JIGSAW-A PROCESS AND FEASIBILITY OF IMPLEMENTING GUIDELINE RECOMMENDATIONS FOR THE CARE OF OSTEOARTHRITIS IN WEST-AFRICA

Babatunde, Opeyemi; Adetunji, Oladapo; Alonge, Ibidunni; Owoyemi, Tolulope; Ayinmode, Ebunoluwa; Ogunbanjo, Adebimpe; White, Simon; Adebajo, Adewale; Mallen, Christian; Dziedzic, Krysia

Abstract

Objectives: To assess the feasibility of a guideline-informed model of care for osteoarthritis in primary healthcare and community pharmacy settings in West-African context.

Methods: 4-phase mixed-methods programme of research undertaken in south-west Nigeria, West-Africa. Phases 1-2 involved contextual adaptation of guideline-informed care - Joint Implementation of Guidelines for OSteoArthritis in West-Africa (JIGSAW-A):
•focus groups (n=4) with patients, community pharmacists and healthcare professionals (HCPs) to identify patient preferences and support needs of HCPs;
•Stakeholders resource contextualisation/co-design (i.e. Osteoarthrtitis guidebook in local languages, HCPs training/support package). Iterative co-design workshops (n=3) using participatory approaches, model OA consultation simulations and consensus agreement.
Phase 3: Following training, and a 12-week pilot implementation period, patient-reported quality of care was assessed by the OsteoArthritis Quality Indicator questionnaire (modified 9-item, scale 0–100%, 100%=best) and implementation of the JIGSAW-A model of care was evaluated using the RE-AIM framework. Patient and HCP interviews explored barriers and facilitators, usefulness and acceptability. In phase 4, recommendations for further scale-up and wider implementation of integrated osteoarthritis care were specified.

Results: Phases 1-2 highlight the burden and impact of everyday living with joint pain; and misinformation which affects help seeking. Participants expressed the need for a broad information and education campaign, and access to self-management support which informed iterative contextualisation of osteoarthritis care and patient information resources used to support pilot implementation in phase 3.
Over 12-weeks, twelve HCPs (community pharmacies, physiotherapists, and doctors) were involved in evaluation across nine sites. Of 369 patient consultations that were reported, high rates of quality indicator achievement were found for self-management advice (97%), topical analgesic use (89%), and exercise recommendations (87%). Compliance with full patient assessment in line with the protocol was poor (17%).

Conclusions: We found that evidence-based care for osteoarthritis, involving community pharmacies (as a usual first point of call) and other primary care clinicians is feasible and may improve aspects of care in low-resource settings. Further research is needed to ascertain long-term sustainability and cost-effectiveness.

Citation

Babatunde, O., Adetunji, O., Alonge, I., Owoyemi, T., Ayinmode, E., Ogunbanjo, A., White, S., Adebajo, A., Mallen, C., & Dziedzic, K. (in press). JIGSAW-A PROCESS AND FEASIBILITY OF IMPLEMENTING GUIDELINE RECOMMENDATIONS FOR THE CARE OF OSTEOARTHRITIS IN WEST-AFRICA. BMJ Global Health,

• Journal Article Type: Article
• Acceptance Date: Apr 13, 2025
• Deposit Date: Apr 16, 2025
• Journal: BMJ Global Health
• Print ISSN: 2059-7908
• Electronic ISSN: 2059-7908
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Keywords: Osteoarthritis, Primary care, Community Pharmacies, Healthcare Professionals, Nigeria, West-Africa
• Public URL: https://keele-repository.worktribe.com/output/1196750