Swimming against the tide in implementing change in paediatric physiotherapy for asthma and dysfunctional breathing: stakeholder reflections through digital storytelling

Physiotherapy management of childhood asthma and dysfunctional breathing across the UK is inequitable. To address this, a Theory of Change (ToC) model was developed and implemented at three NHS sites. Storytelling is recognized in the NHS as an accessible methodology presenting a narrative of lived experience in participants’ own voices. This project explored multi-stakeholder experiences to identify barriers and opportunities from those asked to deliver change in NHS clinics and those receiving care during this time. Three stories were created from workshops with four physiotherapists delivering outpatient services and a teenage patient and their parent treated during the time of the innovations project. This resulted in three online videos comprised of illustrative/documentary images co-created with each story’s participant: Physiotherapist story: https://youtu.be/Pd7vJIUpYMo?si=JOR0m3ZJoIKr-n-D. Patient story: https://www.youtube.com/watch?v=b6wn5ciNgto. Parent story: https://youtu.be/5-1SSexaD-M?si=mtphptpz-ja1KpIa. Whilst stakeholders reported paediatric outpatient physiotherapy intervention being greatly beneficial, their stories illustrate institutional and socio-economic barriers to accessing services. Staff reported frustration at fundamental requirements not being prioritized for services to run effectively. Patient and parent each described limited knowledge of dysfunctional breathing in community care, resulting in incorrect diagnoses and treatments. Service provider and recipient experiences of this innovation project highlight issues to investigate, thereby refining the ToC base assumptions before national implementation.