Barriers and facilitators to implementing core osteoarthritis treatments in China: a mixed-method study

Objective

To understand current practices and identify barriers and facilitators to implementing guideline recommended core OA treatments in China.

Methods

An exploratory mixed-methods design was employed, involving healthcare professionals managing OA in mainland China. The qualitative phase included semi-structured interviews (n=15) and a qualitative survey (n=181). A quantitative survey (n=302) evaluated the clinical applicability of identified themes, common practices, knowledge, and self-rated confidence in core capabilities about OA. Qualitative data were analyzed through thematic and content analysis using NVivo, and descriptive statistics were applied to quantitative data using RStudio.

Results

Participants representing six professions provided their perspectives qualitatively. Five themes emerged as barriers: widespread misconceptions about OA; limitations in current medical insurance policies; insufficient multidisciplinary collaboration; lack of workplace support; and low patient adherence to self-management. Three themes emerged as facilitators: telehealth and community-based delivery pathways; professional training and patient education resources; and personalized services with positive feedback.

Across 19 provinces in China, participants representing seven different health professions completed the quantitative survey. The most commonly used treatments for OA were physical agent therapy (56%), while exercise therapy was utilized by only 9%. The average OA knowledge score was 31.2 (±8.9) out of 55. Self-rated confidence was lowest for “referrals and interdisciplinary collaboration” (3.4±0.1, “somewhat confident”). The most applicable factors impacting the implementation of core OA treatments included patient comorbidities, knowledge of pain science and exercise therapy, and financial support (all 2.8±0.8, “applicable”).

Conclusion

Core OA treatments recommended by international clinical guidelines are infrequently implemented in China.

SIGNIFICANCE AND INNOVATIONS

• This study is the first to explore the barriers and facilitators to implementing core osteoarthritis (OA) treatments in China, providing comprehensive insights into the unique challenges within the Chinese healthcare system.

• It highlights the substantial underutilization of exercise therapy in OA care (9%), reflecting a potential mismatch between guideline recommendations and clinical practice, and underscores the need for targeted implementation strategies.

• Major barriers include widespread misconceptions about OA, limited multidisciplinary collaboration, and insufficient financial and organizational support for non-pharmacological interventions.

• The study emphasizes the potential of telehealth and community-based care to address disparities in OA management and improve access to evidence-based, guideline-recommended OA treatments in diverse clinical settings across China.