Sage Journals: Discover world-class research

Abstract

The need for an effective health personnel team is important due to the increasing complexity of patient care and increasing co-morbidities. Interprofessional collaboration (IPC) among healthcare professionals offers appropriate collaborative management for humans. This study aimed to assess the attitude and barriers to IPC in hospitals among healthcare professionals in Lahore, Pakistan. A cross-sectional study was conducted using a convenience sampling technique. Healthcare professionals (speech-language pathologists, audiologists, physiotherapists, occupational therapists, psychologists, psychiatrists, neurologists, ENT specialists, pediatricians, dentists, and nursing staff) working at Children Hospital, Shaikh Zayed Hospital, Pakistan Society for the Rehabilitation of the Disabled (PSRD), Lahore, Pakistan were included. The paper and online survey questionnaire composed in the google form and attitudes toward healthcare teams scale (ATHCT) and barriers scale toward interprofessional collaboration were used. Statistical package for the social sciences (SPSS) version 21 was used to analyze the survey data through frequency analyses and percentage distributions. Most of the respondents (response rate = 88.1%) had positive attitudes toward IPC and strongly agreed on 9 positive statements in ATHCT. Statistically, Major barriers were role and leadership ambiguity 68.6%, different goals of individual team members 68.1%, and 53.3% strongly agreed on the difference in levels of authority, power, expertise, and income. Although healthcare professionals have an optimistic attitude toward IPC, several healthcare professionals come across challenges during the practice of IPC. To overcome the analyzed barriers, the higher healthcare authorities must encourage interprofessional collaborative strategies and models.

Keywords

attitude cross-sectional interprofessional collaboration health personnel delivery of health care humans

What do we already know about this topic?

In the past few years, the prevalence of complicated and chronic health disorders has led to the immense need for an effective healthcare team.

How does your research contribute to the field?

This research may be helpful in re-developing and improving healthcare strategies for the patient, taking IPC as a powerful approach to overcome the shortage of healthcare workers.

What are your research’s implications toward theory, practice, or policy?

This research highlights the barriers and attitudes that may further help to develop and practice coordinated approaches for better management which ultimately may improve the quality of life in patients who require special medical assistance.

Introduction

Interprofessional collaboration (IPC) is a way of communication in which 2 or more healthcare professionals share their knowledge through discussion, and provide their best management for the patients, their families, and health organizations.¹ Thus, in the healthcare sector IPC is a collaborative partnership responsible for the quality of care to the patients according to their needs.² IPC in education and practice is recognized by the World Health Organization (WHO) as a unique method for delivery of health that will also help to relieve the global manpower deficit in this field.³

Collaborative practice improves the quality of care and enhances health systems.⁴ Health professionals independently perform assessment procedures and few treatment interventions but management goals; specifically, long-term goals are established together. All team members communicate and work cooperatively according to the patient’s needs. IPC also enriches patient satisfaction, and lessens medical errors, improving health outcomes and healthcare quality.^5,6

In the past few years, the prevalence of complicated and chronic health disorders raised led to the immense need for an effective healthcare team.^7,8 Currently, there is also a necessity to work effectively in crossways between the hospital, community settings, and allied health sciences.^8,9 For the assessment of the effectiveness of collaboration; an initial phase toward it, is to evaluate the attitudes of healthcare professionals and the barriers they are facing in the way of IPC.^10,11

Health professionals’ attitudes toward their own and other healthcare professionals’ disciplines may influence their willingness to collaborate.¹² It can influence how they perceive and behave toward other health professionals.^13,14 Accomplishment of IPC is dependent on attitude-relevant features such as trust building, durable communication strategies, common management goals development, understanding required power differences for decision making, and IPC-supported health organizational structures.^12,15 There are abundant barriers in IPC that not only affect the patient’s healthcare as well as the health organization’s status.¹⁶

Literature addressing multidisciplinary education and collaboration consistently supports the significance of collaboration between healthcare professionals.¹⁷ Christine Straub et al, conducted a study on nursing staff’s and physicians’ acquisition to find their attitudes to interprofessional education (IPE) and IPC in pediatrics.¹⁸ Benjamin Ansa et al conducted a study on attitudes and behavior toward IPC among healthcare professionals in an academic medical center.¹ Michael Palapal conducted a cross-sectional study on Filipino therapists’ experiences and attitudes toward IPE and collaboration to label the professed scope of IPE involvement, among Filipino occupational therapists, physical therapists, and speech-language pathologists (SLPs).¹⁹ A national survey of SLPs’ commitment to interprofess-ional collaborative practice in schools was conducted by Danika Pfeiffer et al.²⁰ In Pakistan, Muhammad Naveed Babur conduct a study in 2017 on IPC among rehabilitation professionals in stroke restoration.²¹ Mehwish Liaqat et al. conducted a cross-sectional study to assess perception and barriers to interprofessional communication among nurses in Shaikh Zayed Hospital, Lahore Pakistan.²²

As there is a huge study gap obvious from the literature review in the native population and most studies were conducted in a single setting or targeted population from a single medical department. Literature regarding IPC in the clinical setting involving allied health professionals, doctors, and nursing staff together is lacking. Most studies aimed to evaluate perception and attitude toward IPC, there is a need to rule out the barriers too. Perception of collaborative education and practice seems unclear among Pakistani health organizations.^21,22 Furthermore, within the health and education systems, the efforts in achieving these principles still appear to be deficient.²¹

The purpose of this study is to provide insight into barriers to IPC faced by native healthcare professionals. Enlightening the barriers and attitudes may further help to deal with them and develop coordinated approaches for better management¹⁶ which ultimately may improve the quality of life in patients who require special medical needs.⁶ Thus, the objective of this study was to find out the attitudes and barriers to IPC in hospitals among healthcare professionals in Lahore, Pakistan.

