1171014

research-article2023
INQXXX10.1177/00469580231171014INQUIRYJabbar et al.

Original Research
INQUIRY: The Journal of Health Care

A Cross-Sectional Study on Attitude and Organization, Provision, and Financing

Volume 60: 1­–11
© The Author(s) 2023
Barriers to Interprofessional Collaboration in Article reuse guidelines:
sagepub.com/journals-permissions

Hospitals Among Health Care Professionals DOI: 10.1177/00469580231171014

https://doi.org/10.1177/00469580231171014
journals.sagepub.com/home/inq

Sana Jabbar, MS1 , Hafiza Shabnum Noor, MS1, Ghazal Awais Butt, MS1,
Syeda Mariyam Zahra, MS1, Aleena Irum, MS1, Saadia Manzoor, MS2,
Tahreem Mukhtar, MS1, and Muhammad Rahil Aslam, MPhil3

Abstract
The need for an effective health personnel team is important due to the increasing complexity of patient care and increasing
co-morbidities. Interprofessional collaboration (IPC) among healthcare professionals offers appropriate collaborative
management for humans. This study aimed to assess the attitude and barriers to IPC in hospitals among healthcare
professionals in Lahore, Pakistan. A cross-sectional study was conducted using a convenience sampling technique. Healthcare
professionals (speech-language pathologists, audiologists, physiotherapists, occupational therapists, psychologists, psychiatrists,
neurologists, ENT specialists, pediatricians, dentists, and nursing staff) working at Children Hospital, Shaikh Zayed Hospital,
Pakistan Society for the Rehabilitation of the Disabled (PSRD), Lahore, Pakistan were included. The paper and online survey
questionnaire composed in the google form and attitudes toward healthcare teams scale (ATHCT) and barriers scale toward
interprofessional collaboration were used. Statistical package for the social sciences (SPSS) version 21 was used to analyze
the survey data through frequency analyses and percentage distributions. Most of the respondents (response rate = 88.1%)
had positive attitudes toward IPC and strongly agreed on 9 positive statements in ATHCT. Statistically, Major barriers were
role and leadership ambiguity 68.6%, different goals of individual team members 68.1%, and 53.3% strongly agreed on the
difference in levels of authority, power, expertise, and income. Although healthcare professionals have an optimistic attitude
toward IPC, several healthcare professionals come across challenges during the practice of IPC. To overcome the analyzed
barriers, the higher healthcare authorities must encourage interprofessional collaborative strategies and models.

Keywords
attitude, cross-sectional, interprofessional collaboration, health personnel, delivery of health care, humans

What do we already know about this topic?

In the past few years, the prevalence of complicated and chronic health disorders has led to the immense need for an
effective healthcare team.
How does your research contribute to the field?
This research may be helpful in re-developing and improving healthcare strategies for the patient, taking IPC as a power-
ful approach to overcome the shortage of healthcare workers.
What are your research’s implications toward theory, practice, or policy?
This research highlights the barriers and attitudes that may further help to develop and practice coordinated approaches for
better management which ultimately may improve the quality of life in patients who require special medical assistance.

Introduction partnership responsible for the quality of care to the patients

Interprofessional collaboration (IPC) is a way of communica-
tion in which 2 or more healthcare professionals share their
knowledge through discussion, and provide their best man-
agement for the patients, their families, and health organiza-
tions.1 Thus, in the healthcare sector IPC is a collaborative
according to their needs.2 IPC in education and practice is
recognized by the World Health Organization (WHO) as a
unique method for delivery of health that will also help to
relieve the global manpower deficit in this field.3
Collaborative practice improves the quality of care and
enhances health systems.4 Health professionals independently

