Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

All rights reserved. This publication is intended for use solely by faculty, students, and staff of Nova Southeastern University. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, now known or later developed, including but not limited to photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author or the publisher.

First Advisor

Melissa Tovin

Date of original Performance / Presentation

January 2024

Publication Date / Copyright Date

1-1-2024

Abstract

Background and Purpose: To meet evolving societal health needs and improve patient outcomes, health systems are moving towards value-based care (VBC), shifting the focus to quality, provider performance, and the patient experience. Person-centered care (PCC) is key to VBC but is often overlooked, especially in chronic low back pain (CLBP) treatment, where patient values often conflict with healthcare provider approaches. This issue is more pronounced in under-resourced regions like the Caribbean, where healthcare can be more paternalistic. Understanding the perspectives of both patients and providers is crucial to improving PCC. This study aims to: 1) explore views on PCC among CLBP patients and physicians in Trinidad and Tobago, and 2) identify areas of discordance. Methods: Utilizing a generic qualitative approach, semi-structured focus groups and follow-up interviews were conducted, separating patients from physicians to gather each group’s unique beliefs, values, and perspectives on established domains of PCC. Using these domains as a framework, data were analysed via deductive coding followed by the constant comparison method toward theme development. Comparisons were made between groups. Results: Views on PCC differed in some domains. A new domain “Access,” emerged from the data as key to PCC. Three overarching themes also emerged: 1) The doctor as a conductor, which describes the focal role of the doctor, 2) PCC as an emergent process, reflecting its dynamism and the intricate relationships among its domains, and 3) Stigmergy, which denotes the implicit and indirect modes of coordination in the healthcare system. Conclusions: Key findings highlight the doctor's pivotal role in orchestrating care and the intricate, interdependent nature of PCC domains. Notably, the concept of "Access" emerged as a fundamental domain for effective PCC. The influence of implicit coordination mechanisms in the health system underscores the complexity of achieving true PCC. Clinical Relevance: The implications of this study extend to all HCPs treating CLBP, offering a transformative perspective on care delivery. By identifying gaps between patient and provider perspectives, the results highlight care practices that need congruence with patient values and provide a roadmap for healthcare education and practice to deliver more efficacious and compassionate care in VBC.

Disciplines

Physical Therapy

Keywords

low back pain; Patient-centered care; Person-centered Care

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