Supporting the implementation of Osteoarthritis Management Programs in low-and middle-income settings: Understanding clinician training outcomes alongside perceived program barriers and facilitators in Malawi

ObjectiveTo examine Malawian physiotherapists knowledge and beliefs about Osteoarthritis (OA) and their perceived capabilities to deliver an Osteoarthritis Management Program (OMP) to people with knee and hip OA; and to identify OMP barriers and facilitators in Malawi. DesignTwo-phased mixed methods formative evaluation MethodsPhase 1: Malawian physiotherapists participated in the GLA:D(R) Australia training course and answered quantitative pre-and-post course questions that were descriptively summarized, and analysed using McNemars test, where appropriate. Phase 2: semi-structured focus groups generated qualitative data that were thematically analysed and mapped to the Consolidated Framework for Implementation Research. Mixed methods data were integrated through triangulation. ResultsEleven Malawian physiotherapists [9 (82%) female, 10 (91%) with 5-10 years clinical experience] participated. Post training course, participants knowledge of OA management increased regarding the benefits of therapeutic exercise (p=0.002), importance of weight management (p=0.004), and acceptable symptoms profile (p=0.008). Participants confidence and beliefs in managing knee and hip OA also increased. Implementation barriers included program costs, current medical management of OA with painkillers, and infrastructure challenges. Implementation facilitators included the content and organisation of GLA:D(R), the ability to adapt the program, and OA awareness and education among other health professionals. ConclusionKnowledge, confidence, and beliefs in managing knee and hip OA improved post GLA:D(R) training in Malawian physiotherapists. Increasing education of physiotherapists, other health professionals and the general public about evidence-based OA management and making contextual adaptions to the GLA:D(R) training and program structure may facilitate future implementation of OMP, such as GLA:D(R), in low-and-middle income countries.