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2 INQUIRY
perform assessment procedures and few treatment interven-
tions but management goals; specifically, long-term goals are
established together. All team members communicate and
work cooperatively according to the patient’s needs. IPC also
enriches patient satisfaction, and lessens medical errors,
improving health outcomes and healthcare quality.5,6
In the past few years, the prevalence of complicated and
chronic health disorders raised led to the immense need for
an effective healthcare team.7,8 Currently, there is also a
necessity to work effectively in crossways between the hos-
pital, community settings, and allied health sciences.8,9 For
the assessment of the effectiveness of collaboration; an ini-
tial phase toward it, is to evaluate the attitudes of healthcare
professionals and the barriers they are facing in the way of
IPC.10,11
Health professionals’ attitudes toward their own and other
healthcare professionals’ disciplines may influence their
willingness to collaborate.12 It can influence how they per-
ceive and behave toward other health professionals.13,14
Accomplishment of IPC is dependent on attitude-relevant
features such as trust building, durable communication strat-
egies, common management goals development, understand-
ing required power differences for decision making, and
IPC-supported health organizational structures.12,15 There are
abundant barriers in IPC that not only affect the patient’s
healthcare as well as the health organization’s status.16
Literature addressing multidisciplinary education and
collaboration consistently supports the significance of col-
laboration between healthcare professionals.17 Christine
Straub et al, conducted a study on nursing staff’s and physi-
cians’ acquisition to find their attitudes to interprofessional
education (IPE) and IPC in pediatrics.18 Benjamin Ansa et al
conducted a study on attitudes and behavior toward IPC
among healthcare professionals in an academic medical
center.1 Michael Palapal conducted a cross-sectional study
on Filipino therapists’ experiences and attitudes toward IPE
and collaboration to label the professed scope of IPE
involvement, among Filipino occupational therapists, physi-
cal therapists, and speech-language pathologists (SLPs).19 A
national survey of SLPs’ commitment to interprofess-
ional collaborative practice in schools was conducted by
Danika Pfeiffer et al.20 In Pakistan, Muhammad Naveed
1
Riphah International University, Lahore, Pakistan
2
Bakhtawar Amin Memorial Hospital, Multan, Pakistan
3
The Islamia University of Bahawalpur, Bahawalpur, Pakistan
Received 8 June 2022; revised 17 March 2023; revised manuscript accepted 3 April 2023
Corresponding Authors:
Sana Jabbar, Faculty of Rehabilitation & Allied Health Sciences, Riphah College of Rehabilitation Sciences, Riphah International University Lahore, Lahore
05450, Pakistan.
Email: sanajabbar06@gmail.com
Muhammad Rahil Aslam, Faculty of Medicine and Allied Health Sciences, University College of Conventional Medicine, The Islamia University of
Bahawalpur, Bahawalpur 63100, Pakistan.
Email: rahil.aslam17@gmail.com
Babur conduct a study in 2017 on IPC among rehabilitation
professionals in stroke restoration.21 Mehwish Liaqat et al.
conducted a cross-sectional study to assess perception and
barriers to interprofessional communication among nurses
in Shaikh Zayed Hospital, Lahore Pakistan.22
As there is a huge study gap obvious from the literature
review in the native population and most studies were con-
ducted in a single setting or targeted population from a single
medical department. Literature regarding IPC in the clinical
setting involving allied health professionals, doctors, and
nursing staff together is lacking. Most studies aimed to eval-
uate perception and attitude toward IPC, there is a need to
rule out the barriers too. Perception of collaborative educa-
tion and practice seems unclear among Pakistani health orga-
nizations.21,22 Furthermore, within the health and education
systems, the efforts in achieving these principles still appear
to be deficient.21
The purpose of this study is to provide insight into barri-
ers to IPC faced by native healthcare professionals.
Enlightening the barriers and attitudes may further help to
deal with them and develop coordinated approaches for bet-
ter management16 which ultimately may improve the quality
of life in patients who require special medical needs.6 Thus,
the objective of this study was to find out the attitudes and
barriers to IPC in hospitals among healthcare professionals
in Lahore, Pakistan.
Material & Methods
Context
In the Pakistan context, both IPC and IPE are significant to
strong primary care as well as better health outcomes for the
population.23 Healthcare professionals who required IPC in
daily life for proper management of the speech-language patho-
logical patient were studied, including speech-language pathol-
ogists, audiologists, physiotherapists, occupational therapists,
psychologists/psychiatrists, neurologists, ENT specialists, pedi-