Material & Methods

Context

In the Pakistan context, both IPC and IPE are significant to strong primary care as well as better health outcomes for the population.²³ Healthcare professionals who required IPC in daily life for proper management of the speech-language pathological patient were studied, including speech-language pathologists, audiologists, physiotherapists, occupational therapists, psychologists/psychiatrists, neurologists, ENT specialists, pediatricians, dentists, and nursing staff. They are interdependently linked with each other. Speech-language pathology had diversity in etiology and clinical features. These healthcare professionals rely on each other for complete clinical and instrumental examination of such patients. Thus, a coordinated approach is mandatory at a time to rule out the cause and for proper management.

Study Design

The descriptive cross-sectional study design was used.^1,19,22 Attitudes and barriers among the population were measured through the attitudes toward healthcare teams scale (ATHCT) and the barriers scale toward IPC. Both scales were used based on previously validated, reliable, published instruments and considered appropriate for the aim of this study.^1,9,19,24,25

Reliability Testing

To test whether our selected scales were reliable for the current study, we performed a reliability test of the scales by Cronbach’s Alpha (α) test using the statistical package for the social sciences (SPSS).

Study Settings and Population

The population for the study was healthcare professionals (speech-language pathologist, audiologist, physiotherapist, occupational therapist, psychologist, psychiatrist, neurologist, ENT specialist, pediatrician, dentist, and nursing staff) of both genders, male and female. The study population included an age range of 25 or above, working at Children Hospital, Shaikh Zayed Hospital, and Pakistan Society for the Rehabilitation of the Disabled (PSRD), Lahore. These healthcare professionals were targeted who required IPC for proper management of the speech-language pathological patient and had the clinical experience of at least 6 months.

Sampling

For the current study, a convenience sampling technique was used. The sample size was 247 calculated by an online sample size calculator at a 95% confidence level with a 5% margin of error according to the related population mentioned in published literature.²⁶

Duration of Study

The study was conducted for 6 months that is, starting from April 2021 to September 2021, after synopsis approval in March 2021.

Data Collection

A single-stage survey was conducted for data collection. The questionnaire consists of 5 responses based on the Likert scale. The first part of the survey consisted of 5 items to get the participant’s demographic information including gender, age range, workplace, area of specialty, and clinical experience. The second part contained a 14-item ATHCT scale, and the third part was confined to the 10-Item barriers scale toward IPC.

Due to the COVID-19 pandemic, all the healthcare professionals were not available at the time in their respective clinical settings. Thus, 90 paper questionnaires were distributed directly by guiding them about the research study. Informed consent was taken. Using the same questionnaire, an online survey was created with google forms, having a prior additional section of sufficient study information for better understanding and an informed consent box below to confirm their willingness. 170 online survey questionnaires were distributed among healthcare professionals of the targeted clinical setting with the help of their respective hospital management via social contact groups. The survey questionnaire was available on google forms for 6 weeks. A total of 260 questionnaires were distributed to achieve a sample size of 247, out of which 229 responded. The survey’s response rate was 88.1%.

Ethical Considerations

For the current research, firstly I obtained approval from the principal of Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University Lahore, Pakistan. After that, I also got permission from the Director of Children Hospital, Shaikh Zayed Hospital, and Pakistan Society for the Rehabilitation of the Disabled (PSRD), Lahore to conduct this research. Permission letters were then submitted to the research and ethics committee of Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University Lahore, Pakistan, and ethical approval of this research study were obtained with reference no. REC/RCR&AHS/21/0604. Informed consent was taken from study participants individually. The concepts of concealment and secrecy were considered.

Data Analysis

An online survey was established in google forms same as a paper survey questionnaire. Scores were allocated to each item in the ATHCT scale and barriers scale toward IPC according to the Likert Scale rankings with a range of “1” to “5.” “Strongly agree” was scored as 5 and “Strongly disagree” was scored as 1. The google form respondent sheet was downloaded as an excel file. All the data from the paper survey were encoded in the same excel file using Microsoft Excel 2010 installed in a password-protected desk PC owned by the researcher. Microsoft Excel data sheet was imported into SPSS version 21 to analyze the data. All the data were statistically analyzed through frequency analyses and percentage distributions.

Results

Demographic Analysis

A total of 229 healthcare professionals responded to the survey, with 260 people receiving invitations (response rate = 88.1%). In total, completed surveys (N = 229) were used in the analysis. The majority of respondents were females (n = 136, 59.4%) and (n = 93 40.6%) males. The ages of the respondents were mostly distributed between ≥25and 35 years (n = 177, 76.6%) and the majority of healthcare professionals worked in the public sector (n = 131, 56.7%). Most respondents were speech-language pathologists (n = 66, 28.6%), while audiologists (n = 10, 4.3%) accounted for the least number of participants. The mainstream of the respondents (n = 104, 45%) had 1 to 5 years of clinical experience. The frequency and percentage of the entire demographic data are given in (Table 1).

