Factors affecting the provision of guideline-recommended pain care in rural Australia: A consolidated program theory from a realist needs assessment

Little research has investigated what factors affect rural healthcare providers’ provision of guideline-recommended pain care. The authorship team developed a realist approach to conducting a needs assessment to investigate such factors. A realist program theory was refined and consolidated through realist-informed interviews and in-person and online focus groups with rural Australian healthcare providers who support patients affected by chronic pain. Data were extracted and retroductively analysed iteratively between rounds of data collection. Formal theories of behaviour were referenced to interpret the findings. Thirty-four providers participated. It was uncovered that providers’ intentions to provide guideline-recommended pain care arise from the combined influence of factors internal to providers including providers’ perceived control to overcome barriers (e.g., knowledge, skills), perceptions regarding the risk of patient attrition, and level of motivation to comply with local guideline-divergent norms. Whether these intentions lead to provision of recommended pain care or not relates to factors external to providers regarding opportunities allotted by models of care that support the providers’ patients, with public models having more constraints than private and compensable models. Further, rural healthcare providers were found to consistently encounter challenges under time pressures caused by short appointment times and busy practice schedules that could trigger ‘fast practice habits’ to override providers’ positive intentions. These findings suggest that aligning community norms with guideline-recommendations, improving models of care that constrain providers’ care, and reducing time pressures, may be worthwhile targets for initiatives that aim to improve the provision of guideline-recommended pain care in rural Australia.

Perspective

Internal (e.g., knowledge, perceptions, motivations, habits) and external (e.g., models of care, appointment times) factors affect rural healthcare providers’ provision of recommended pain care. Provision of recommended pain care in rural settings can be facilitated by improving community norms, models of care, and reducing time pressures on providers.