atricians, dentists, and nursing staff. They are interdependently
linked with each other. Speech-language pathology had diver-
sity in etiology and clinical features. These healthcare profes-
sionals rely on each other for complete clinical and instrumental
Jabbar et al.
examination of such patients. Thus, a coordinated approach is
mandatory at a time to rule out the cause and for proper
management.
Study Design
The descriptive cross-sectional study design was used.1,19,22
Attitudes and barriers among the population were measured
through the attitudes toward healthcare teams scale (ATHCT)
and the barriers scale toward IPC. Both scales were used
based on previously validated, reliable, published instru-
ments and considered appropriate for the aim of this
study.1,9,19,24,25
Reliability Testing
To test whether our selected scales were reliable for the cur-
rent study, we performed a reliability test of the scales by
Cronbach’s Alpha (α) test using the statistical package for
the social sciences (SPSS).
Study Settings and Population
The population for the study was healthcare professionals
(speech-language pathologist, audiologist, physiotherapist,
occupational therapist, psychologist, psychiatrist, neurolo-
gist, ENT specialist, pediatrician, dentist, and nursing staff)
of both genders, male and female. The study population
included an age range of 25 or above, working at Children
Hospital, Shaikh Zayed Hospital, and Pakistan Society for
the Rehabilitation of the Disabled (PSRD), Lahore. These
healthcare professionals were targeted who required IPC for
proper management of the speech-language pathological
patient and had the clinical experience of at least 6 months.
Sampling
For the current study, a convenience sampling technique was
used. The sample size was 247 calculated by an online sam-
ple size calculator at a 95% confidence level with a 5% mar-
gin of error according to the related population mentioned in
published literature.26
Duration of Study
The study was conducted for 6 months that is, starting from
April 2021 to September 2021, after synopsis approval in
March 2021.
Data Collection
A single-stage survey was conducted for data collection. The
questionnaire consists of 5 responses based on the Likert
scale. The first part of the survey consisted of 5 items to get
3
the participant’s demographic information including gender,
age range, workplace, area of specialty, and clinical experi-
ence. The second part contained a 14-item ATHCT scale, and
the third part was confined to the 10-Item barriers scale
toward IPC.
Due to the COVID-19 pandemic, all the healthcare pro-
fessionals were not available at the time in their respective
clinical settings. Thus, 90 paper questionnaires were distrib-
uted directly by guiding them about the research study.
Informed consent was taken. Using the same questionnaire,
an online survey was created with google forms, having a
prior additional section of sufficient study information for
better understanding and an informed consent box below to
confirm their willingness. 170 online survey questionnaires
were distributed among healthcare professionals of the tar-
geted clinical setting with the help of their respective hospi-
tal management via social contact groups. The survey
questionnaire was available on google forms for 6 weeks. A
total of 260 questionnaires were distributed to achieve a sam-
ple size of 247, out of which 229 responded. The survey’s
response rate was 88.1%.
Ethical Considerations
For the current research, firstly I obtained approval from the
principal of Riphah College of Rehabilitation and Allied
Health Sciences, Riphah International University Lahore,
Pakistan. After that, I also got permission from the Director
of Children Hospital, Shaikh Zayed Hospital, and Pakistan
Society for the Rehabilitation of the Disabled (PSRD),
Lahore to conduct this research. Permission letters were then
submitted to the research and ethics committee of Riphah
College of Rehabilitation and Allied Health Sciences, Riphah
International University Lahore, Pakistan, and ethical
approval of this research study were obtained with reference
no. REC/RCR&AHS/21/0604. Informed consent was taken
from study participants individually. The concepts of con-
cealment and secrecy were considered.
Data Analysis
An online survey was established in google forms same as a
paper survey questionnaire. Scores were allocated to each
item in the ATHCT scale and barriers scale toward IPC
according to the Likert Scale rankings with a range of “1” to
“5.” “Strongly agree” was scored as 5 and “Strongly dis-
agree” was scored as 1. The google form respondent sheet
was downloaded as an excel file. All the data from the paper
survey were encoded in the same excel file using Microsoft
Excel 2010 installed in a password-protected desk PC owned
by the researcher. Microsoft Excel data sheet was imported
into SPSS version 21 to analyze the data. All the data were
statistically analyzed through frequency analyses and per-
centage distributions.
4 INQUIRY

