A Multi-Method Analysis of the Cultural, Sociodemographic and Economic Elements in Osteoarthritis Care

Background: Osteoarthritis (OA) quality of care is influenced by various cultural, sociodemographic, and economic elements that shape the context in which first-line interventions are implemented. This thesis aims at providing insights to improve OA care quality by analysing the role of healthcare professionals' knowledge and adherence to clinical practice guidelines and patients' sociodemographic (e.g., sex and age) and economic factors (e.g., income), and their experience and beliefs of OA care, through four studies. Methods: The four studies analysed: 1) physiotherapists’ knowledge of and adherence to OA clinical practice guidelines (survey-based study in Italy); 2) patients’ experience of the OA care process (qualitative study in Italy); 3) association between demographic, socioeconomic and disease-related factors and exercise adherence in OA (register-based study in Sweden); 4) income inequalities in people attending an OA first-line intervention and whether these inequalities changed after attending it (cohort study in Sweden). Results: Study 1 revealed that Italian physiotherapists knew but did not always apply first-line interventions. Study 2 suggested that people with OA experience an uncertain care process due to the lack of clear explanations, resulting in a negative attitude towards first‐line interventions. Study 3 found associations between exercise adherence and age, sex, socioeconomic status, disease severity and self-efficacy. All the investigated factors explained 1% of the exercise adherence variability. Study 4 indicated income inequalities among participants to an OA first-line intervention that widened after it. Conclusion: Several areas in the OA care process require attention. Physiotherapists must bridge the gap between their knowledge of and adherence to OA clinical practice guidelines. Patients need to be guided throughout their care process to be more empowered. Further studies on the factors associated with OA exercise adherence are necessary. Finally, we need to address inequalities in OA care, prioritising upstream interventions.