“Farmers Don't Go to Doctors. They Don't Ask for Help”: Exploring Farmers' Experiences and Perceived Barriers to Healthcare Access for Persistent Low Back Pain

No conflicts of interest Sources of funding: This research was undertaken in partial fulfilment of an MRes in Clinical and Health Research at the University of Southampton, funded by the NIHR South Central Insight Programme. Background Farmers experience disproportionately high rates of persistent low back pain (LBP) compared to the general workforce yet make little use of formal healthcare; this is despite evidence that early intervention for LBP reduces long-term disability. This study, therefore, aimed to explore farmers' use of, experiences, and perceived barriers to accessing healthcare for persistent LBP. Methods This sequential explanatory mixed-methods study recruited British farmers with persistent LBP (≥3 months) from agricultural shows and online forums. Surveys were employed to collect data about musculoskeletal health status and healthcare use. On-line video interviews with a subset of participants explored farmers' perceptions of healthcare. Interviews were audio-recorded and transcribed verbatim. Analysis was informed by an Interpretive Phenomenological approach. 85 participants completed the surveys, and four participants (each with 20+years faming experience) were interviewed (mean duration 62 mins). Results Farmers reported moderately impaired health-status because of LBP (mean MSK-HQ score 30.6/56 (SD=10.08)) and although 79% adopted self-management strategies, only 9% had accessed healthcare. Four interconnected themes were identified as crucial in shaping these decisions: (1) ‘my identity as a farmer’, (2) ‘context at the time of seeking help’, (3) ‘threat’, and (4) ‘healthcare experiences’. Farmers avoided accessing formal healthcare for LBP as doing so was perceived to be inconsistent with their occupational identity and capacity to manage seasonal pressures; farmers' experiences of healthcare reinforced these beliefs. Conclusion To increase farmers' early uptake of healthcare for LBP, services should provide care that aligns with farmers' occupational identity and access that is responsive to seasonal pressures.