Table 1. Demographic Characteristics (N = 229), Where show positive attitude while 3 of them represent negative atti-
N = Total no. of Study Participants. tude that is, A2, A6, and A9. Most of the speech-language
Frequency Percent pathologists, physiotherapists, neurologists, and ENT special-
ists strongly agreed on 9 positive statements (A1, A3, A4, A5,
Gender Male 93 40.6 A7, A8, A11, A12, A13) and agree on 2 (A10, A14) while
Female 136 59.4 strongly disagreeing with all 3 negative statements (A2, A6,
Age Range in ≥25-35 years 177 76.6 A9). Audiologists mostly had a strong agreement on 8 positive
years 35-45 years 41 17.7 statements (A1, A3, A4, A5, A8, A11, A12, A13), half of them
<45 years 11 4.8 strongly agreed on A7, agreed on A10 and A14 while strongly
Work Place Private sector 21 9.1
disagreed on all 3 negative statements (A2, A6, A9).
in Lahore Public sector 131 56.7
Occupational therapists had distinct opinions toward attitude
Both Public and Private sector 77 33.3
as most of them strongly agreed on 4 positive statements (A3,
Clinical 6 months-1 year 81 35.1
experience 1-5 years A4, A18, A12), agreed on 4 positive ones (A1, A10, A11, A14)
104 45.0
more than 5 years 44 19.0
while many neutral responses on 2 negative statements (A2,
Area of Speech-language pathologist 66 28.6 A6) and agreed on A9. Similarly, most pediatricians strongly
specialty Audiologist 10 4.3 agreed on 6 positive attitude statements (A1, A3, A4, A7, A11,
Physiotherapist 39 16.9 A12) while having different levels of agreement on the remain-
Occupational therapist 21 9.1 ing but they showed strong agreement on A2 that is, negative
Psychologist/Psychiatrist 16 6.9 statement. Many dentists also strongly agreed on 6 positive
Neurologist 12 5.2 statements (A1, A3, A4, A5, A7, A8) while most nursing staff
ENT specialist 11 4.8 had a positive strong agreement on (A1, A3, and A4), both
Pediatrician 17 7.4 showed various counts of agreement in the remaining, and
Dentist 12 5.2 strongly disagree on 3 negative statements (A2, A6, A9).
Nursing staff 25 10.8 Psychologists/psychiatrists showed the most color of opinions
as having different counts for their level of agreement on posi-
tive attitude statements, on the other hand, showed neutral
Results responses on 2 (A2, A9) negative statements and disagreed on
A6. Generally, speech-language pathologists, audiologists,
Demographic Analysis physiotherapists, pediatricians, dentists, neurologists, and
A total of 229 healthcare professionals responded to the survey, ENT specialists had the most positive attitude, and psycholo-
with 260 people receiving invitations (response rate = 88.1%). gists/psychiatrists showed various levels of agreement
In total, completed surveys (N = 229) were used in the analysis. (Supplemental Table 3).
The majority of respondents were females (n = 136, 59.4%) and The descriptive analysis of the whole population in a
(n = 93 40.6%) males. The ages of the respondents were mostly 14-item ATHCT scale, in terms of frequency and percentage,
distributed between ≥25and 35 years (n = 177, 76.6%) and the is shown in (Table 2). Conclusively healthcare physicians
majority of healthcare professionals worked in the public sec- had an optimistic attitude toward IPC. For the visual presen-
tor (n = 131, 56.7%). Most respondents were speech-language tation of the positive attitude of healthcare professionals
pathologists (n = 66, 28.6%), while audiologists (n = 10, 4.3%) toward IPC, a compound bar chart of the ATHCT scale is
accounted for the least number of participants. The mainstream given below (Figure 1).
of the respondents (n = 104, 45%) had 1 to 5 years of clinical
experience. The frequency and percentage of the entire demo- Barriers to IPC
graphic data are given in (Table 1).
The study participants were questioned about the barriers
to IPC that they had encountered or witnessed throughout
Reliability Analysis their clinical experience. Among speech-language patholo-
Reliability analysis for the ATHCT scale was 0.858 and for gists, most strongly agreed that B1, B2, B3, B6, B9, B10,
barriers toward the IPC scale was 0.822 measured by and B12 are the barriers they face during their clinical
Cronbach’s Alpha (α) in SPSS. Thus, according to the pres- practice. B3 and B12 were commonly seen among all.
ent study data both scales show highly positive reliability Audiologists and physiotherapists represent the results as
(Supplemental Tables 1 and 2). SLPs. Almost all of their population strongly agreed on B3
and B12. The occupational therapist showed various opin-
ions, half of the population agreed on B7, B8, and B9.
Attitude Toward IPC Most pediatricians strongly agreed on B3, B9, and B12.
Participants in the study were asked about their attitudes Most dentists showed strong agreement on B1, B6, and
toward IPC among healthcare professionals of other disci- B12 while B2, B3, B9, and B10 were common too. The
plines and patient care. In the ATHCT scale, 9 statements difference of opinions can be seen among nursing staff,
Jabbar et al. 5