Table 1.

Demographic Characteristics (N = 229), Where N = Total no. of Study Participants.

		Frequency	Percent
Gender	Male	93	40.6
Gender	Female	136	59.4
Age Range in years	≥25-35 years	177	76.6
	35-45 years	41	17.7
	<45 years	11	4.8
Work Place in Lahore	Private sector	21	9.1
	Public sector	131	56.7
	Both Public and Private sector	77	33.3
Clinical experience	6 months-1 year	81	35.1
	1-5 years	104	45.0
	more than 5 years	44	19.0
Area of specialty	Speech-language pathologist	66	28.6
Area of specialty	Audiologist	10	4.3
	Physiotherapist	39	16.9
	Occupational therapist	21	9.1
	Psychologist/Psychiatrist	16	6.9
	Neurologist	12	5.2
	ENT specialist	11	4.8
	Pediatrician	17	7.4
	Dentist	12	5.2
	Nursing staff	25	10.8

Reliability Analysis

Reliability analysis for the ATHCT scale was 0.858 and for barriers toward the IPC scale was 0.822 measured by Cronbach’s Alpha (α) in SPSS. Thus, according to the present study data both scales show highly positive reliability (Supplemental Tables 1 and 2).

Attitude Toward IPC

Participants in the study were asked about their attitudes toward IPC among healthcare professionals of other disciplines and patient care. In the ATHCT scale, 9 statements show positive attitude while 3 of them represent negative attitude that is, A2, A6, and A9. Most of the speech-language pathologists, physiotherapists, neurologists, and ENT specialists strongly agreed on 9 positive statements (A1, A3, A4, A5, A7, A8, A11, A12, A13) and agree on 2 (A10, A14) while strongly disagreeing with all 3 negative statements (A2, A6, A9). Audiologists mostly had a strong agreement on 8 positive statements (A1, A3, A4, A5, A8, A11, A12, A13), half of them strongly agreed on A7, agreed on A10 and A14 while strongly disagreed on all 3 negative statements (A2, A6, A9). Occupational therapists had distinct opinions toward attitude as most of them strongly agreed on 4 positive statements (A3, A4, A18, A12), agreed on 4 positive ones (A1, A10, A11, A14) while many neutral responses on 2 negative statements (A2, A6) and agreed on A9. Similarly, most pediatricians strongly agreed on 6 positive attitude statements (A1, A3, A4, A7, A11, A12) while having different levels of agreement on the remaining but they showed strong agreement on A2 that is, negative statement. Many dentists also strongly agreed on 6 positive statements (A1, A3, A4, A5, A7, A8) while most nursing staff had a positive strong agreement on (A1, A3, and A4), both showed various counts of agreement in the remaining, and strongly disagree on 3 negative statements (A2, A6, A9). Psychologists/psychiatrists showed the most color of opinions as having different counts for their level of agreement on positive attitude statements, on the other hand, showed neutral responses on 2 (A2, A9) negative statements and disagreed on A6. Generally, speech-language pathologists, audiologists, physiotherapists, pediatricians, dentists, neurologists, and ENT specialists had the most positive attitude, and psychologists/psychiatrists showed various levels of agreement (Supplemental Table 3).

The descriptive analysis of the whole population in a 14-item ATHCT scale, in terms of frequency and percentage, is shown in (Table 2). Conclusively healthcare physicians had an optimistic attitude toward IPC. For the visual presentation of the positive attitude of healthcare professionals toward IPC, a compound bar chart of the ATHCT scale is given below (Figure 1).

Table 2.

Descriptive Analysis of ATHCT Scale Items in Frequency (f) and Percent (%).

