title: Patient reported barriers and facilitators to using a self-management booklet for hip and knee osteoarthritis in primary care: results of a qualitative interview study.
abstract: BACKGROUND
  To enhance guideline-based non-surgical management of hip or knee osteoarthritis (OA), a multidisciplinary, stepped-care strategy has been implemented in primary care in a region of the Netherlands. To facilitate this implementation, the self-management booklet "Care for Osteoarthritis" was developed and introduced. The aim of the booklet was to educate patients about OA, to enhance the patient's active role in the treatment course, and to improve the communication with health care providers. To successfully introduce the booklet on a large scale we assessed barriers and facilitators for patients to using this booklet.
  
  
  METHODS
  Seventeen primary care patients with hip or knee OA who received the self-management booklet participated in this qualitative study using semi-structured interviews. Purposive sampling was used to ensure diversity of the patients' view about the booklet. The interviews were transcribed verbatim and analysed using a thematic analysis approach.
  
  
  RESULTS
  Three core themes with patient perceived barriers and facilitators to use the booklet emerged from the interviews: 1) the role of health care providers, 2) the patient's perceptions about OA and its manageability, and 3) the patient's perceptions about the usefulness of the booklet and patient's information needs. Regarding the first theme, a barrier was the lack of encouragement from health care providers to use the booklet in the treatment course of OA. Moreover, patients had doubts concerning the health care providers' endorsement of non-surgical treatment for OA. Barriers from the second theme were: thinking that OA is not treatable or that being pro-active during the treatment course is not important. In contrast, being convinced about the importance of an active participation in the treatment course was a facilitator. Third, patients' perceptions about the usefulness of the booklet and patients' information needs were both identified as barriers as well as facilitators for booklet use.
  
  
  CONCLUSIONS
  This study contributes to the understanding of patient perceived barriers and facilitators to use a self-management booklet in the treatment course of OA. The results offer practical starting points to tailor the implementation activities of the booklet nationwide and to introduce comparable educational tools in OA primary care or in other chronic diseases.
authors.affiliation: Department of Rheumatology, Sint Maartenskliniek, PO box 9011, Nijmegen 6500, GM, The Netherlands. n.cuperus@maartenskliniek.nl.
authors.forename: Nienke
authors.initials: N
authors.lastname: Cuperus
authors.forename: Agnes J
authors.initials: AJ
authors.lastname: Smink
authors.forename: Sita M A
authors.initials: SM
authors.lastname: Bierma-Zeinstra
authors.forename: Joost
authors.initials: J
authors.lastname: Dekker
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Schers
authors.forename: Fijgje
authors.initials: F
authors.lastname: de Boer
authors.forename: Cornelia H
authors.initials: CH
authors.lastname: van den Ende
authors.forename: Thea P M
authors.initials: TP
authors.lastname: Vliet Vlieland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003142:Communication; D019468:Disease Management; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D015207:Osteoarthritis, Hip / Q000523:psychology* / Q000628:therapy; D020370:Osteoarthritis, Knee / Q000523:psychology* / Q000628:therapy; D010174:Pamphlets; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D036301:Qualitative Research; D012648:Self Care / Q000379:methods / Q000523:psychology*