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
Author Information
Nicole Robak: Faculty of Kinesiology and Recreation Management, Frank Kennedy Centre, University of Manitoba, University Crescent University of Manitoba (Fort Garry Campus), Winnipeg, MB, Canada. ORCID
Elena Broeckelmann: Faculty of Kinesiology and Recreation Management, Frank Kennedy Centre, University of Manitoba, University Crescent University of Manitoba (Fort Garry Campus), Winnipeg, MB, Canada. ORCID
Silvano Mior: Graduate Education and Research, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada. ORCID
Melissa Atkinson-Graham: Graduate Education and Research, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada. ORCID
Jennifer Ward: Faculty of Kinesiology and Recreation Management, Frank Kennedy Centre, University of Manitoba, University Crescent University of Manitoba (Fort Garry Campus), Winnipeg, MB, Canada.
Muriel Scott: Cross Lake Health Services, Cross Lake, P.O. Box 190, Manitoba, R0B 0J0, Canada.
Steven Passmore: Faculty of Kinesiology and Recreation Management, Frank Kennedy Centre, University of Manitoba, University Crescent University of Manitoba (Fort Garry Campus), Winnipeg, MB, Canada. ORCID
Deborah Kopansky-Giles: Graduate Education and Research, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada. ORCID
Patricia Tavares: Graduate Education and Research, Canadian Memorial Chiropractic College, 6100 Leslie Street, Toronto, ON, M2H 3J1, Canada. ORCID
Jean Moss: World Spine Care Canada, 3000 Langstaff Road Unit 15, Concord, ON, L4K 4R7, Canada. ORCID
Jacqueline Ladwig: Faculty of Kinesiology and Recreation Management, Frank Kennedy Centre, University of Manitoba, University Crescent University of Manitoba (Fort Garry Campus), Winnipeg, MB, Canada. ORCID
Cheryl Glazebrook: Faculty of Kinesiology and Recreation Management, Frank Kennedy Centre, University of Manitoba, University Crescent University of Manitoba (Fort Garry Campus), Winnipeg, MB, Canada. ORCID
David Monias: Cross Lake Band, Cross Lake, No. 276 Pimicikamak Okimawin, P.O Box 10, Cross Lake, MB, R0B0J0, Canada.
Helga Hamilton: Cross Lake Health Services, Cross Lake, P.O. Box 190, Manitoba, R0B 0J0, Canada.
Donnie McKay: Cross Lake Health Services, Cross Lake, P.O. Box 190, Manitoba, R0B 0J0, Canada.
Randall Smolinski: Cross Lake Nursing Station, Box 160 Cross Lake, Manitoba, R0B 0J0, Canada.
Scott Haldeman: University of California, Irvine, Irvine, CA, 92697, USA. ORCID
André Bussières: Faculty of Kinesiology and Recreation Management, Frank Kennedy Centre, University of Manitoba, University Crescent University of Manitoba (Fort Garry Campus), Winnipeg, MB, Canada. andre.bussieres@uqtr.ca. ORCID
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.