14-item (ATHCT)	Responses (N = 229), where N = total no. of study participants.
14-item (ATHCT)	Strongly disagree f (%)	Disagree f (%)	Neutral f (%)	Agree on f (%)	Strongly agree on f (%)
A1. Patients/clients receiving interprofessional care are more likely than others to be treated	1 (0.4%)	9 (3.9%)	24 (10.5%)	31 (13.5%)	164 (71.6%)
A2. Developing an interprofessional patient/client care plan is excessively time-consuming.	108 (47.2%)	50 (21.8%)	28 (12.2%)	25 (10.9%)	18 (7.9%)
A3. The give and take among team members helps them make better patient/client care decisions.	1 (0.4%)	8 (3.5%)	9 (3.9%)	43 (18.8%)	168 (73.4%)
A4. Inter-professional approach makes the delivery of care more efficient.	3 (1.3%)	4 (1.7%)	16 (7.0%)	40 (17.5%)	166 (72.5%)
A5. Developing a patient/client care plan with other team members avoids errors in delivering care.	21 (9.2%)	25 (10.9%)	13 (5.7%)	40 (17.5%)	130 (56.8%)
A6. Working in inter professional manner unnecessarily complicates things most of the time.	109 (47.6%)	50 (21.8%)	37 (16.2%)	23 (10.0%)	10 (4.4%)
A7. Working in inter professional environment keeps most health professionals enthusiastic and interested in their jobs.	17 (7.4%)	32 (14.0%)	22 (9.6%)	34 (14.8%)	124 (54.1%)
A8. Inter professional approach improves the quality of care to patients/clients.	16 (7.0%)	19 (8.3%)	11 (4.8%)	45 (19.7%)	138 (60.3%)
A9. In most instances, the time required for inter professional consultations could be better spent in other ways.	108 (47.2%)	50 (21.8%)	34 (14.8%)	24 (10.5%)	13 (5.7%)
A10. Health professionals working as teams are more responsive than others to the emotional and financial needs of patients/clients	32 (14.0%)	25 (10.9%)	27 (11.8%)	119 (52.0%)	26 (11.4%)
A11. Inter professional approach permits health professionals to meet the needs of family caregivers as well as patients.	13 (5.7%)	25 (10.9%)	13 (5.7%)	55 (24.0%)	123 (53.7%)
A12. Having to report observations to a team helps team members better understand the work of other health professionals.	3 (1.3%)	10 (4.4%)	13 (5.7%)	49 (21.4%)	154 (67.2%)
A13. Hospital patients who receive inter professional team care are better prepared for discharge than other patients.	28 (12.2%)	20 (8.7%)	18 (7.9%)	44 (19.2%)	119 (52.0%)
A14. Team meetings foster communication among team members from different professions or disciplines.	33 (14.4%)	23 (10.0%)	27 (11.8%)	111 (48.5%)	35 (15.3%)

Figure 1.

Compound bar chart of the ATHCT scale toward Interprofessional collaboration.

Barriers to IPC

The study participants were questioned about the barriers to IPC that they had encountered or witnessed throughout their clinical experience. Among speech-language pathologists, most strongly agreed that B1, B2, B3, B6, B9, B10, and B12 are the barriers they face during their clinical practice. B3 and B12 were commonly seen among all. Audiologists and physiotherapists represent the results as SLPs. Almost all of their population strongly agreed on B3 and B12. The occupational therapist showed various opinions, half of the population agreed on B7, B8, and B9. Most pediatricians strongly agreed on B3, B9, and B12. Most dentists showed strong agreement on B1, B6, and B12 while B2, B3, B9, and B10 were common too. The difference of opinions can be seen among nursing staff, almost half of them strongly agreed on B3 and similarly, psychologists/psychiatrists showed agreement on B8. Many neurologists strongly agreed on B1, B2, B3, B6, B9, B10, and B12. ENT specialists strongly agreed on B1, B2, B3, B9, B10, and B12. Speech-language pathologists, audiologists, physiotherapists, pediatricians, neurologists, and ENT specialists were facing more barriers in their way of IPC comparatively according to their frequency on the Likert scale. (Supplemental Table 4).

A bar chart representing the major barriers for each healthcare profession individually according to their count number on the Likert scale is given. Overall, the major barriers were B3 and B9. Although B1, B2, and B12 were also seen commonly (Figure 2)

Figure 2.

A bar chart showing the major barriers among each healthcare profession.

Major barriers to IPC among all healthcare professionals, out of N = 229, reported as role and leadership ambiguity; strongly agreed by 68.6% of study participants. 68.1% strongly agreed on the different goals of individual team members, and 53.3% strongly agreed on the difference in levels of authority, power, expertise, and income. The table below shows the level of agreement among healthcare professionals in terms of frequency and percentage. (Table 3)For the visual presentation of the major barriers toward IPC, a compound bar chart is given below (Figure 3).

Table 3.

Descriptive analysis of barriers toward Interprofessional collaboration scale items in frequency (f) and percent (%).

Barriers toward IPC	Responses (N = 229), where N = total no. of study participants.
Barriers toward IPC	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
B1. Lack of a clearly stated, shared, and measurable purpose	24 (10.5%)	22 (9.6%)	26 (11.4%)	42 (18.3%)	115 (50.2%)
B2. Lack of training in inter professional collaboration	25 (10.9%)	28 (12.2%)	19 (8.3%)	41 (17.9%)	116 (50.7%)
B3. Role and leadership ambiguity	2 (0.9%)	9 (3.9%)	25 (10.9%)	36 (15.7%)	157 (68.6%)
B4. Team too large or too small	33 (14.4%)	42 (18.3%)	38 (16.6%)	100 (43.7%)	16 (7.0%)
Team not composed of appropriate professionals	108 (47.2%)	40 (17.5%)	20 (8.7%)	29 (12.7%)	32 (14.0%)
B5. Lack of appropriate mechanism for timely exchange of information	18 (7.9%)	40 (17.5%)	17 (7.4%)	38 (16.6%)	116 (50.7%)
B6. Need for orientation for new members	24 (10.5%)	44 (19.2%)	17 (7.4%)	108 (47.2%)	36 (15.7%)
B7. Lack of framework for problem discovery and resolution	25 (10.9%)	44 (19.2%)	13 (5.7%)	123 (53.7%)	24 (10.5%)
B8. Difference in levels of authority, power, expertise, income	18 (7.9%)	31 (13.5%)	20 (8.7%)	38 (16.6%)	122 (53.3%)
B9. Difficulty in engaging the community	14 (6.1%)	35 (15.3%)	29 (12.7%)	39 (17.0%)	112 (48.9%)
B10. Lack of commitment of team members.	68 (29.7%)	75 (32.8%)	28 (12.2%)	23 (10.0%)	35 (15.3%)
B11. Different goals of individual team members.	3 (1.3%)	9 (3.9%)	21 (9.2%)	40 (17.5%)	156 (68.1%)
B12. Apathy of team members	106 (46.3%)	34 (14.8%)	31 (13.5%)	43 (18.8%)	15 (6.6%)
B13. Inadequate decision making	43 (18.8%)	68 (29.7%)	23 (10.0%)	37 (16.2%)	58 (25.3%)
B14. Conflict regarding individual relationships to the patient	73 (31.9%)	71 (31.0%)	29 (12.7%)	34 (14.8%)	22 (9.6%)

