Perceptions of new graduate chiropractors in their management of paediatric patients in the eThekwini municipality

Abstract

Chiropractic is the most frequently utilised complementary and alternative medicine therapy by children and adolescents worldwide. Evidence suggests that childhood health and lifestyle can impact on the health and quality of life in adulthood. The chiropractic care of paediatric patients should therefore be considered as a viable, conservative approach to the holistic management of children. The chiropractic management of paediatric patients is still however surrounded by controversy, from the public and other healthcare professions, largely due to the lack of scientific research in this field. With the adoption of evidence-based practice, it is imperative that the chiropractic profession remain dynamic, continually exploring, questioning and researching the elements that contribute towards effective chiropractic paediatric treatment and management. This study endeavours to provide a new viewpoint from the perspective of new graduate chiropractors on their confidence and competence with regards to paediatric patient management, which are aspects, regarded by multiple studies, as vital elements of successful patient management in the healthcare sector. The findings of this research can provide a greater understanding of the methods which can be implemented in order to foster knowledge, skill and overall confidence during tertiary education, with respect to the field of chiropractic paediatric training. Aim of the study The aim of the study was to assess the perceptions of new graduate chiropractors in their management of paediatric patients in the eThekwini Municipality. Methodology A qualitative, explorative, descriptive research design was utilised for this study. A purposive sample of 10 new graduate chiropractors in the eThekwini Municipality were interviewed. Their perceptions with regards to their paediatric patient management were obtained through semi-structured interviews. Eight key questions, relating to chiropractic paediatric patient management and paediatric educational training, were used to encourage the discussion. The data collected were stored electronically and then transcribed. The transcripts were then coded and analysed by the researcher to identify categories and subcategories. Interpretation of the coded data thereafter occurred, utilising the themes and sub-themes previously identified by the researcher. Results Four main themes were identified in the study, namely self-perception of confidence, knowledge and skill in paediatric patient management; exposure and training received in the chiropractic course; challenges encountered in paediatric patient management; and further enhancement of paediatric patient management. Participants expressed a lack of confidence and competence with regards to their management of the paediatric population. A strong correlation was exhibited between their perceived lack of skill in paediatric treatment and management and increased referral rates for this patient category. Participants stated that their lack of exposure to paediatric patients during the chiropractic paediatric curriculum in the course, negatively impacted on their diagnostic and orthopaedic assessment skills, as well as their ability to facilitate treatment to this age group. Participants identified areas of enhancement in the chiropractic paediatric component of the chiropractic programme. A variety of obstacles encountered by new graduate chiropractors were discussed, including parental satisfaction and influence on paediatric treatment; communication and time management skills; uncooperative patients and lack of competence and confidence with regards to paediatric patient management. Methods to improve paediatric assessment and treatment were then highlighted and discussed further. Conclusion This study is the first in South Africa to assess the perceptions of new graduate chiropractors in their management of paediatric patients. These perceptions were based on a variety of factors such as self-perceived competence, self- confidence, professional education and continued professional development, as well as practitioner experience. While new graduate chiropractors acknowledged the beneficial aspects of the chiropractic paediatric component of the chiropractic programme, they provided constructive feedback and recommendations for further enhancement of the chiropractic paediatric curriculum in the chiropractic course. The lack of exposure to paediatric patients prior to private practice was highlighted as a key factor that negatively impacted on new graduate chiropractors’ confidence to assess, treat and manage this patient population. Therefore, it is recommended that the findings of this research be utilised by the Durban University of Technology’s Chiropractic Department in order to enhance the quality of their chiropractic paediatric curriculum.