Patient experiences and perspectives of health service access for carpal tunnel syndrome in Aotearoa New Zealand: a normalisation process theory-informed qualitative study
Abstract Background Early access to care for carpal tunnel syndrome (CTS) can avoid higher rates of surgery and permanent harm yet is often delayed, particularly for populations more likely to underutilise care. Objective We sought to explore patient experiences and perspectives of health service ac...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-024-10871-x |
| _version_ | 1797209455456157696 |
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| author | Miranda Bűhler Carol Atmore Meredith Perry Sue Crengle Pauline Norris G. David Baxter |
| author_facet | Miranda Bűhler Carol Atmore Meredith Perry Sue Crengle Pauline Norris G. David Baxter |
| author_sort | Miranda Bűhler |
| collection | DOAJ |
| description | Abstract Background Early access to care for carpal tunnel syndrome (CTS) can avoid higher rates of surgery and permanent harm yet is often delayed, particularly for populations more likely to underutilise care. Objective We sought to explore patient experiences and perspectives of health service access for CTS to inform an equity-focussed co-design of a health service for improving early care access. Methods In this Normalisation Process Theory (NPT)-informed qualitative study we conducted semistructured in-depth interviews with 19 adults with experience of CTS. Recruitment prioritised New Zealand Māori, Pasifika, low-income, and rural populations. Data were analysed using deductive then inductive thematic analysis. Results We identified five major themes: (1) the ‘Significant Impact of CTS’ of the sense-making and relational work to understand the condition, deciding when to get care, compelling clinicians to provide care, and garnering help from others; (2) ‘Waiting and Paying for Care’– the enacting, relational, and appraising work to avoid long wait times unless paying privately, particularly where quality of care was low, employment relations poor, or injury compensation processes faltered; (3) circumstances of ‘Occupation and CTS Onset’ whereby the burden of proof to relate onset of CT symptoms to occupation created excessive relational and enacting work; (4) the ‘Information Scarcity’ of good information about CTS and the high relational and appraising work associated with using online resources; (5) ‘Negotiating Telehealth Perspectives’ where telehealth was valued if it meant earlier access for all despite the challenges it held for many. Conclusion Quality, culturally and linguistically responsive information and communication from clinicians and health services will improve equitable early access to CTS care including realising the potential of telehealth modes of care. Policy changes that reduce individual burden of proof in injury compensation claims processes, enable time off work to attend health appointments, and increase public funding for surgical resources would improve early access to CTS care particularly for Māori and Pacific populations and those in small and rural workplaces. NPT is valuable for understanding where opportunities lie to reduce inequitable delays to accessing care including the impact of racism, particularly for populations more likely to underutilise care. |
| first_indexed | 2024-04-24T09:54:58Z |
| format | Article |
| id | doaj.art-089a03a5a70448478e335ca59e4cb2bb |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-24T09:54:58Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-089a03a5a70448478e335ca59e4cb2bb2024-04-14T11:11:26ZengBMCBMC Health Services Research1472-69632024-04-0124111210.1186/s12913-024-10871-xPatient experiences and perspectives of health service access for carpal tunnel syndrome in Aotearoa New Zealand: a normalisation process theory-informed qualitative studyMiranda Bűhler0Carol Atmore1Meredith Perry2Sue Crengle3Pauline Norris4G. David Baxter5Department of General Practice & Rural Health, Dunedin School of Medicine, University of OtagoDepartment of General Practice & Rural Health, Dunedin School of Medicine, University of OtagoCentre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of OtagoNgāi Tahu Māori Health Research Unit, University of OtagoSchool of Pharmacy, University of OtagoCentre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of OtagoAbstract Background Early access to care for carpal tunnel syndrome (CTS) can avoid higher rates of surgery and permanent harm yet is often delayed, particularly for populations more likely to underutilise care. Objective We sought to explore patient experiences and perspectives of health service access for CTS to inform an equity-focussed co-design of a health service for improving early care access. Methods In this Normalisation Process Theory (NPT)-informed qualitative study we conducted semistructured in-depth interviews with 19 adults with experience of CTS. Recruitment prioritised New Zealand Māori, Pasifika, low-income, and rural populations. Data were analysed using deductive then inductive thematic analysis. Results We identified five major themes: (1) the ‘Significant Impact of CTS’ of the sense-making and relational work to understand the condition, deciding when to get care, compelling clinicians to provide care, and garnering help from others; (2) ‘Waiting and Paying for Care’– the enacting, relational, and appraising work to avoid long wait times unless paying privately, particularly where quality of care was low, employment relations poor, or injury compensation processes faltered; (3) circumstances of ‘Occupation and CTS Onset’ whereby the burden of proof to relate onset of CT symptoms to occupation created excessive relational and enacting work; (4) the ‘Information Scarcity’ of good information about CTS and the high relational and appraising work associated with using online resources; (5) ‘Negotiating Telehealth Perspectives’ where telehealth was valued if it meant earlier access for all despite the challenges it held for many. Conclusion Quality, culturally and linguistically responsive information and communication from clinicians and health services will improve equitable early access to CTS care including realising the potential of telehealth modes of care. Policy changes that reduce individual burden of proof in injury compensation claims processes, enable time off work to attend health appointments, and increase public funding for surgical resources would improve early access to CTS care particularly for Māori and Pacific populations and those in small and rural workplaces. NPT is valuable for understanding where opportunities lie to reduce inequitable delays to accessing care including the impact of racism, particularly for populations more likely to underutilise care.https://doi.org/10.1186/s12913-024-10871-xHealth services accessibilityCarpal tunnel syndromeQualitative researchHealth EquityNormalisation process theoryCo-design |
| spellingShingle | Miranda Bűhler Carol Atmore Meredith Perry Sue Crengle Pauline Norris G. David Baxter Patient experiences and perspectives of health service access for carpal tunnel syndrome in Aotearoa New Zealand: a normalisation process theory-informed qualitative study BMC Health Services Research Health services accessibility Carpal tunnel syndrome Qualitative research Health Equity Normalisation process theory Co-design |
| title | Patient experiences and perspectives of health service access for carpal tunnel syndrome in Aotearoa New Zealand: a normalisation process theory-informed qualitative study |
| title_full | Patient experiences and perspectives of health service access for carpal tunnel syndrome in Aotearoa New Zealand: a normalisation process theory-informed qualitative study |
| title_fullStr | Patient experiences and perspectives of health service access for carpal tunnel syndrome in Aotearoa New Zealand: a normalisation process theory-informed qualitative study |
| title_full_unstemmed | Patient experiences and perspectives of health service access for carpal tunnel syndrome in Aotearoa New Zealand: a normalisation process theory-informed qualitative study |
| title_short | Patient experiences and perspectives of health service access for carpal tunnel syndrome in Aotearoa New Zealand: a normalisation process theory-informed qualitative study |
| title_sort | patient experiences and perspectives of health service access for carpal tunnel syndrome in aotearoa new zealand a normalisation process theory informed qualitative study |
| topic | Health services accessibility Carpal tunnel syndrome Qualitative research Health Equity Normalisation process theory Co-design |
| url | https://doi.org/10.1186/s12913-024-10871-x |
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