Figure 3.

Compound bar chart of barriers toward interprofessional collaboration scale.

Discussion

The current study examined the attitude toward IPC in hospitals among healthcare professionals in Lahore, Pakistan. It further explores the barriers faced during their clinical experience of IPC. The World Health Organization (WHO) acknowledged that to attain the developmental millenium health goals, health workers trained in IPC are required.²⁷ American Speech-Language-Hearing Association (ASHA) planned a 10-year (2015-2025) objectives of envisioned future in which IPE and IPC training is important.²⁸

Most studies on IPC were produced abroad, and many were conducted in a solitary setting or within a population of a specific field therefore their generalizability in the local population is problematic.^29-31 More research was conducted to find out insight, attitude, and perception toward the IPC,^14,32-34 the impact or need of early IPE among medical care graduates.^17,35-37 This study was conducted in the local climate that is, in Lahore, Pakistan. The context surveyed attitudes as well as barriers to proficient cooperation between healthcare professionals of medical and allied health sciences. It contains public and private clinical settings, showing more generalizability.

In this research, the healthcare professionals appreciate the significance of IPC in the practical delivery of patient care and appreciated the need for a healthcare team working together for it. The positive attitude found in physicians is more than in nursing staff similar to the results reported by Straub et al.^18,19,38 Filipino occupational therapists, physiotherapists, and SLPs, out of 14 ATHCT items 3 negative statements were perceived as neutral while the remaining 11 positive items were perceived with general agreement same as occupational therapists in the result of this study but in contrast physiotherapists and SLPs showed strong agreement toward positive items, and strongly disagree on 3 remaining negative items in the current study.¹⁹ Similar to the current study, various healthcare professions; nurses (nursing and pediatric nursing), therapists (physical therapy, speech-language therapy), and diagnostic professionals (biomedical science and radiography) showed an overall positive attitude toward IPC in the related study and also expressed a neutral attitude in IP learning and IP interactions.³⁹ In another study, medical students held a firm optimistic belief in ATHCT items except having a variation in their level of agreement in different positive items as “working in an interprofessional environment keeps health professionals enthusiastic and interested in their jobs” 60.9% and team meetings foster communication among members of different disciplines 87% whereas it is 54.1% and 15.7% in current study respectively.³⁸ Few researchers give evidence that before graduation comparatively short educational intervention in students of healthcare discipline can positively change attitudes toward learning and collaboration.^12,40

Results of a study, the attitudes of physicians and nurses among each other working in different hospitals in the Islamabad-Rawalpindi region of Pakistan showed that nurses value IPC more than their physician colleagues contradictory to this in the current study speech-language pathologists, audiologists, physiotherapists, pediatricians, dentists, neurologists, and ENT specialists had the most positive attitude.⁴¹ Attitudes of medicine, nursing, and social work students toward IPC teamwork and willingness for IPE were ruled out. Medical students had a more positive attitude comparatively. Though in this study along with medical health workers (neurologists, pediatricians, dentists, and ENT specialists), allied health workers (SLPs, audiologists, and physiotherapists) also showed a more positive attitude.⁴² On the other side, the attitudes of medicine and nursing students toward interprofessional teams were less positive than pharmacy and social work students in previous research.⁴³ Overall the responses in this study were optimistic toward IPC, and there were no statistically huge contrasts seen between the attitudes of healthcare professionals, as had been previously shown by other studies.^{1,29,35,44-46}

In a study, barriers to collaboration for school-based SLPs during the provision of special education services were time management, resistance from other professionals, and deficiency of provision from the administration.²⁰ While in the current study, for SLPs in clinical settings, major barriers were role and leadership ambiguity, and the different goals of individual team members. In primary care physicians, the main barriers referred to lack of time and training, lack of clear roles, and poor communication in contrast to our study in which role and leadership ambiguity along with different goals of individual team members were major barriers. Whereas lack of training and poor communication were encountered by 50% of healthcare physicians in hospitals.⁴⁷ Remarkably in the current study, organizational resource constraints, personal beliefs of the health professional team, and inability to access adequate care information were not the main barriers as seen in a recent study.⁴⁸

The nursing staff in the current study faced role and leadership ambiguity as the main hurdle in IPC similarly nursing staff in Sheikh Zayed Hospital, Lahore also encountered less understanding of the nursing profession by other health professionals and job stress as a major barrier.²² Among operating room healthcare professionals (Nurses, anesthesiologists, surgeons, perfusionists) perceptions and responsibilities across healthcare professionals were reported as the key barrier similarly role ambiguity is one of the major barriers in the current study whereas another barrier from that study (difficulty in engaging due to being unfamiliar with team members) was challenged by almost half of the population.⁴⁹

One research discussed regulatory and medico-legal barriers, which were mainly to interprofessional practice⁵⁰ whereas another study showed professional cultures as a barrier to effective interprofessional teamwork.⁵¹ Awareness of the educational, systemic, and interpersonal factors which promote the cultural differences among health professions, can help guide the development of advanced educational approaches to enhance interprofessional collaborative practice.