Table 2. Descriptive Analysis of ATHCT Scale Items in Frequency (f) and Percent (%).

Responses (N = 229), where N = total no. of study participants.

Strongly disagree Disagree f Neutral f Agree on f Strongly agree

14-item (ATHCT) f (%) (%) (%) (%) on f (%)
A1. Patients/clients receiving interprofessional care 1 (0.4%) 9 (3.9%) 24 (10.5%) 31 (13.5%) 164 (71.6%)
are more likely than others to be treated
A2. Developing an interprofessional patient/client 108 (47.2%) 50 (21.8%) 28 (12.2%) 25 (10.9%) 18 (7.9%)
care plan is excessively time-consuming.
A3. The give and take among team members helps 1 (0.4%) 8 (3.5%) 9 (3.9%) 43 (18.8%) 168 (73.4%)
them make better patient/client care decisions.
A4. Inter-professional approach makes the delivery 3 (1.3%) 4 (1.7%) 16 (7.0%) 40 (17.5%) 166 (72.5%)
of care more efficient.
A5. Developing a patient/client care plan with other 21 (9.2%) 25 (10.9%) 13 (5.7%) 40 (17.5%) 130 (56.8%)
team members avoids errors in delivering care.
A6. Working in inter professional manner 109 (47.6%) 50 (21.8%) 37 (16.2%) 23 (10.0%) 10 (4.4%)
unnecessarily complicates things most of the time.
A7. Working in inter professional environment 17 (7.4%) 32 (14.0%) 22 (9.6%) 34 (14.8%) 124 (54.1%)
keeps most health professionals enthusiastic and
interested in their jobs.
A8. Inter professional approach improves the quality 16 (7.0%) 19 (8.3%) 11 (4.8%) 45 (19.7%) 138 (60.3%)
of care to patients/clients.
A9. In most instances, the time required for inter 108 (47.2%) 50 (21.8%) 34 (14.8%) 24 (10.5%) 13 (5.7%)
professional consultations could be better spent in
other ways.
A10. Health professionals working as teams are 32 (14.0%) 25 (10.9%) 27 (11.8%) 119 (52.0%) 26 (11.4%)
more responsive than others to the emotional and
financial needs of patients/clients
A11. Inter professional approach permits health 13 (5.7%) 25 (10.9%) 13 (5.7%) 55 (24.0%) 123 (53.7%)
professionals to meet the needs of family
caregivers as well as patients.
A12. Having to report observations to a team helps 3 (1.3%) 10 (4.4%) 13 (5.7%) 49 (21.4%) 154 (67.2%)
team members better understand the work of
other health professionals.
A13. Hospital patients who receive inter professional 28 (12.2%) 20 (8.7%) 18 (7.9%) 44 (19.2%) 119 (52.0%)
team care are better prepared for discharge than
other patients.
A14. Team meetings foster communication among 33 (14.4%) 23 (10.0%) 27 (11.8%) 111 (48.5%) 35 (15.3%)
team members from different professions or
disciplines.

almost half of them strongly agreed on B3 and similarly,
psychologists/psychiatrists showed agreement on B8.
Many neurologists strongly agreed on B1, B2, B3, B6, B9,
B10, and B12. ENT specialists strongly agreed on B1, B2,
B3, B9, B10, and B12. Speech-language pathologists,
audiologists, physiotherapists, pediatricians, neurologists,
and ENT specialists were facing more barriers in their way
of IPC comparatively according to their frequency on the
Likert scale. (Supplemental Table 4).
A bar chart representing the major barriers for each
healthcare profession individually according to their count
number on the Likert scale is given. Overall, the major barri-
ers were B3 and B9. Although B1, B2, and B12 were also
seen commonly (Figure 2)
Major barriers to IPC among all healthcare profession-
als, out of N = 229, reported as role and leadership
ambiguity; strongly agreed by 68.6% of study participants.
68.1% strongly agreed on the different goals of individual
team members, and 53.3% strongly agreed on the differ-
ence in levels of authority, power, expertise, and income.
The table below shows the level of agreement among
healthcare professionals in terms of frequency and per-
centage. (Table 3)For the visual presentation of the major
barriers toward IPC, a compound bar chart is given below
(Figure 3).
Discussion
The current study examined the attitude toward IPC in hospi-
tals among healthcare professionals in Lahore, Pakistan. It
further explores the barriers faced during their clinical expe-
rience of IPC. The World Health Organization (WHO)
6 INQUIRY

