RESEARCH QUESTION How can older women and primary healthcare professionals be empowered
to improve osteoporosis care?
BACKGROUND The Women's Health Strategy for England highlights the lack of focus on older
women's needs and experiences. The Investigators talked to 32 older women across five
public engagement workshops. These women felt unseen, unimportant, unheard and
uninformed. They also felt bone/joint health and osteoporosis were important issues for
older women (aged 70+). Osteoporosis leads to around 180,000 fractures per year causing
significant pain, disability and death. The related cost, in the United Kingdom, is
estimated at £4.4 billion a year. Women are four times more likely to suffer with
osteoporosis than men and tend to suffer fractures earlier. Despite comprehensive
guidelines being available, evidence suggests that osteoporosis care is lacking in
primary care.
AIMS AND OBJECTIVES To develop strategies to improve osteoporosis care using insights
from the experience of primary healthcare professionals and older women.
METHODS Ethnographic meta-analysis literature review, in-depth interviews and
co-production workshops. An information specialist will update the preliminary literature
review. The Investigators will synthesise evidence from older women and healthcare
professionals to identify new theoretical constructs. Findings will be reviewed in
co-production workshops and used to focus initial lines of enquiry. The Investigators
will purposively sample 30 older women, from across England, aged 70+ to interview. They
will also elicit the views of healthcare professionals in primary care. Interviews will
explore the process of diagnosis, treatment and management of osteoporosis. Information
from interviews will initially be reviewed by the Investigators.
Following a Constructivist Grounded Theory approach, the Investigators will take initial
findings to co-production workshops on a regular basis throughout fieldwork. Workshops
will facilitate iterative analysis and identify theoretical sampling gaps. This process
may change the types of questions asked or who is interviewed. The Investigators will
combine information from all interviews to identify barriers and facilitators for older
women's osteoporosis care, and cross-reference this with existing guidelines.
Professional 'expert witnesses' will join the workshops when required. Finally,
recommendations for improving osteoporosis care will be co-produced . Areas of further
work that would improve osteoporosis care in the future will also be identified.
PATIENT AND PUBLIC INVOLVEMENT Lay members will be involved in co-production workshops
throughout the research. The Investigators will also work with an expert patient
co-applicant in overall management of the project.
TIMELINES FOR DELIVERY Following 3 months of pre-award set-up, the Investigators will
conduct the literature review and develop the interview schedule in months 1-3.
Interviews and workshops will happen in months 4-11. A final analysis and report will be
available in month 18.
IMPACT AND DISSEMINATION Findings will be sent to Integrated Care Boards responsible for
local commissioning to facilitate 'better fit' services. The Investigators will also
produce dissemination products for wide distribution through a variety of professional
networks. Academic papers will be published in journals targeted at healthcare
professionals. Summary information and advice, for older women, will be disseminated via
national and community networks and presentations nationwide. These outputs will be aimed
at supporting successful implementation of the All Party Parliamentary Group
recommendations for better diagnosis, treatment and management.
