AN EVALUATION OF THE PERCEPTION OF HEALTHCARE PROFESSIONALS TOWARDS INTER-PROFESSIONAL COLLABORATION IN PRIMARY CARE SETTINGS IN NIGERIA

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

As healthcare systems progress in their efforts to enhance the quality and efficiency of health services, there is a growing requirement for collaborative endeavours among healthcare professionals (HCP) from many disciplines. Thus, healthcare professionals must obtain the necessary expertise and cultivate the abilities required to collaborate efficiently, thereby influencing patient care results in a good manner. In 2010, the World Health Organisation (WHO) produced an influential paper named "Framework for Action on Interprofessional Education and Collaborative Practice" (Kendrick et al., 2018), which had a significant impact. Within this framework, the World Health Organisation (WHO) strongly supported the creation of team-based collaboration models in several healthcare domains to improve the provision of healthcare services (Kendrick et al., 2018).

 Inter-professional collaboration (IPC) in healthcare settings is defined by the World Health Organisation (WHO) as the provision of comprehensive services by multiple health workers from different professional backgrounds. This collaboration involves working with patients, families, carers, and communities to deliver the highest quality of care across different settings (WHO, 2017: Kendrick et al., 2018). The fundamental principles of cooperation are derived from the notions of shared responsibility, collective decision-making, inter-professional communication, accountability, and education (Kelvin et al., 2019). Collaboration entails healthcare professionals (HCPs) with diverse backgrounds working together in a harmonious and coordinated manner to meet patient needs and enhance patient care outcomes (Foley et al., 2017). The Canadian National Inter-Professional Competency Framework (2019) outlines six essential criteria for successful collaborative practice. These criteria encompass inter-professional communication, team function, collaborative leadership, confidence in one's professional role, understanding of other healthcare team roles and responsibilities, and negotiation skills for conflict resolution in the context of patient/client/family/community-centered care (Michael, 2021). 

Collaborative practice offers numerous advantages in terms of organisational, healthcare team, patient, and healthcare professional benefits (Rollins et al., 2019). The WHO framework emphasises that IPC contributes to the enhancement of healthcare systems, optimisation of healthcare services, and improvement in health outcomes and quality of patient care. These factors typically serve as the main drivers for implementing team-based care inside institutions (WHO, 2021). Furthermore, the implementation of Integrated Patient Care (IPC) leads to an elevated degree of patient contentment, enhanced reception of medical treatment, and improved health results in both acute and primary healthcare (PHC) environments (Tony, 2019). Moreover, research has indicated that misunderstanding and insufficient teamwork have detrimental effects on the healthcare system and health outcomes. These factors are also identified as major contributors to preventable errors in patient care and the deterioration of care quality (Danny et al., 2017; Mteweti et al., 2019). 

The PHC environment is considered a fundamental component of the healthcare delivery system, as it often serves as the initial point of contact for a large number of patients (Mteweti et al., 2019). Moreover, due to the growing intricacy of healthcare requirements in primary healthcare (PHC), there is a necessity for enhanced and effective infection prevention and control. This is crucial for delivering high-quality services, attaining improved health results and patient contentment, and enhancing job happiness among healthcare professionals (Rick, Steve & Marion, 2019). A systematic review was conducted to find research examining the relationships between policy (macro), organisational (meso), care team (micro), and individual characteristics, and collaboration in interprofessional primary care teams. The review presented a conceptual model that encompasses these different levels (Liu et al., 2022). The study revealed that over 70% of the characteristics identified were at the micro-level, indicating that specific actions might be taken to enhance infection prevention and control (IPC) in primary care teams. The key considerations within the healthcare team in primary healthcare (PHC) were categorised into formal processes, such as audits and having a team vision, and social processes, such as open communication and supportive colleagues. Additionally, team attitude in feeling part of the team and team structure were also identified as important factors (Liu et al., 2022).

 Nevertheless, the process of cooperation and teamwork in primary healthcare (PHC) is frequently more intricate than it may seem, requiring careful planning and allocation of resources to enable the successful attainment of collaborative objectives (Emmanuel et al., 2021). Inter-professional collaboration (IPC) is seen as a form of cooperation among various healthcare professionals (HCP), using their complementary expertise and skills to benefit patients and optimise resource utilisation (Liu et al., 2022: Owen et al., 2018: Elsouss, 2018: Foldevi, 2017). The promotion of inter-professional primary care teams is replacing traditional physician-led team-based care and has been demonstrated to enhance collaboration (Owen et al., 2018). Several primary healthcare (PHC) settings have adopted innovative care models, such as family medicine groups, which prioritize inter-professional collaboration as a core objective (Rick et al., 2019). In order to establish effective inter-professional cooperation (IPC) strategies in practical contexts, it is crucial to examine the attitudes of healthcare professionals (HCP) towards collaboration. Positive attitudes are vital for the successful execution of IPC (Clinton, 2021). Moreover, it is crucial to identify and effectively solve problems and hurdles in order to successfully develop a collaborative atmosphere. The motivations of inter-professional collaboration (IPC) encompass the shared interest of healthcare professionals (HCP) to work together, the possibility for enhancing patient care quality, and the improvement of practice experiences (Liu et al., 2022). On the other hand, obstacles to inter-professional collaboration (IPC) consist of insufficient understanding of the roles, duties, and limits of other healthcare professionals, issues related to confidentiality, and a lack of training that promotes collaboration among different professions (Liu et al., 2022).