Figure 1. Compound bar chart of the ATHCT scale toward Interprofessional collaboration.

Figure 2. A bar chart showing the major barriers among each healthcare profession.
Jabbar et al. 7

Table 3. Descriptive analysis of barriers toward Interprofessional collaboration scale items in frequency (f) and percent (%).

Responses (N = 229), where N = total no. of study participants.

Barriers toward IPC Strongly disagree Disagree Neutral Agree Strongly agree
B1. Lack of a clearly stated, shared, and measurable 24 (10.5%) 22 (9.6%) 26 (11.4%) 42 (18.3%) 115 (50.2%)
purpose
B2. Lack of training in inter professional 25 (10.9%) 28 (12.2%) 19 (8.3%) 41 (17.9%) 116 (50.7%)
collaboration
B3. Role and leadership ambiguity 2 (0.9%) 9 (3.9%) 25 (10.9%) 36 (15.7%) 157 (68.6%)
B4. Team too large or too small 33 (14.4%) 42 (18.3%) 38 (16.6%) 100 (43.7%) 16 (7.0%)
Team not composed of appropriate professionals 108 (47.2%) 40 (17.5%) 20 (8.7%) 29 (12.7%) 32 (14.0%)
B5. Lack of appropriate mechanism for timely 18 (7.9%) 40 (17.5%) 17 (7.4%) 38 (16.6%) 116 (50.7%)
exchange of information
B6. Need for orientation for new members 24 (10.5%) 44 (19.2%) 17 (7.4%) 108 (47.2%) 36 (15.7%)
B7. Lack of framework for problem discovery and 25 (10.9%) 44 (19.2%) 13 (5.7%) 123 (53.7%) 24 (10.5%)
resolution
B8. Difference in levels of authority, power, 18 (7.9%) 31 (13.5%) 20 (8.7%) 38 (16.6%) 122 (53.3%)
expertise, income
B9. Difficulty in engaging the community 14 (6.1%) 35 (15.3%) 29 (12.7%) 39 (17.0%) 112 (48.9%)
B10. Lack of commitment of team members. 68 (29.7%) 75 (32.8%) 28 (12.2%) 23 (10.0%) 35 (15.3%)
B11. Different goals of individual team members. 3 (1.3%) 9 (3.9%) 21 (9.2%) 40 (17.5%) 156 (68.1%)
B12. Apathy of team members 106 (46.3%) 34 (14.8%) 31 (13.5%) 43 (18.8%) 15 (6.6%)
B13. Inadequate decision making 43 (18.8%) 68 (29.7%) 23 (10.0%) 37 (16.2%) 58 (25.3%)
B14. Conflict regarding individual relationships to 73 (31.9%) 71 (31.0%) 29 (12.7%) 34 (14.8%) 22 (9.6%)
the patient

