Exploring communication as a means to deliver patient education for musculoskeletal care by chiropractors in the eThekwini Municipality

Abstract

Background: Communication is a fundamental tool used by all healthcare practitioners, as well as chiropractors, in delivering care. Practitioners use communication to connect with their patients to form trusting relationships and obtain clinically relevant information to reach a diagnosis. It is also used to deliver important healthcare information to the patient regarding their condition, relevant lifestyle changes, interventions and outcomes. The way a practitioner has utilized communication, their ability to deliver succinct patient education that is empathetic and relevant to the patients’ life, and preferences are important factors in the success of the treatment and management delivered. Despite this, communication is still considered a complex phenomenon with little concordance on its success experienced by both the patient and the practitioner. Patient education has been identified as a key factor in delivering optimal management and care of musculoskeletal disease, which is a central component of chiropractic scope of practice. It has also been identified as an important component of chronic care management and encouraging self-management, which is a fundamental part of managing risk factors for both musculoskeletal disease and chronic disease. The eThekwini Municipality, the study location, is a socioeconomically diverse region, which historically suffers from language and social disparities, which affect the delivery and success of healthcare. This research adds a unique insight into how chiropractors in eThekwini utilize communication to deliver patient education to their patients. Methodology: A qualitative research methodology was utilized to collect data through semi-structured interviews. The data were analyzed using thematic analysis to extract the meaning and understanding of the interviews. Eight interviews were conducted before data saturation was reached. Results: Three main themes, namely communication skills, communication barriers and communication techniques, emerged from the data with a number of sub-themes. Conclusion: The results revealed that all the participants thought communication skills and patient education were fundamental to how they delivered care. Their perception on the acquisition of these skills were varied and ranged from passive time in practice, foundational at a university level, and necessitating further studies. When exploring the barriers, it was thought that although patient perception was an important factor, this could be as a result of a consumeristic medical system, poor communication on the practitioners part and a lack of a unified profession identity of chiropractic. Socioeconomic, language and cultural issues still affect the delivery of care and adequate patient education, even though South Africa has been a democracy for 29 years. Communication techniques have evolved, including the utilization of communication technologies, which can contribute to patient-centeredness. Paternalistic and diseasecentered communication techniques still underpin manual therapy but patient-centered techniques are emerging.