Views and perspectives toward implementing the Global Spine Care Initiative (GSCI) model of care, and related spine care program by the people in Cross Lake, Northern Manitoba, Canada: a qualitative study using the Theoretical Domain Framework (TDF)

Nicole Robak; Elena Broeckelmann; Silvano Mior; Melissa Atkinson-Graham; Jennifer Ward; Muriel Scott; Steven Passmore; Deborah Kopansky-Giles; Patricia Tavares; Jean Moss; Jacqueline Ladwig; Cheryl Glazebrook; David Monias; Helga Hamilton; Donnie McKay; Randall Smolinski; Scott Haldeman; André Bussières

doi:10.1186/s43058-024-00636-2

Views and perspectives toward implementing the Global Spine Care Initiative (GSCI) model of care, and related spine care program by the people in Cross Lake, Northern Manitoba, Canada: a qualitative study using the Theoretical Domain Framework (TDF)

Implement Sci Commun. 2024 Sep 17;5(1):100. doi: 10.1186/s43058-024-00636-2.

Authors

Nicole Robak¹, Elena Broeckelmann¹, Silvano Mior², Melissa Atkinson-Graham^{2

3

4}, Jennifer Ward¹, Muriel Scott⁵, Steven Passmore¹, Deborah Kopansky-Giles^{2

6}, Patricia Tavares², Jean Moss⁷, Jacqueline Ladwig¹, Cheryl Glazebrook¹, David Monias⁸, Helga Hamilton⁵, Donnie McKay⁵, Randall Smolinski⁹, Scott Haldeman^{10

11}, André Bussières^{12

13

14}

Affiliations

¹ Faculty of Kinesiology and Recreation Management, Frank Kennedy Centre, University of Manitoba, University Crescent University of Manitoba (Fort Garry Campus), Winnipeg, MB, Canada.
² Graduate Education and Research, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada.
³ Département Chiropratique, Boulevard Des Forges, Université du Québec À , Trois-Rivières, Trois-Rivières , Canada.
⁴ Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1G 0C5, Canada.
⁵ Cross Lake Health Services, Cross Lake, P.O. Box 190, Manitoba, R0B 0J0, Canada.
⁶ Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5 Floor, Toronto, ON, M5G 1V7, Canada.
⁷ World Spine Care Canada, 3000 Langstaff Road Unit 15, Concord, ON, L4K 4R7, Canada.
⁸ Cross Lake Band, Cross Lake, No. 276 Pimicikamak Okimawin, P.O Box 10, Cross Lake, MB, R0B0J0, Canada.
⁹ Cross Lake Nursing Station, Box 160 Cross Lake, Manitoba, R0B 0J0, Canada.
¹⁰ University of California, Irvine, Irvine, CA, 92697, USA.
¹¹ World Spine Care, 17602 17 Street, Suite 102-263, Tustin, CA, 92780, USA.
¹² Faculty of Kinesiology and Recreation Management, Frank Kennedy Centre, University of Manitoba, University Crescent University of Manitoba (Fort Garry Campus), Winnipeg, MB, Canada. [email protected].
¹³ Département Chiropratique, Boulevard Des Forges, Université du Québec À , Trois-Rivières, Trois-Rivières , Canada. [email protected].
¹⁴ School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, 3630 Prom Sir-William-Osler, Montréal, Québec, H3G 1Y5, Canada. [email protected].

Abstract

Background: Back pain is very common and a leading cause of disability worldwide. Due to health care system inequalities, Indigenous communities have a disproportionately higher prevalence of injury and acute and chronic diseases compared to the general Canadian population. Indigenous communities, particularly in northern Canada, have limited access to evidence-based spine care. Strategies established in collaboration with Indigenous peoples are needed to address unmet healthcare needs, including spine care (chiropractic and movement program) services. This study aimed to understand the views and perspectives of Cross Lake community leaders and clinicians working at Cross Lake Nursing Station (CLNS) in northern Manitoba regarding the implementation of the Global Spine Care Initiative (GSCI) model of spine care (MoC) and related implementation strategies.

Method: A qualitative exploratory design using an interpretivist paradigm was used. Twenty community partners were invited to participate in semi-structured interviews underpinned by the Theoretical Domains Framework (TDF) adapted to capture pertinent information. Data were analyzed deductively and inductively, and the interpretation of findings were explored in consultation with community members and partners.

Results: Community leaders (n = 9) and physicians, nurses, and allied health workers (n = 11) emphasized: 1) the importance of contextualizing the MoC (triaging and care pathway) and proposed new services through in-person community engagement; 2) the need and desire for local non-pharmacological spine care approaches; and 3) streamlining patient triage and CLNS workflow. Recommendations for the streamlining included reducing managerial/administrative duties, educating new incoming clinicians, incorporating follow-up appointments for spine pain patients, and establishing an electronic medical record system along with a patient portal. Suggestions regarding how to sustain the new spine care services included providing transportation, protecting allocated clinic space, resolving insurance coverage discrepancies, addressing misconceptions about chiropractic care, instilling the value of physical activity for self-care and pain relief, and a short-term (30-day) incentivised movement program which considers a variety of movement options and offers a social component after each session.

Conclusion: Community partners were favorable to the inclusion of a refined GSCI MoC. Adapting the TDF to unique Indigenous needs may help understand how best to implement the MoC in communities with similar needs.

Keywords: Chiropractic; Implementation science; Indigenous; Medically underserved area; Non-pharmacological; Qualitative research; Spine care; Theoretical domains framework; Vulnerable population.