acknowledged that to attain the developmental millenium
health goals, health workers trained in IPC are required.27
American Speech-Language-Hearing Association (ASHA)
planned a 10-year (2015-2025) objectives of envisioned
future in which IPE and IPC training is important.28
Most studies on IPC were produced abroad, and many
were conducted in a solitary setting or within a population of
a specific field therefore their generalizability in the local
population is problematic.29-31 More research was conducted
to find out insight, attitude, and perception toward the
IPC,14,32-34 the impact or need of early IPE among medical
care graduates.17,35-37 This study was conducted in the local
climate that is, in Lahore, Pakistan. The context surveyed
attitudes as well as barriers to proficient cooperation between
healthcare professionals of medical and allied health sci-
ences. It contains public and private clinical settings, show-
ing more generalizability.
In this research, the healthcare professionals appreciate the
significance of IPC in the practical delivery of patient care
and appreciated the need for a healthcare team working
together for it. The positive attitude found in physicians is
more than in nursing staff similar to the results reported by
Straub et al.18,19,38 Filipino occupational therapists, physio-
therapists, and SLPs, out of 14 ATHCT items 3 negative state-
ments were perceived as neutral while the remaining 11
positive items were perceived with general agreement same
as occupational therapists in the result of this study but in
contrast physiotherapists and SLPs showed strong agreement
toward positive items, and strongly disagree on 3 remaining
negative items in the current study.19 Similar to the current
study, various healthcare professions; nurses (nursing and
pediatric nursing), therapists (physical therapy, speech-lan-
guage therapy), and diagnostic professionals (biomedical sci-
ence and radiography) showed an overall positive attitude
toward IPC in the related study and also expressed a neutral
attitude in IP learning and IP interactions.39 In another study,
medical students held a firm optimistic belief in ATHCT
items except having a variation in their level of agreement in
different positive items as “working in an interprofessional
environment keeps health professionals enthusiastic and
interested in their jobs” 60.9% and team meetings foster com-
munication among members of different disciplines 87%
whereas it is 54.1% and 15.7% in current study respectively.38
Few researchers give evidence that before graduation com-
paratively short educational intervention in students of health-
care discipline can positively change attitudes toward learning
and collaboration.12,40
Results of a study, the attitudes of physicians and nurses
among each other working in different hospitals in the
Islamabad-Rawalpindi region of Pakistan showed that nurses
value IPC more than their physician colleagues contradictory
to this in the current study speech-language pathologists, audi-
ologists, physiotherapists, pediatricians, dentists, neurologists,
and ENT specialists had the most positive attitude.41 Attitudes
of medicine, nursing, and social work students toward IPC
teamwork and willingness for IPE were ruled out. Medical
students had a more positive attitude comparatively. Though
in this study along with medical health workers (neurologists,
8 INQUIRY

Figure 3. Compound bar chart of barriers toward interprofessional collaboration scale.

