Barriers and Facilitators for the Implementation of an Osteoarthritis Management Programs in a Low-Income Setting: An Exploratory Study of Malawian Physiotherapists

OBJECTIVE: To (i) examine Malawian physiotherapists’ knowledge and beliefs about osteoarthritis (OA), and their perceived capabilities to deliver an OA management program to people with knee and hip OA; and (ii) identify barriers and facilitators for an OA management program in Malawi. DESIGN: Two-phased mixed methods formative evaluation METHODS: In phase 1, Malawian physiotherapists participated in the GLA:D® Australia training course and answered quantitative pre-and-post course questions that were descriptively summarized, and analysed using McNemar’s test, where appropriate. In phase 2, semi-structured focus groups generated qualitative data that were thematically analysed and mapped to the Consolidated Framework for Implementation Research. Mixed methods data were integrated through triangulation. RESULTS: Eleven Malawian physiotherapists 9 (82%) female, 10 (91%) with 5–10 years clinical experience participated. From pre- to post training course, participants’ knowledge of OA management (percentage change) increased regarding the benefits of therapeutic exercise (91%), importance of weight management (82%), and acceptable symptoms profile (73%). Participants’ confidence and beliefs in managing knee and hip OA also increased. Implementation barriers included program costs, current medical management of OA with painkillers, and infrastructure challenges. Implementation facilitators included the content and organisation of GLA:D®, adaptability of the program, and OA awareness and education among other health professionals. CONCLUSION: Knowledge, confidence, and beliefs in managing knee and hip OA improved post GLA:D® training in Malawian physiotherapists. Increasing education of physiotherapists, other health professionals and the public about evidence-based OA management and making contextual adaptions to the GLA:D® training and program structure may facilitate implementation of OA management program, such as GLA:D®, in low-and-middle income countries.