Abstract

Aims

Identify opportunities to improve knowledge translation for post-operative pain management in Rwanda by exploring clinician and environmental factors affecting this practice.

Methods

The theory of planned behavior (TPB) guided development of a questionnaire to measure intent to assess and treat postoperative pain. Focus groups and individual interviews were used to contextualize the final questionnaire and generate questions related to pain management practice. Health care providers from two Rwandan teaching hospitals involved in postoperative pain management completed the TPB questionnaire in May 2015. TPB subscale scores were analyzed to identify demographic and practice characteristics associated with intention to treat pain. The general linear model was used to test effect of attitudes, subjective norms, and perceived control on behavioral intent to treat pain.

Results

Forty-six percent of participants (N = 131) had training in acute pain management, 56% used a pain protocol, and 74% used pain scales. Tramadol (78%), morphine (79%), and paracetamol (75%) were used most often to treat pain. Drug availability was the most frequently reported barrier to treating pain. Though intention to treat pain was high, only attitudes and perceived control about assessing pain were associated with intention to treat pain. The theme of fear of the adverse effects of pain medications was consistent across focus groups and interviews in both sites.

Conclusions

System and knowledge barriers exist: interventions to address these barriers may lead to improved postoperative pain care. Further validation of the TPB questionnaire is required to address cultural and language factors specific to the Rwandan context.

Details

Title
Barriers and facilitators to postoperative pain management in Rwanda from the perspective of health care providers: A contextualization of the theory of planned behavior
Author
Gaston Nyirigira 1   VIAFID ORCID Logo  ; Wilson, Rosemary A 2   VIAFID ORCID Logo  ; VanDenKerkhof, Elizabeth G 2   VIAFID ORCID Logo  ; Goldstein, David H 3 ; Twagirumugabe, Theogene 4 ; Mahaffey, Ryan 5 ; Parlow, Joel 5 ; Johnson, Ana P 6 

1  Anaesthesia, Critical Care and Pain, Butare University Teaching Hospital, Butare, Rwanda 
2  School of Nursing, Queen’s University, Kingston, Ontario, Canada; Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston Health Sciences Centre, Kingston, Ontario, Canada 
3  Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston Health Sciences Centre, Kingston, Ontario, Canada; Department of Anesthesiology, Brockville General Hospital, Brockville, Ontario, Canada 
4  College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda 
5  Department of Anesthesiology and Perioperative Medicine, Queen’s University, Kingston Health Sciences Centre, Kingston, Ontario, Canada 
6  Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada 
Pages
87-102
Publication year
2018
Publication date
Jan 2018
Publisher
Taylor & Francis Ltd.
e-ISSN
2474-0527
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1080/24740527.2018.1451251
ProQuest document ID
2277556803
Copyright
© 2018 Gaston Nyirigira, Rosemary A. Wilson, Elizabeth G. VanDenKerkhof, David H. Goldstein, Theogene Twagirumugabe, Ryan Mahaffey, Joel Parlow, and Ana P. Johnson. Published with license by Taylor & Francis Group, LLC. This work is licensed under the Creative Commons Attribution License http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.