Nigeria, similar to several other low- and middle-income nations, encounters substantial obstacles in its healthcare system. The challenges encompass a scarcity of healthcare personnel, insufficient infrastructure, and a substantial disease burden (Njoku et al., 2023). The primary care setting in Nigeria serves as the initial point of contact for patients and plays a vital role in the healthcare system. Although the significance of IPC is acknowledged, there is a scarcity of research specifically examining the perceptions and involvement of healthcare professionals in Nigeria in collaborative practices within primary care settings. The perspectives of healthcare professionals on infection prevention and control (IPC) are shaped by multiple factors, such as their professional education, workplace conditions, cultural milieu, and the specific obstacles they face inside the healthcare system. Gaining a comprehensive understanding of different viewpoints is crucial in order to identify obstacles that hinder successful collaboration and to develop strategies that can improve teamwork among healthcare practitioners. This study aims to assess the perspectives of healthcare professionals in Nigeria regarding inter-professional collaboration in primary care settings.

1.2 Statement of the problem

Primary care settings in Nigeria play a vital role in providing comprehensive and easily accessible healthcare to the public. Inter-professional collaboration, which involves healthcare experts from different disciplines working together to achieve shared patient care objectives, is widely acknowledged as a crucial factor in improving the quality and effectiveness of healthcare services (Tunde, 2023). Although Nigerian primary care facilities have the potential to benefit from inter-professional collaboration, there are substantial obstacles to its effective implementation. The hurdles may arise due to variables such as differing professional attitudes, communication obstacles, and varying degrees of comprehension of collaborative activities.

Balogun (2022) contends that the existence of conventional hierarchical frameworks within Nigerian healthcare institutions can hinder the exchange of open communication and restrict collaboration. Inflexible hierarchies can create barriers between different staff levels and impede a collaborative approach to patient care. Consequently, professionals may end up taking on redundant activities and obligations (Tunde, 2023). Ambiguous or overlapping tasks and responsibilities within the healthcare profession can lead to perplexity and discord among practitioners. Without clearly defined roles, team members may face challenges in effectively coordinating their actions (Balogun, 2022). Many healthcare practitioners in Nigeria may lack adequate training in collaborative procedures and team-based treatment. A lack of sufficient understanding of interdisciplinary teamwork can hinder their ability to effectively operate in a collaborative environment (Akanimoh et al., 2020). Effective collaboration requires clear and consistent communication. Challenges such as language barriers, cultural differences, and limited communication skills may hinder cooperation and the delivery of high-quality healthcare. Mensah and colleagues (2020). Mensah (2020) argues that the presence of rivalries and conflicts among healthcare personnel can have a negative impact on teamwork. Interpersonal conflicts may arise due to variables such as rivalry, differing professional perspectives, or personal disputes (Balogun, 2022).

The objective is to assess the perspectives of healthcare practitioners on inter-professional collaboration in basic healthcare settings in Nigeria. Gaining comprehension of different perspectives is crucial in order to recognise current obstacles and enablers to collaboration, and to formulate tactics that can improve teamwork among healthcare practitioners. Therefore, this investigation is necessary.

Objectives of the study

The primary objective of this study is to critically evaluate the viewpoints of healthcare professionals regarding inter-professional collaboration in primary care settings in Nigeria. Specific objectives of this study are to:

To evaluate the perceptions of healthcare professionals towards inter-professional collaboration in primary care settings in Nigeria.

To evaluate the perceptions of healthcare professionals of the current of inter-professional collaboration being implemented in primary care settings in Nigeria

To evaluate the perceptions of healthcare professionals of the barriers to effective inter-professional collaboration in primary care settings in Nigeria.

To evaluate the perceptions of healthcare professionals of the impact of inter-professional collaboration on patient care in primary care settings in Nigeria

1.4 Research Questions

The following research questions which are in line with the objectives of this study will be answered in this study:

What are the perceptions of healthcare professionals towards inter-professional collaboration in primary care settings in Nigeria?

What are the perceptions of healthcare professionals concerning current practices of inter-professional collaboration used in primary care settings in Nigeria?

What are the perceptions of healthcare professionals concerning the main barriers to effective inter-professional collaboration in primary care settings in Nigeria?

