An Investigation of Health Care Professionals' Attitudes and Beliefs Toward the Management of Chronic Pain in Older Adults

  • Paul A. Cameron

    Student thesis: Doctoral ThesisDoctor of Philosophy


    Understanding unhelpful attitudes and beliefs of those delivering healthcare to specific populations is important to ensure that patient treatment is not adversely affected. The identification of these, followed by the provision of targeted education, would be expected to lead to improvements in this situation. The management of chronic pain by health care professionals (HCPs) can be affected by their attitudes and beliefs toward such management. In addition to this effect it has been found that older adults often face poor chronic pain management due to their age. The combined effect of these attitudes and beliefs is likely to diminish effective management of the older adult patient group, and it is important to be able to identify the existence of such attitudes and beliefs in order to address them.

    Five main research objectives are addressed in this thesis. Chapter one discusses the theoretical underpinnings for these research questions and chapter two provides a research outline and operational definitions. Thereafter subsequent chapters (three to seven) discuss five original pieces of empirical research (Phase I to V). First, a systematic search and critical review was undertaken to identify if suitable measures existed to measure attitudes and beliefs of health care professionals toward the chronic pain management of older adults. This review found no questionnaire that could identify attitudes and beliefs of HCPs managing chronic pain in older adults. Second, semi-structured interviews were conducted with HCPs (n=13) and analysed under a constructivist/interpretivist paradigm using grounded theory, in order to identify a full content domain for managing pain in older adults. The results of this analysis revealed six domains to be important; Mobility, Psychology, Communication, Time, Resources and Physiology. Third, a structured approach was taken to adapt a questionnaire previously designed for measuring the attitudes and beliefs of HCPs for a mixed population of chronic pain sufferers, in an evidenced manner, in order to evaluate content validity. Fourth, the newly created ProfABS-OA v3 was piloted with a sample population of nurses in a pain special interest group (n=41) to allow analysis of reliability and construct validity. Fifth and finally, a larger survey was conducted across a broad range of HCPs (n=391) in order to further evaluate reliability, construct validity, and biographical variables across a wider professional group.

    The final results showed that the ProfABS-OA was a reliable and valid measure for measuring the attitudes and beliefs of HCPs in their management of chronic pain of older adults. In addition, results revealed a statistically significant difference in mean scores between professions, indicating that attitudes and beliefs may differ between occupational groups. Interestingly, it was noted that some professions, (GPs and Psychologists), had no significant difference in scores within their professional group when compared with the receipt or non-receipt of post-graduate pain education. This may suggest that their attitudes and beliefs may have been fashioned at a much earlier stage, and post-graduate education may only have a minimal impact on changing them.
    Date of Award2016
    Original languageEnglish
    SponsorsUniversity College London
    SupervisorBlair Smith (Supervisor) & Patricia A. Schofield (Supervisor)

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