Abstract
Background and purpose
Ageing is associated with increased physical and psychological co-morbidities that make healthcare provision for older adults complex and nuanced. Physiotherapists are a key workforce involved in the care of older adults to support quality of life throughout the ageing process. However, projections for increasing discrepancies between the physiotherapy workforce and older populations require ways to maximise the impact of each interaction between physiotherapists and older adults. One consideration is the extent to which an older adult can engage in physiotherapy. Patient engagement is a concept that refers to a patient’s connection to their healthcare, their willingness to place effort towards health outcomes, and describes both a patient state and a process. Examining the perspectives of physiotherapists who work with older adults is pertinent to understanding the factors associated with successful patient engagement and subsequent areas to optimise. This study explored physiotherapists’ understanding of the main influences on patient engagement in the context of Aotearoa New Zealand.
Methods
In this interpretive description study, thirteen participants (New Zealand-registered physiotherapists) with experience of working with older adults in the past twelve months, were recruited via written or verbal advertisements. Audio-recorded one-hour long interviews were transcribed, summarised, and sent to the participant for review and feedback. Data was analysed with an inductive content analysis approach in five stages (immersion, recording ideas, coding, condensing, and consultation with supervisors and the Kaiaki Mātāmua) alongside reflexive journaling throughout the analytic process.
Results
Participant physiotherapists described four major influences that interacted to impact patient engagement: 1) physiotherapists’ characteristics, 2) their perception of patients’ characteristics, 3) processes and outcomes of engagement, and 4) wider systemic factors. Participants acquired skills and underlying knowledge through clinical experiences to support patient engagement. Patient characteristics that physiotherapists associated with likelihood to engage included patients’ perceptions of physiotherapy, lifestyle factors, and physical environment. Engagement between participants and patients primarily revolved around the process of building and maintaining a therapeutic relationship. Power dynamics between the participants, patients, and their family also impacted the relationship’s construction. Participants’ and patients’ behaviours were constrained by the health system and wider society within which engagement takes place.
Discussion
Engagement was seen by participants as an iterative process. In addition to other processes of engagement, connection forms the foundation of engagement. While study findings showed that physiotherapists may understand certain aspects of forming connections, there are opportunities to further develop connection-building, specifically with the patient’s family. The culture of physiotherapy is task-focused with an emphasis on measurable patient outcomes as a sign of successful engagement. Physiotherapists may be conscious of power imbalances in relationships with patients but should monitor for culturally embedded beliefs that put reciprocal power-sharing at risk. Several opportunities for skill development were identified to increase physiotherapists’ readiness to engage. Contextual factors, such as service capacity and design, significantly influence physiotherapist engagement with patients. These may be addressed through strategic development of leadership and services to achieve healthy ageing processes for older adults.