As in the present study role ambiguity, lack of IPC training, and clear and timely shared information were the similar main barriers in a different study targeting general practitioners, pharmacists, mental health workers, midwives, physiotherapists, social workers, and receptionists. The other main barriers to that study were confidentiality and responsibility, long-term funding, and joint monitoring.⁵² Likewise clear, appropriate, and timely shared information is the main barrier among psychiatrists, pharmacists, nurses, occupational therapists, psychologists, and social workers.¹⁶

In this study, speech-language pathologists, audiologists, physiotherapists, pediatricians, neurologists, and ENT specialists were facing more difficulties in their way of IPC relatively. Thus, health standards can be raised by overcoming role and leadership ambiguity and managing different goals of individual team members as highlighted by many professionals in the current study. This confirms the need for persistent emphasis on IPC in healthcare professionals and the need to value the distinctive skill of these professionals to provide good patient care. It also suggests the hospital management should support appropriate mechanisms for the timely and proper exchange of information and help to engage the community by conducting awareness seminars.

A limitation of this study was the subjective nature of survey research as reflected in these results. Results may not apply to the total population of healthcare professionals across the country because the study was limited to one city and only hospital setups. A purely quantitative study also leaves several questions open.

Conclusion

It is concluded that the most positive attitude represented by speech-language pathologists, audiologists, physiotherapists, pediatricians, dentists, neurologists, and ENT specialists compare to the occupational therapist, nursing staff, and psychologists/psychiatrists as they showed various levels of agreement on positive ATHCT items. Conclusively healthcare physicians had an optimistic attitude toward IPC demonstrated by statistical analysis of each ATHCT scale item in terms of frequency and percentage. Out of 14 items, the majority strongly agreed on 9 positive statements, agreed on 2 positive statements, and strongly disagrees with 3 negative statements toward IPC. On statical evaluation, Speech-language pathologists, audiologists, physiotherapists, pediatricians, neurologists, and ENT specialists were facing more barriers. Major barriers toward IPC statistically were role and leadership ambiguity and different goals of individual team members.

This research can help Pakistan in re-planning, taking IPC as a strategy to address the shortage of health workers. Healthcare professionals had an essential positive perspective and give importance to IPC thus resolving the barriers can enhance health outcomes. To overcome the analyzed barriers, interprofessional collaborative strategies and models must be encouraged by the hospital administration and higher healthcare authorities. To further strengthen professional collaboration, IPE is recommended for students of medical and allied health sciences. Further systemic review studies were recommended to comprehend and critically analyze the existing research studies.

Supplemental Material

sj-docx-1-inq-10.1177_00469580231171014 – Supplemental material for A Cross-Sectional Study on Attitude and Barriers to Interprofessional Collaboration in Hospitals Among Health Care Professionals

Supplemental material, sj-docx-1-inq-10.1177_00469580231171014 for A Cross-Sectional Study on Attitude and Barriers to Interprofessional Collaboration in Hospitals Among Health Care Professionals by Sana Jabbar, Hafiza Shabnum Noor, Ghazal Awais Butt, Syeda Mariyam Zahra, Aleena Irum, Saadia Manzoor, Tahreem Mukhtar and Muhammad Rahil Aslam in INQUIRY: The Journal of Health Care Organization, Provision, and Financing

Footnotes

Acknowledgements

We are thankful to the Head of Department, Riphah College of Rehabilitation Sciences, Faculty of Rehabilitation & Allied Health Sciences, Riphah International University Lahore for the directions to complete the study and moral support.

Author’s Note

Ghazal Awais Butt is also affiliated to Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan.

Author’s Contribution

SJ and HSN designed the study and wrote the manuscript. GAB and SMZ assisted in the literature search related to the study. AI and SM helped in manuscript drafting and editing. TM and MRA critically reviewed the manuscript. All the authors approved the final version of the manuscript.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethical Considerations

For the current research, firstly I obtained approval from the principal of Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University Lahore, Pakistan. After that, I also got permission from the Director of Children Hospital, Shaikh Zayed Hospital, and Pakistan Society for the Rehabilitation of the Disabled (PSRD), Lahore to conduct this research. Permission letters were then submitted to the research & ethics committee of Riphah College of Rehabilitation and Allied Health Sciences, Riphah International University Lahore, Pakistan, and ethical approval of this research study was obtained with reference no. REC/RCR&AHS/21/0604. Informed consent was taken from study participants individually. The concepts of concealment and secrecy were considered.

ORCID iDs

Sana Jabbar

Muhammad Rahil Aslam

Supplemental Material

Supplemental material for this article is available online.

