Barriers and Facilitators for the Implementation of an Osteoarthritis Management Programs in a Low-Income Setting: An Exploratory Study of Malawian Physical Therapists.

Abstract

<b>OBJECTIVE:</b> To (1) examine Malawian physical therapists' knowledge and beliefs about osteoarthritis (OA), and their perceived capabilities to deliver an OA management program to people with knee and hip OA, and (2) identify barriers and facilitators for an OA management program in Malawi. <b>DESIGN:</b> Two-phased mixed-methods formative evaluation. <b>METHODS:</b> In phase 1, Malawian physical therapists participated in the Good Life with osteoArthritis in Denmark (GLA:D) Australia training course and answered quantitative precourse and postcourse questions that were descriptively summarized, and analysed using McNemar's test, where appropriate. In phase 2, semistructured focus groups generated qualitative data that were thematically analyzed and mapped to the Consolidated Framework for Implementation Research. Mixed-methods data were integrated through triangulation. <b>RESULTS:</b> Eleven Malawian physical therapists (9 [82%] female, 10 [91%] with 5-10 years of clinical experience) participated. From pretraining to posttraining course, participants' knowledge of OA management (percentage change) increased regarding the benefits of therapeutic exercise (91%), importance of weight management (82%), and acceptable symptoms profile (73%). Participants' confidence and beliefs in managing knee and hip OA also increased. Implementation barriers included program costs, current medical management of OA with painkillers, and infrastructure challenges. Implementation facilitators included the content and organization of GLA:D, adaptability of the program, and OA awareness and education among other health professionals. <b>CONCLUSION:</b> Knowledge, confidence, and beliefs in managing knee and hip OA improved post-GLA:D training in Malawian physical therapists. Increasing education of physical therapists, other health professionals, and the public about evidence-based OA management and making contextual adaptions to the GLA:D training and program structure may facilitate implementation of OA management program, such as GLA:D, in low- and-middle-income countries. <i>J Orthop Sports Phys Ther 2026;56(3):193-208. Epub 4 February 2026. doi:10.2519/jospt.2026.13317</i>.