Understanding how patients’ pain beliefs influence chronic low back pain management in Ghana: a grounded theory approach
Introduction Chronic low back pain (CLBP) is associated with negative consequences in high and low/middle-income countries. Pain beliefs are important psychosocial factors that affect the occurrence and progression of CLBP and may be influenced by the sociocultural context and interactions with heal...
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2022-12-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/12/e061062.full |
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| author | Fiona Moffatt Josephine Ahenkorah Ampiah Claire Diver Paapa Kwesi Ampiah |
| author_facet | Fiona Moffatt Josephine Ahenkorah Ampiah Claire Diver Paapa Kwesi Ampiah |
| author_sort | Fiona Moffatt |
| collection | DOAJ |
| description | Introduction Chronic low back pain (CLBP) is associated with negative consequences in high and low/middle-income countries. Pain beliefs are important psychosocial factors that affect the occurrence and progression of CLBP and may be influenced by the sociocultural context and interactions with healthcare professionals (HCPs). The pain beliefs of Ghanaian patients with CLBP are unknown and the factors influencing pain beliefs in African contexts are unclear.Objectives To explore the pain beliefs of Ghanaian patients with CLBP, how they influence CLBP management/coping and to identify the mechanisms influencing them.Design Qualitative study using individual semistructured face-to-face interviews, situated within Straussian grounded theory principles and critical realist philosophy.Participants Thirty patients with CLBP accessing physiotherapy at two teaching hospitals in Ghana.Results Participants suggested dominant biomedical/mechanical beliefs (related to CLBP causes, posture and activity, and the belief of an endpoint/cure for CLBP). Maladaptive beliefs and practices, in particular fear-avoidance beliefs, and dependence on passive management and coping, were common among participants. These beliefs and practices were mostly influenced by HCPs and sociocultural expectations/norms. Although spirituality, pacing activity and prescribed exercises were commonly mentioned by participants, other active strategies and positive beliefs were expressed by a few participants and influenced by patients’ themselves. Limited physiotherapy involvement, knowledge and awareness were also reported by participants, and this appeared to be influenced by the limited physiotherapy visibility in Ghana.Conclusion Participants’ narratives suggested the dominant influence of HCPs and the sociocultural environment on their biomedical/mechanical beliefs. These facilitated maladaptive beliefs and adoption of passive coping and management practices. Therefore, incorporation of more positive beliefs and holistic/active strategies by Ghanaian patients and HCPs may be beneficial. Furthermore, patient empowerment and health literacy opportunities to address unhelpful CLBP/sociocultural beliefs and equip patients with management options for CLBP could be beneficial. |
| format | Article |
| id | doaj-art-e05f821bc48c497a874e4f0db89fb804 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-e05f821bc48c497a874e4f0db89fb8042025-08-20T03:52:15ZengBMJ Publishing GroupBMJ Open2044-60552022-12-01121210.1136/bmjopen-2022-061062Understanding how patients’ pain beliefs influence chronic low back pain management in Ghana: a grounded theory approachFiona Moffatt0Josephine Ahenkorah Ampiah1Claire Diver2Paapa Kwesi Ampiah3School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK1 Division of Physiotherapy, Chiropractic and Sports Rehabilitation, London South Bank University, London, UK2 Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK2 Department of Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UKIntroduction Chronic low back pain (CLBP) is associated with negative consequences in high and low/middle-income countries. Pain beliefs are important psychosocial factors that affect the occurrence and progression of CLBP and may be influenced by the sociocultural context and interactions with healthcare professionals (HCPs). The pain beliefs of Ghanaian patients with CLBP are unknown and the factors influencing pain beliefs in African contexts are unclear.Objectives To explore the pain beliefs of Ghanaian patients with CLBP, how they influence CLBP management/coping and to identify the mechanisms influencing them.Design Qualitative study using individual semistructured face-to-face interviews, situated within Straussian grounded theory principles and critical realist philosophy.Participants Thirty patients with CLBP accessing physiotherapy at two teaching hospitals in Ghana.Results Participants suggested dominant biomedical/mechanical beliefs (related to CLBP causes, posture and activity, and the belief of an endpoint/cure for CLBP). Maladaptive beliefs and practices, in particular fear-avoidance beliefs, and dependence on passive management and coping, were common among participants. These beliefs and practices were mostly influenced by HCPs and sociocultural expectations/norms. Although spirituality, pacing activity and prescribed exercises were commonly mentioned by participants, other active strategies and positive beliefs were expressed by a few participants and influenced by patients’ themselves. Limited physiotherapy involvement, knowledge and awareness were also reported by participants, and this appeared to be influenced by the limited physiotherapy visibility in Ghana.Conclusion Participants’ narratives suggested the dominant influence of HCPs and the sociocultural environment on their biomedical/mechanical beliefs. These facilitated maladaptive beliefs and adoption of passive coping and management practices. Therefore, incorporation of more positive beliefs and holistic/active strategies by Ghanaian patients and HCPs may be beneficial. Furthermore, patient empowerment and health literacy opportunities to address unhelpful CLBP/sociocultural beliefs and equip patients with management options for CLBP could be beneficial.https://bmjopen.bmj.com/content/12/12/e061062.full |
| spellingShingle | Fiona Moffatt Josephine Ahenkorah Ampiah Claire Diver Paapa Kwesi Ampiah Understanding how patients’ pain beliefs influence chronic low back pain management in Ghana: a grounded theory approach BMJ Open |
| title | Understanding how patients’ pain beliefs influence chronic low back pain management in Ghana: a grounded theory approach |
| title_full | Understanding how patients’ pain beliefs influence chronic low back pain management in Ghana: a grounded theory approach |
| title_fullStr | Understanding how patients’ pain beliefs influence chronic low back pain management in Ghana: a grounded theory approach |
| title_full_unstemmed | Understanding how patients’ pain beliefs influence chronic low back pain management in Ghana: a grounded theory approach |
| title_short | Understanding how patients’ pain beliefs influence chronic low back pain management in Ghana: a grounded theory approach |
| title_sort | understanding how patients pain beliefs influence chronic low back pain management in ghana a grounded theory approach |
| url | https://bmjopen.bmj.com/content/12/12/e061062.full |
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