Table 3 Major themes and sub-themes for interviews with provider referral participants (n = 17)

Theme1: Lack of Knowledge of the Direct Access Program

“He′s the one [physician] that suggested I try this program [MSK program]. I didn’t know anything about it, and I was like, “Yeah, $20, that’s good. “ (14)

Theme 2: Patients’ Attitudes Toward and Beliefs about Treatment and Illness

Sub-Theme 1: Lack of Consideration of Physical Therapy Regardless of Past Experience

“I don’t know. I just didn’t think about that. I really didn’t. I didn’t think physical therapy was going to help me. Because it was something, I thought I had to live with. I never thought about it, really. I didn’t want to kind of miss things and I really didn’t think about physical therapy during that part.” (28)

Sub-Theme 2: Preference for Pharmacological Treatments

“I was trying to find a quick release for the pain, instead of thinking that it was going to go away, like maybe a shot or something. I think I was looking for a quick relief when I knew it was going to take longer then, I wanted it to be over with.” (17)

Sub-Theme 3: Need for Physician Reassurance

“I wanted to make sure that there wasn’t anything structurally wrong or that there wasn’t an actual injury before starting physical therapy. I wanted the opinion of a medical doctor before I started seeking other professional consults. I didn’t want to postpone getting to the real root of the cause. If that was the case, why go to physical therapy before going to a medical doctor. I wanted to make sure that there wasn’t anything physically wrong with my shoulders.” (4)

Sub-Theme 4: Coincidental Discussion

“It was more of a convenience thing as well because I knew I had the appointment for my annual physical. I knew that if there was something that needed to be done, then he could get the ball rolling” (25)

Theme 3: Necessary Physician Care

“I don’t know, like I lifted something wrong or bent wrong, something along those lines. The sciatic issues that I had I had never treated medically. It was just some strengthening that relieved my problems. It probably happened two times before, not severe though. Over the next several days up until that Wednesday night that I worked I noticed my leg was starting to get painful, the sciatic type pain, the pain was just getting so severe that I ended up going to [emergency care] to see if they could do something for me.” (2)