Abstract
Background
Understanding care seeking behaviour is vital to enabling access to care. In the context of
low back pain (LBP), chiropractors offer services to patients of all ages. Currently, geriatric
sub-populations tend to be under-investigated, despite the disproportionate effects of LBP
on older adults. In the Netherlands, the chiropractic profession is relatively unknown and
therefore, generally speaking, is not considered as the first choice for conservative musculoskeletal
primary health care. The aim of this paper was to explore the experiences of older
adults with LBP, seeking chiropracic care for the first time, in order to identify perceived barriers
and facilitators in this process.
Methods
Stage 1: Participants 56 years of age and older with chronic LBP who either sought or did
not seek chiropractic care were interviewed to provide detailed information on the factors
that promoted or impeded care-seeking behaviour. A purposive sampling strategy was used
to recruit participants through a network of researchers, chiropractors and other healthcare
professionals offering musculoskeletal health care services. Individuals with underlying
pathology, previous surgery for LBP, or insufficient mastery of the Dutch language were
excluded. Data were collected until saturation was reached and thematically analysed.
Stage 2: To further explore the themes, a focus group interview was conducted with a
provider stakeholder group consisting of:two physiotherapists, a nurse practitioner, a geriatrician,
and a chiropractor. All interviews were conducted online, voice recorded, and transcribed
verbatim. Results
We interviewed 11 older adults with low back pain. During this process four themes
emerged that captured their perception and experiences in either seeking or dismissing chiropractic
care for their LBP; these being ‘generic’, ‘financial’, ‘expectation’, and ‘the image
of the chiropractor’. The focus group members largely confirmed the identified themes,
highlighting a lack of awarenes and accessibility as key barriers to care. On the other hand,
whe chiropractior as an alternative care provider, with a focus on manual interventions, was
seen as a facilitator.
Conclusions
The lack of knowledge about chiropractic care was found to be the most important barrier to
seeking care. The most important facilitator was insufficient resolution of their symptoms following
previous care, making patients look further for a solution for their problem. These barriers
and facilitators seem not to differ greatly from barriers and facilitators found among
younger patients with neck pain. Age and health condition may therefore be weak determinants
of care. This new information may help us optimize accessibility for older adults to the
chiropractor.
Results
We interviewed 11 older adults with low back pain. During this process four themes
emerged that captured their perception and experiences in either seeking or dismissing chiropractic
care for their LBP; these being ‘generic’, ‘financial’, ‘expectation’, and ‘the image
of the chiropractor’. The focus group members largely confirmed the identified themes,
highlighting a lack of awarenes and accessibility as key barriers to care. On the other hand,
whe chiropractior as an alternative care provider, with a focus on manual interventions, was
seen as a facilitator.
Conclusions
The lack of knowledge about chiropractic care was found to be the most important barrier to
seeking care. The most important facilitator was insufficient resolution of their symptoms following
previous care, making patients look further for a solution for their problem. These barriers
and facilitators seem not to differ greatly from barriers and facilitators found among
younger patients with neck pain. Age and health condition may therefore be weak determinants
of care. This new information may help us optimize accessibility for older adults to the
chiropractor.