Enhancing patient-centred chiropractic care in Canada: identifying barriers, enablers, and strategies through a qualitative needs assessment.

Background: The Canadian Chiropractic Association (CCA) initiated a quality improvement project to develop best practices aimed at enhancing the patient experience.

Objectives: (1) Identify and prioritise the key moments in the new patient experience that could be improved by providing chiropractors with focused support and resources; (2) explore views, barriers, and enablers to implementing these best practices; and (3) develop recommendations to facilitate the adoption of these practices.

Methods: We conducted a qualitative needs assessment using a human-centred design approach, focused on understanding the needs and experiences of end-users to create tailored solutions. The Theoretical Domains Framework (TDF) was employed to explore chiropractors' knowledge use and behaviour change, and TDF domains were mapped to Behaviour Change Techniques (BCTs) to develop targeted strategies for addressing identified barriers and enablers. Thirteen chiropractors from across Canada participated in semi-structured interviews and related activities.

Results: The key moments where participants felt they needed the most support were "treatment", "report of findings", "informed consent", "physical examination", and "before the appointment". All participants agreed with the best practices seed statements. Key barriers included gaps in knowledge, communication skills, and resource availability, particularly in rural areas. Enablers included collaboration with other health professionals, mentorship, and access to practice tools. Recommendations include enhanced training in communication and treatment planning, increased access to resources in rural areas, and fostering collaborative relationships among health professionals.

Conclusion: Understanding the barriers and enablers to implementing best practices can inform targeted strategies to improve patient-centred care in chiropractic practice across Canada.