to help the individual manage their health and well-being. Purpose: The present thesis aims to determine and identify barriers and facilitators to recommending and using DHIs by MSK patients and physiotherapists in Saudi Arabia. Methods: This study used sequential explanatory mixed methods. A cross-sectional design utilised an online questionnaire based on the Unified Theory of Acceptance and Use of Technology (UTAUT) and cultural factors for two populations (MSK patients and physiotherapists). Eighteen users (11 physiotherapists and seven patients with different MSKs) were interviewed within seven physiotherapy departments. This study was conducted during the time period when the use of DHIs was made mandatory by the Ministry of Health (MOH). An audio recording, verbatim transcription, and English translation of the interviews were conducted. Descriptive analysis was used to interpret the quantitative data, and reflexive thematic analysis was used to analyse the qualitative data. Findings: The questionnaire was completed by 143 respondents (76 physiotherapists and 67 MSK patients). Regarding the patient's characteristics, the most common condition for patients was low back pain (LBP) 46.3% and arthritis 25.4 %, with the majority being chronic conditions (71.6 %). The experience level of utilising DHIs up to two months was common for physiotherapists and less than two months for patients. Almost 90% of patients received no training before using DHIs. Regarding the UTAUT framework, there were mixed views on the compatibility of DHIs with patients’ needs. However, both physiotherapists and patients agreed that DHIs improved their therapeutic relationships. Notably, both the physiotherapists and patients also had a substantial level of agreement about their intentions to use and expectations of using DHIs in the future. However, their rate of agreement was lower for using DHI regularly. Four themes were identified under thematic analysis, revealing the areas that support the utilisation of DHIs. Concepts reported within all four themes included aspects, such as perceived effectiveness, patients' willingness to use DHIs, cultural impact, and social influences. The study indicated that physiotherapists who used DHIs before the health delivery organisation deemed this type of delivery mandatory were likely to recommend DHIs to patients with MSKs. Conclusion: The study reveals that despite initials challenges, such as lack of training and mixed views on compatibility with patient needs, DHIs were viewed positively by both physiotherapists and patients for managing MSK disorders. Although there is a high agreement among physiotherapists and patients about their intentions and expectations to use DHIs in the future, efforts should be made to enhance their regular use in Saudi Arabia. Implications and recommendations: The study contributes both theoretical and practical implications. Concerning its theoretical contribution, it enriches the literature on DHIs by using the associated constructs of the UTAUT model. Its practical contribution offers valuable information to guide and support the implementation of DHI and training of public hospital physiotherapists and enhance MSK patients' awareness of the benefits of using DHIs. Having physiotherapists who are familiar with DHIs and can demonstrate ways to apply them is a potentially effective strategy to increase the use of this treatment method Further research is needed to provide insight into the barriers and facilitators that non-users of DHIs may encounter because the current study only included users of DHIs.