Table 3

Quotes for respective category supporting barriers to implementation

Quote number (Q)Category /illustrative quotesQuoted by
Lack of time
1‘Medical file, medical history, clinical assessment, lab tests, imaging, medication … there is often a lack of time, consequently, patient education is provided but in a less optimal way’.Rheumatologist, Belgium
2‘Not all the needs of patients can be extracted within the set time of current PE’.Nurse, Japan
3‘It is ideal to meet various needs, but on the other hand, increasing the burden on the provider side is an issue’.Rheumatologist, Japan
4‘Evaluation is never performed, no time is allocated to it’.Registered Nurse, Belgium
Lack of training
5‘Lack of training in the area on my part; little time available’. (Recommendation 1)Registered Nurse, Portugal
6‘Inflammatory chronic disease nursing and nurse specialist in this field have not been established. Therefore, as information, and knowledge and skills of nurses are insufficient, nurses may not be able to take care of patients based on the personal situation’. (Recommendation 3)Nurse Educator, Japan
7‘Ignorance of the [EULAR] recommendations’ (Recommendation 1)Registered Nurse, Portugal
8‘I think we don't do it because we don't know how to do it. Especially [CBT] and stress management’ (Recommendation 3) Rheumatologist, France
9PE [may] varies depending on the years of experience of the nurse. (Recommendation 1)Nurse, Japan
10‘Not enough training providers in our country’ (Recommendation 6)Rheumatologist, Bulgaria
11‘Finding appropriate patients and training them to be trainers are all challenges’ (Recommendation 7).Registered Nurse, Hong Kong
Lack of staff
12‘We do not currently have the resources to incorporate CBT or stress management strategies into patient self management. We do refer some patients to the pain team service …however waiting lists are very lengthy’ (Recommendation 5)Registered Nurse, UK
Lack of assessment tools
13‘At follow up with the patient it will emerge what the patient needs to be re-informed about and what is missing, but we don't use any tool for this evaluating…’ (Recommendation 6)Registered Nurse, Sweden].
14‘No framework for follow-up’ (Recommendation 6)Rheumatologist, Belgium
15‘Lack of time to organize follow-up and evaluation consultations’ (Recommendation 6).Family Doctor, Portugal
Limited resources
16‘Not all patients have access to the Internet’ (Recommendation 4)Nurse, Finland
17‘Face-to-face online support and telephone support at a general hospital like ours are not possible’ (Recommendation 4)Nurse, Japan
18‘Group sessions and online cannot be used due to institutional restrictions’. (Recommendation 4)Occupational Therapist, Japan
Concerns about online PE
19‘My preferred method to answer patients’ questions is absolutely individually and face-to-face, online contact and written material can be misunderstood; however, this (online/written) is possible for most patients in case of sharing more general information’ (Recommendation 3)Rheumatologist, Belgium
20‘Online interaction seems not an ideal approach in my opinion. For example, information shared via email could be misinterpreted wrongly’. (Recommendation 4)Rheumatologist, Belgium
21‘Online self-learning can be misleading’ (Recommendation 3)Rheumatologist, Japan
Concerns about patient-delivered PE (Recommendation 7)
22‘It is mandatory that the physician should control over the information provided to the patient’.(Recommendation 7)Rheumatologist, France
23 The presence of non-healthcare personnel would open the door to dubious situations’. (Recommendation 7)Rheumatologist, Italy
Lack of systematic PE
24‘Not systematic’ (Recommendation 2)Occupational Therapist, Norway
25‘Very rare monitoring of patients with [IA)’ (Recommendation 2)Registered Nurse, Portugal
26‘The focus is on newly diagnosed patients, there is no organised PE aside from ordinary doctor- and nurse visits’ (Recommendation 2)Rheumatologist, Sweden
27‘Patients come often spontaneously to PE after reading a poster, receiving a flyer etc… Not enough on doctor’s initiative…(not] according to a defined agenda’. (Recommendation 2)Pharmacist, France
28‘It’s up to me to keep me updated about appropriate pedagogics’ (Recommendation 8)Nurse, Sweden
29‘I do not think we do [PE] according to the most up-to date research findings’ (Recommendation 8).Physiotherapist, Hungary
Lack of funding
30‘The money for training costs is reduced year by year’ (Recommendation 8).Nurse, Finland
31‘Do not have the money’ (Recommendation 8).Physiotherapist, Hungary
Lack of patient participation in disease management
32‘Patient with incorrect beliefs, patient thinking that only treatment is important, patient not wanting or unable to change their everyday life activities’ (Recommendation 1).Occupational Therapist, France
33‘The patient is not willing to come to the nurse’s office. All patients do not understand that there is something to be done by the caregiver in treating the patient’. (Recommendation 1).Nurse, Finland
34I always offer it, and the rheumatologist always offers this, however, when the patient indicates that he or she does not want to be ready for this, it will not happen. We do not see all patients with inflammatory arthritis, so [PE] is not standard care(Recommendation 1).Specialist Nurse, The Netherlands