Patient and therapist experiences of a self-management group programme for fatigue in primary care: a qualitative...

As health systems shift care from specialised to primary care settings, questions arise about implementing complex interventions such as self‑management programmes. This is especially relevant for the growing population with chronic neurological disorders requiring long‑term support in primary care. 'Energetic', an interdisciplinary self‑management group programme delivered by occupational therapists and physiotherapists, was originally developed in specialist rehabilitation to improve participation and functional endurance in people with neurological conditions and fatigue. Although effective in specialist care, little is known about how patients and therapists experience its delivery in primary care, where resources and infrastructure differ substantially.

This study examines how patients with chronic neurological conditions and fatigue, and their therapists, experience the implementation and delivery of the Energetic self‑management group programme in primary care.

Energetic was implemented in primary care in three regions in the Netherlands. A qualitative study was conducted using semi‑structured interviews with 10 patients and seven therapists (three occupational therapists and four physiotherapists) from three primary care settings. Interviews were audio-recorded and transcribed verbatim. Participants were asked about their experiences with participating in the programme, its implementation and delivery in primary care, and perceived barriers and benefits. Data were analysed using an iterative, inductive thematic approach.

Three overarching themes were constructed from the data: 1) The content of the programme is considered comprehensive; 2) The programme is believed to strengthen self-management and particpation; and 3) The implementation is experienced to be challenging within the primary care healthcare system. Patients experienced participating in the programme as meaningful, reporting better self-management and participation. Therapists reported similar developments. Regarding implementation therapists described persistent difficulties related to recruitment, organisation, and financing, and noted that system constraints required administrative improvisation to deliver the programme as intended. Differences in perspectives were also apparent: e.g., patients valued access to sports facilities, whereas all therapists considered such facilities difficult to provide within primary care.

Patients and therapists experienced the Energetic programme as meaningful and valuable in primary care practice. However, therapists reported problems in recruitment, reimbursement and administrative barriers that constrained the programme's implementation. These findings illustrate how promising programmes can struggle to find their way into routine primary care, and therefore to patients living longer at home.