References

Ansa

Zechariah

Gates

Johnson

Heboyan

De Leo

Attitudes and behavior towards interprofessional collaboration among healthcare professionals in a large academic medical center. Healthcare. 2020;8(3):323.

Tvrdy

Lenz

Kemp

Weissling

A Qualitative Study of an Interprofessional Collaborative Practicum Cohort. UCARE Symposium, University of Nebraska-Lincoln, Spring 2020.

Fernandez

Cyr

Perreault

Brault

Revealing tacit knowledge used by experienced health professionals for interprofessional collaboration. J Interprof Care. 2020;34(4):537-544.

McGettigan

McKendree

Interprofessional training for final year healthcare students: a mixed methods evaluation of the impact on ward staff and students of a two-week placement and of factors affecting sustainability. BMC Med Educ. 2015;15(1):1-10.

Hallam

Livesay

Morda

Sharples

Jones

de Courten

. Do commencing nursing and paramedicine students differ in interprofessional learning and practice attitudes: evaluating course, socio-demographic and individual personality effects. BMC Med Educ. 2016;16(1):1-9.

Reeves

Pelone

Harrison

Goldman

Zwarenstein

Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2017;6(6):CD000072.

Lavelle

Attoe

Tritschler

Cross

Managing medical emergencies in mental health settings using an interprofessional in-situ simulation training programme: a mixed methods evaluation study. Nurse Educ Today. 2017;59:103-109.

Mulholland

Barnett

Spencer

Interprofessional learning and rural paramedic care. Rural Remote Health. 2014;14(3):444-456.

Curran

Heath

Kearney

Button

Evaluation of an interprofessional collaboration workshop for post-graduate residents, nursing and allied health professionals. J Interprof Care. 2010;24(3):315-318.

10.

Lie

Forest

Kysh

Sinclair

Interprofessional education and practice guide No. 5: Interprofessional teaching for prequalification students in clinical settings. J Interprof Care. 2016;30(3):324-330.

11.

Zwarenstein

Goldman

Reeves

Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes. Cochrane Database Syst Rev. 2009;3:CD000072.

12.

Avrech Bar

Katz Leurer

Warshawski

Itzhaki

. The role of personal resilience and personality traits of healthcare students on their attitudes towards interprofessional collaboration. Nurse Educ Today. 2018;61:36-42.

13.

Coster

Norman

Murrells

, et al. Interprofessional attitudes amongst undergraduate students in the health professions: a longitudinal questionnaire survey. Int J Nurs Stud. 2008;45(11):1667-1681.

14.

Milutinović

Lovrić

Simin

Interprofessional education and collaborative practice: Psychometric analysis of the readiness for Interprofessional Learning Scale in undergraduate Serbian healthcare student context. Nurse Educ Today. 2018;65:74-80.

15.

Moyce

Bigbee

Keenan

Assessing faculty attitudes after participation in an interprofessional teaching scholars programme. J Interprof Care. 2017;31(1):129-131.

16.

Chong

Aslani

Chen

TF.

Shared decision-making and interprofessional collaboration in mental healthcare: a qualitative study exploring perceptions of barriers and facilitators. J Interprof Care. 2013;27(5):373-379.

17.

Kenaszchuk

Rykhoff

Collins

McPhail

van Soeren

Positive and null effects of interprofessional education on attitudes toward interprofessional learning and collaboration. Adv Health Sci Educ. 2012;17(5):651-669.

18.

Straub

Heinzmann

Krueger

Bode

SFN

. Nursing staff’s and physicians’ acquisition of competences and attitudes to interprofessional education and interprofessional collaboration in pediatrics. BMC Med Educ. 2020;20(1);1-8.

19.

MP.

Filipino therapists’ experiences and attitudes of interprofessional education and collaboration: A cross-sectional survey. J Interprof Care. 2017;31(6):761-770.

20.

Pfeiffer

Pavelko

Hahs-Vaughn

Dudding

CC.

A national survey of speech-language pathologists' engagement in interprofessional collaborative practice in schools: identifying predictive factors and barriers to implementation. Lang Speech Hear Serv Sch. 2019;50(4):639-655.

21.

Babur

Liaqat

Interprofessional collaboration among rehabilitation professionals. Pak Armed Forces Med J. 2017;6:908-913.

22.

Liaqat

Afzal

Kausar Perveen

Gillani

SA.

Assess perception and barriers of interprofessional communication among nurses in shaikh zayed hospital, lahore pakistan. Sci Int. 2017;29(3):645-649.

23.

Huda

Building the primary healthcare workforce for interprofessional collaboration. Liaquat National J Prim Care. 2021;3:56-57.

24.

Grant

Finochio

; The California Primary Care Consortium Subcommittee on Inter-Disciplinary Collaboration. Interdisciplinary Collaborative Teams in Primary Care: A Model Curriculum and Resource Guide. Pew Health Prof Curric; 1995.

25.

Common barriers to interprofessional healthcare team work.pdf.

26.

Imran

Chaudry

Azeem

Bhatti

Choudhary

Cheema

MA.

A survey of Autism knowledge and attitudes among the healthcare professionals in Lahore, Pakistan. BMC Pediatr. 2011;11(1):1-6.

27.