pediatricians, dentists, and ENT specialists), allied health
workers (SLPs, audiologists, and physiotherapists) also
showed a more positive attitude.42 On the other side, the atti-
tudes of medicine and nursing students toward interprofes-
sional teams were less positive than pharmacy and social work
students in previous research.43 Overall the responses in this
study were optimistic toward IPC, and there were no statisti-
cally huge contrasts seen between the attitudes of healthcare
professionals, as had been previously shown by other
studies.1,29,35,44-46
In a study, barriers to collaboration for school-based SLPs
during the provision of special education services were time
management, resistance from other professionals, and defi-
ciency of provision from the administration.20 While in the
current study, for SLPs in clinical settings, major barriers
were role and leadership ambiguity, and the different goals of
individual team members. In primary care physicians, the
main barriers referred to lack of time and training, lack of
clear roles, and poor communication in contrast to our study
in which role and leadership ambiguity along with different
goals of individual team members were major barriers.
Whereas lack of training and poor communication were
encountered by 50% of healthcare physicians in hospitals.47
Remarkably in the current study, organizational resource
constraints, personal beliefs of the health professional team,
and inability to access adequate care information were not
the main barriers as seen in a recent study.48
The nursing staff in the current study faced role and lead-
ership ambiguity as the main hurdle in IPC similarly nursing
staff in Sheikh Zayed Hospital, Lahore also encountered less
understanding of the nursing profession by other health pro-
fessionals and job stress as a major barrier.22 Among operat-
ing room healthcare professionals (Nurses, anesthesiologists,
surgeons, perfusionists) perceptions and responsibilities
Jabbar et al.
across healthcare professionals were reported as the key bar-
rier similarly role ambiguity is one of the major barriers in
the current study whereas another barrier from that study
(difficulty in engaging due to being unfamiliar with team
members) was challenged by almost half of the
population.49
One research discussed regulatory and medico-legal bar-
riers, which were mainly to interprofessional practice50
whereas another study showed professional cultures as a bar-
rier to effective interprofessional teamwork.51 Awareness of
the educational, systemic, and interpersonal factors which
promote the cultural differences among health professions,
can help guide the development of advanced educational
approaches to enhance interprofessional collaborative
practice.
As in the present study role ambiguity, lack of IPC train-
ing, and clear and timely shared information were the similar
main barriers in a different study targeting general practitio-
ners, pharmacists, mental health workers, midwives, physio-
therapists, social workers, and receptionists. The other main
barriers to that study were confidentiality and responsibility,
long-term funding, and joint monitoring.52 Likewise clear,
appropriate, and timely shared information is the main bar-
rier among psychiatrists, pharmacists, nurses, occupational
therapists, psychologists, and social workers.16
In this study, speech-language pathologists, audiologists,
physiotherapists, pediatricians, neurologists, and ENT spe-
cialists were facing more difficulties in their way of IPC rela-
tively. Thus, health standards can be raised by overcoming
role and leadership ambiguity and managing different goals
of individual team members as highlighted by many profes-
sionals in the current study. This confirms the need for per-
sistent emphasis on IPC in healthcare professionals and the
need to value the distinctive skill of these professionals to
provide good patient care. It also suggests the hospital man-
agement should support appropriate mechanisms for the
timely and proper exchange of information and help to
engage the community by conducting awareness seminars.
A limitation of this study was the subjective nature of sur-
vey research as reflected in these results. Results may not
apply to the total population of healthcare professionals
across the country because the study was limited to one city
and only hospital setups. A purely quantitative study also
leaves several questions open.
Conclusion
It is concluded that the most positive attitude represented by
speech-language pathologists, audiologists, physiotherapists,
pediatricians, dentists, neurologists, and ENT specialists
compare to the occupational therapist, nursing staff, and psy-
chologists/psychiatrists as they showed various levels of
agreement on positive ATHCT items. Conclusively health-
care physicians had an optimistic attitude toward IPC demon-
strated by statistical analysis of each ATHCT scale item in
9
terms of frequency and percentage. Out of 14 items, the
majority strongly agreed on 9 positive statements, agreed on
2 positive statements, and strongly disagrees with 3 negative
statements toward IPC. On statical evaluation, Speech-
language pathologists, audiologists, physiotherapists, pedia-
tricians, neurologists, and ENT specialists were facing more
barriers. Major barriers toward IPC statistically were role and
leadership ambiguity and different goals of individual team
members.
This research can help Pakistan in re-planning, taking IPC
as a strategy to address the shortage of health workers.
Healthcare professionals had an essential positive perspec-
tive and give importance to IPC thus resolving the barriers
can enhance health outcomes. To overcome the analyzed bar-
riers, interprofessional collaborative strategies and models
must be encouraged by the hospital administration and higher
healthcare authorities. To further strengthen professional col-
laboration, IPE is recommended for students of medical and
allied health sciences. Further systemic review studies were
recommended to comprehend and critically analyze the
existing research studies.
Author’s Note
Ghazal Awais Butt is also affiliated to Armed Forces Institute of
Rehabilitation Medicine, Rawalpindi, Pakistan.
Acknowledgments
We are thankful to the Head of Department, Riphah College of
Rehabilitation Sciences, Faculty of Rehabilitation & Allied Health
Sciences, Riphah International University Lahore for the directions
to complete the study and moral support.
Author’s Contribution
SJ and HSN designed the study and wrote the manuscript. GAB and
SMZ assisted in the literature search related to the study. AI and SM
helped in manuscript drafting and editing. TM and MRA critically
reviewed the manuscript. All the authors approved the final version
of the manuscript.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
Ethical Considerations
For the current research, firstly I obtained approval from the princi-
pal of Riphah College of Rehabilitation and Allied Health Sciences,
Riphah International University Lahore, Pakistan. After that, I also
got permission from the Director of Children Hospital, Shaikh
Zayed Hospital, and Pakistan Society for the Rehabilitation of the
Disabled (PSRD), Lahore to conduct this research. Permission let-
ters were then submitted to the research & ethics committee of
10
Riphah College of Rehabilitation and Allied Health Sciences,
Riphah International University Lahore, Pakistan, and ethical
approval of this research study was obtained with reference no.
REC/RCR&AHS/21/0604. Informed consent was taken from study
participants individually. The concepts of concealment and secrecy
were considered.
ORCID iDs
Sana Jabbar https://orcid.org/0000-0002-7418-5437
Muhammad Rahil Aslam https://orcid.org/0000-0003-0684-9147
Supplemental Material
Supplemental material for this article is available online.
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