What are the perceptions of healthcare professionals concerning the impact of inter-professional collaboration on patient care in primary care settings in Nigeria?

1.5 Research Hypotheses

To determine the effectiveness of this study, the following research null hypotheses will be formulated to guide the study and it will be tested at 0.05% levels of significance.:

Ho: Healthcare professionals in primary care settings in Nigeria generally have negative perceptions towards inter-professional collaboration.

Ha: Healthcare professionals in primary care settings in Nigeria generally have positive perceptions towards inter-professional collaboration

1.6 Significance of the study

The study's results have the potential to significantly enhance healthcare delivery and outcomes by promoting a deeper comprehension of and strategy for inter-professional collaboration in primary care settings in Nigeria.

Inter-professional collaboration (IPC) improves patient outcomes by promoting seamless cooperation among various healthcare specialists. Gaining insight into the perspectives of Nigerian healthcare professionals regarding Infection Prevention and Control (IPC) might result in the development of more effective approaches for implementing cooperative practices, thereby enhancing the standard of care in primary healthcare settings. The healthcare system in Nigeria encounters distinctive obstacles such as constrained resources, elevated disease prevalence, and unequal allocation of healthcare practitioners. Assessing the perspectives of these experts can offer valuable insights into how cooperation can be maximised to effectively tackle these difficulties.

Furthermore, the study can assist in identifying the obstacles that impede efficient collaboration, such as communication challenges, hierarchical impediments, or limitations in resources. On the other hand, it can also emphasise factors that promote effective teamwork. This information is essential for creating specific actions to improve IPC.

Furthermore, gaining insight into the viewpoints of various healthcare professionals can foster mutual respect and comprehension among them. Enhancing team cohesion and job happiness is crucial for retaining highly skilled people in the healthcare system. In Nigeria, where primary care serves as the initial point of contact for several patients, the implementation of effective Infection Prevention and Control (IPC) measures can result in a more complete and well-coordinated healthcare system. By adopting a more integrated approach, this can enhance community health outcomes by effectively tackling a diverse array of health challenges.

Furthermore, the findings from the study might provide valuable information to healthcare policy makers and educational institutions regarding the present condition of infection prevention and control (IPC) in Nigeria. This information can provide valuable insights for the formulation of policies, the design of training programs, and the implementation of curriculum adjustments with the goal of cultivating a more cooperative and interactive atmosphere.

Moreover, the research on Inter-Professional Collaboration (IPC) in primary care settings in Nigeria contributes to the worldwide pool of information on collaborative practices in various environments. This can provide significant comparisons and insights for other countries encountering comparable issues in healthcare collaboration.

1.7 Scope of the study

Broadly, this study focus is to critically evaluate the viewpoints of healthcare professionals regarding inter-professional collaboration in primary care settings in Nigeria. Specifically, this study seeks to evaluate the perceptions of healthcare professionals towards inter-professional collaboration in primary care settings in Nigeria and evaluate the perceptions of healthcare professionals of the current of inter-professional collaboration being implemented in primary care settings in Nigeria. 

Further, this study will focus on evaluating the perceptions of healthcare professionals of the barriers to effective inter-professional collaboration in primary care settings in Nigeria and it also seeks to evaluate the perceptions of healthcare professionals of the impact of inter-professional collaboration on patient care in primary care settings in Nigeria.

 The study is carried out in Nigeria. 

1.8 Limitations of the study

During the examination, the researchers faced several small restrictions, as is common in any human endeavor. The main limitation was the lack of extensive literature on the subject, which was due to the restricted availability of data about the assessment of healthcare professionals' perspectives on inter-professional collaboration in primary care settings in Nigeria. Consequently, a significant investment of time and effort was necessary to identify the appropriate materials, books, or information and collect data. 

Furthermore, this study is constrained by its small sample size and narrow geographic scope, focusing solely on Nigeria. Therefore, the capacity to apply the findings of this study to a broader context is restricted, highlighting the need for more research. 

Moreover, the researcher's constraints were primarily due to financial limitations, as they are a student lacking any financial resources to sustain themselves. The exorbitant transportation fees at the research site posed a challenge in meeting the financial obligations related to transportation expenditures.

Furthermore, the researcher faced a time constraint due to the need to do this research while still fulfilling the obligations of attending lectures and participating in other educational pursuits.

1.9 Definition of terms

Interdisciplinary teamwork: Interdisciplinary teamwork (also known as Inter-Professional collaboration) in healthcare refers to the collaborative approach where professionals from different disciplines work together to deliver comprehensive patient care.

Patient outcome: Patient outcomes are the results from care and treatments patients have received whilst in hospital, other clinical or care settings. They focus on meeting the physical, social, and emotional needs of patients from their own perspective to highlight what is important to them.