WHO. Framework for action on interprofessional education and collaborative practice. World Health Organization; 2010.

28.

Goldberg

Koontz

JS.

Interprofessional case-based problem-solving: Learning from the CLARION experience. Perspect Issues High Educ. 2014;17(2):47-55.

29.

El-Awaisi

El Hajj

Joseph

Diack

Perspectives of practising pharmacists towards interprofessional education and collaborative practice in Qatar. Int J Clin Pharm. 2018;40(5):1388-1401.

30.

Mohammed

Narsipur

Vasthare

Singla

Yan Ran

Suryanarayana

JP.

Attitude towards shared learning activities and interprofessional education among dental students in South India. Eur J Dent Educ. 2021;25(1):159-167.

31.

Woll

Quick

Mazzei

Selameab

Miller

JL.

Working with interpreters as a team in health care (WITH Care) curriculum tool kit for oral health professions. MedEdPORTAL. 2020;16:10894.

32.

Villemure

Georgescu

Tanoubi

Dubé

J-N

Chiocchio

Houle

Examining perceptions from in situ simulation-based training on interprofessional collaboration during crisis event management in post-anesthesia care. J Interprof Care. 2019;33(2):182-189.

33.

Lam

Lopez Filici

Middleton

McGillicuddy

Exploring healthcare professionals’ perceptions of the anesthesia assistant role and its impact on patients and interprofessional collaboration. J Interprof Care. 2018;32(1):24-32.

34.

Cohen

Hagestuen

González-Ramos

, et al. Interprofessional education increases knowledge, promotes team building, and changes practice in the care of Parkinson's disease. Parkinsonism Relat Disord. 2016;22:21-27.

35.

Kadar

Vosko

Sackett

Thompson

HG.

Perceptions of interprofessional education and practice within a complementary and alternative medicine institution. J Interprof Care. 2015;29(4):377-379.

36.

Watkins

KD.

Faculty development to support interprofessional education in healthcare professions: A realist synthesis. J Interprof Care. 2016;30(6):695-701.

37.

Zheng

YHE

Palombella

Salfi

Wainman

. Dissecting through barriers: A follow-up study on the long-term effects of interprofessional education in a dissection course with healthcare professional students. Anat Sci Educ. 2019;12(1):52-60.

38.

Zechariah

Ansa

Johnson

Gates

Leo

Interprofessional education and collaboration in healthcare: an Exploratory Study of the perspectives of medical students in the United States. Healthcare. 2019;7(4):117.

39.

Ulrich

Homberg

Karstens

Mahler

Attitudes towards interprofessional collaboration in young healthcare professionals. J Interprof Care. 2019;33(6):768-773.

40.

Wellmon

Gilin

Knauss

Inman Linn

Changes in student attitudes toward interprofessional learning and collaboration arising from a case-based educational experience. J Allied Health. 2012;41(1):26-34.

41.

Kaifi

Tahir

Ibad

Shahid

Anwar

Attitudes of nurses and physicians toward nurse-physician interprofessional collaboration in different hospitals of Islamabad-Rawalpindi region of Pakistan. J Interprof Care. 2021;35(6):863-868.

42.

Wilcox

Miller-Cribbs

Kientz

Carlson

DeShea

Impact of simulation on student attitudes about interprofessional collaboration. Clin Simul Nurs. 2017;13(8):390-397.

43.

Curran

Sharpe

Forristall

Flynn

Attitudes of health sciences students towards interprofessional teamwork and education. Learn Health Soc Care. 2008;7(3):146-156.

44.

Hong

Shaffer

LS.

Inter-professional collaboration: Early childhood educators and medical therapist working within a collaboration. J Educ Train Stud. 2014;3(1):135-145.

45.

Murdoch

Epp

Vinek

Teaching and learning activities to educate nursing students for interprofessional collaboration: A scoping review. J Interprof Care. 2017;31(6):744-753.

46.

Bode

SFN

Giesler

Heinzmann

Krüger

Straub

. Self-perceived attitudes toward interprofessional collaboration and interprofessional education among different health care professionals in pediatrics. GMS J Med Educ. 2016;33(2):Doc17

47.

Rawlinson

Carron

Cohidon

, et al. An overview of reviews on interprofessional collaboration in primary care: barriers and facilitators. Int J Integr Care. 2021;21(2):32.

48.

Moncatar

TJRT

Nakamura

Siongco

KLL

, et al. Interprofessional collaboration and barriers among health and social workers caring for older adults: a philippine case study. Hum Resour Health. 2021;19(1):52.

49.

Etherington

Burns

Kitto

, et al. Barriers and enablers to effective interprofessional teamwork in the operating room: A qualitative study using the theoretical domains framework. PLoS One. 2021;16(4):e0249576.

50.

Lahey

Currie

Regulatory and medico-legal barriers to interprofessional practice. J Interprof Care. 2005;19 Suppl 1(sup1):197-223.

51.

Hall

Interprofessional teamwork: Professional cultures as barriers. J Interprof Care. 2005;19:188-196.

52.

Supper

Catala

Lustman

Chemla

Bourgueil

Letrilliart

Interprofessional collaboration in primary health care: a review of facilitators and barriers perceived by involved actors. J Public Health. 2014;37(4):716-727.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.05 MB