Abstract
This paper describes a small phenomenological study using an Interpretative Phenomenological Analysis (IPA) to explore the context of managing pain in children in sub-Saharan Africa (SSA). The management of pain is known to be suboptimal and this study is refreshing as it uses an approach that seeks to gain a better understanding from the health professionals’ perspective. This perspective enables the voices of those who manage paediatric pain to bring insights to the problems they face.
The background sets the scene well and brings to light a range of factors that contribute to the prevalence of pain in SSA. Some of these factors such as cultural influences on pain assessment and management might reflect an industrialised country but the reader is left in little doubt of the unique challenges, such as infectious diseases and civil unrest, facing those endeavouring to manage pain in SSA. There is a tradition for authors to draw heavily on published papers from countries that often bear little resemblance to the context of where the current study is located. These authors provide a rich narrative that draws the reader to understand the unique challenges facing people who live in SSA. Perhaps the only missing component was a better understanding of how paediatric pain was experienced and identified by health professionals.
The choice and justification for using IPA for the methodology felt somewhat less convincing. Whilst it is certainly post-positivist other approaches might have been considered which met the desire for recognising the ‘subjectivity and uniqueness of the human experience’. Purposive sampling was used to identify participants for the study through the international organisation CHILD2015. This organisation has a membership of over 4000 HPs from the developing world. Obviously only a sub-sample would be in SSA but it seemed a vast number compared with the purposive sample of just 6 HPs desired and slightly at odds with the qualitative approach taken. Whilst six participants are acceptable for a qualitative study, and justified for this study, it would have been interesting to know if more participants would have uncovered further insights. Similarly, would a more focussed approach, perhaps using a network specific to SSA or even a snowball technique have been more appropriate?
The findings uncover a rich and thought-provoking insight into the barriers facing those managing paediatric pain in SSA. The stories and experiences are often harrowing and it is not a simple picture. The initial expectation for identifying insights and demands that are faced by health professionals working in this difficult context are clearly identified. Interestingly, some of the themes resonate with other studies exploring pain management. The demands of the clinical environment are frequently cited as a barrier to optimal pain assessment and management (Czarnecki et al., 2011). However, whilst the findings amplify some of what we know, they also provide more questions. Are the nurses frustrated due to the parents lacking the skills and knowledge to manage their child’s pain or having too many patients to care for? The importance of cultural context cannot be ignored when planning future improvements and the theme of mythology highlights this poignantly.
This small study offers insightful perspectives for the management of paediatric pain in SSA. Despite the limitations there is perhaps an opportunity to build on this study by using the findings to develop a more comprehensive questionnaire to HPs. This could provide a broader understanding of the extent of the problems and identification of those areas requiring prioritisation. It feels as if this study is the tip of the iceberg. The importance of using the knowledge to provide better paediatric pain management in SSA must be a future goal. Overall this study brings an understanding of the issues facing health professionals managing pain in a very unique part of the world. The data and the interpretation have made a contribution that is difficult to ignore.