Micro, meso and macro issues emerging from focus group discussions: Contributions to a physiotherapy HIV curriculum

Abstract

Background. Physiotherapy in South Africa has not defined its contribution to the management of HIV. As part of developing an appropriate HIV/ AIDS physiotherapy curriculum, focus group discussions (FGDs) with physiotherapy clinicians and educators were undertaken. Objectives. To understand the perceptions and experiences of HIV management in refining an HIV physiotherapy curriculum. Methods. Six focus groups chosen using purposive sampling ensured representation from experienced and newly qualified academics and clinicians. Interpretive content analysis strengthened the knowledge areas required in practice and attitudes based on the groups’ experiences of HIV management. Concepts were identified, and de- and recontextualised to develop categories and themes. Results and discussion. Five themes emerged: the need to include HIV in the physiotherapy curriculum; a physiotherapy-specific HIV curriculum; co-ordinated curriculum design; underlying concerns relating to HIV management and inclusion in the curriculum; and the need for professional development. Further analysis and abstraction highlighted micro, meso and macro issues. Micro issues included content, while meso-level concerns included perceived gaps in the curriculum and recommendations to respond to issues such as therapists’ coping and burnout, therapists’ attitude to HIV, and organisational problems threatening the application of knowledge regarding this condition. At a macro level, participants felt that the political nature of HIV and curriculum structure were problematic and that there was a need for continuous staff development. Conclusion. A list of topics related to HIV, which tallied well with evidence in the literature and patients’ clinical presentations, emerged. The need for a complex, well-designed programme for the physiotherapy management of HIV emerged and was informed by the difficulties experienced at the micro, meso and macro levels of the curriculum.