Barriers and facilitators of direct access model to physiotherapy: intervention design and implementation strategies using the consolidated framework for implementation research

Although the benefits of direct access to physiotherapy are well-documented, challenges in the policy design remain in the context of patient safety and organizational readiness. This study aims to identify barriers and facilitators for implementing the direct access to physiotherapy policy, with a goal of informing the development of policy design options and implementation strategies acceptable to key stakeholders. This qualitative study is a component of a sequential mixed-methods design. Key informant interviews and focus groups were conducted with stakeholders including policymakers, tertiary physiotherapy education academics, employers, physiotherapists, doctors and patients. Data were analyzed using the Consolidated Framework for Implementation Research (CFIR). Physiotherapists and patients highlighted evidence supporting improved accessibility, service efficiency, and better health outcomes associated with direct access. Patients valued improved access and greater choice, while also emphasising the importance of safety and quality assurance. Physiotherapists expressed confidence to perform physical diagnosis, make appropriate referrals, and maintain competence through continuous professional development, and in their ability gained through undergraduate and postgraduate training to identify red flags. Doctors expressed mixed views, with some emphasizing the need for a medical diagnosis prior to physiotherapy access to ensure safety. Key barriers included limited understanding of the government’s proposal, insufficient stakeholder engagement, and concerns regarding patient safety. Facilitators included improving public knowledge, ensuring physiotherapist competency, and clarifying the roles and scope of physiotherapy. Successful implementation of a direct access model requires appropriate policy design, clear protocols, recognition of professional judgement and autonomy, and robust safety measures. Continuous evaluation, public education, and stakeholder engagement are essential to support policy effectiveness and build public trust. These findings provide a foundation for developing an appropriate and acceptable policy design and context-specific implementation strategies, which will be further refined through expert consensus in a subsequent Delphi study.