Fostering change in back pain beliefs and behaviors: When public education is not enough

Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, 8205 114 St. Edmonton, Alberta T6G 2G4, Canada. Electronic address: .
The spine journal: official journal of the North American Spine Society (Impact Factor: 2.43). 10/2012; 12(11). DOI: 10.1016/j.spinee.2012.09.001
Source: PubMed


Mass media campaigns designed to alter societal views and individual behaviors about back pain have been undertaken and evaluated in multiple countries. In contrast to the original Australian campaign, subsequent campaigns have been less successful, with improvements observed in beliefs without the corresponding changes in related behaviors. This article summarizes the results of a literature review, expert panel, and workshop held at the Melbourne International Forum XI: Primary Care Research on Low Back Pain in March 2011 on the role and interplay of various social behavior change strategies, including public education, law and legislation, healthy public policy, and social marketing in achieving a sustained reduction in the societal burden of back pain. Given the complexities inherent to health-related behaviors change, the Rothschild framework is applied in which behavior change strategies are viewed on a continuum from public education at one end through law and health policy at the other. Educational endeavors should likely be augmented with social marketing endeavors and supportive laws and health policy to foster sustained change in outcomes such as work disability and health utilization. Practical suggestions are provided for future interventions aimed at changing back pain-related behaviors. Evaluation of previous back pain mass media campaigns reveals that education alone is unlikely to foster positive and persisting behavioral change without concomitant strategies.

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    • "A recent large, cross-sectional study provided strong evidence to support the present structure, scoring, and construct validity of the BBQ (Bostick, Schopflocher, & Gross, 2013). However, although frequently used (Gross et al., 2012), no longitudinal evaluations of its construct validity have been carried out. The aim of this study was therefore to validate the newly created German version of the BBQ in a prospective population study. "
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    ABSTRACT: This cross-lagged-panel study tested the validity of the German version of the back beliefs questionnaire (BBQ) in predicting pain in the shoulders, neck, and back. A random sample of 2860 individuals participated at baseline, and 73% responded at one-year follow-up. Structural equation modeling was used to carry out a model comparison to evaluate whether paths differed between individuals with and without initial back pain and between those who exercised at baseline and those who did not. Factor analysis showed eight of the nine original items loaded on the expected common factor. High BBQ scores at baseline significantly predicted an increase in shoulder, neck, and back pain in individuals with current back pain (β = .11, p < .05), but not in other respondents (β = .02, p = .259). Similarly, baseline BBQ scores predicted the increase in shoulder, neck, and back pain among those who did not exercise (β = .15, p < .05), but not in those who did (β = .04, ns). The risk of negative back beliefs preceding an increase in shoulder, neck, and back pain was greatest for those with current back pain who did not exercise (β = .29, p < .05). The findings confirmed the validity of the German BBQ. Cognitive behavioral interventions should address pessimistic back beliefs in high-risk groups.
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    • "If, as is claimed, large-scale, expensive education programs purport to target widely held misconceptions about back pain,4,22 they are not sufficiently explicit. Probably one of the most widely held beliefs, and a disabling one for the lay public, is that back pain is a sign that some spinal structure has become abnormally positioned,25 and that unless corrected, the spinal column will become biomechanically unsound and unable to withstand everyday forces. "
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    ABSTRACT: Recent figures show that there has been no change in the upward trend of direct and indirect costs for the largely benign symptom of low back pain in Western societies. This is despite greater understanding and the recommendation of a much more conservative and independent approach to its management. Moreover, in recent years, several large-scale education programs that aim to bring knowledge of the public (including general practitioners) more in line with evidence-based best practice were carried out in different countries. The hope was that the information imparted would change beliefs, ie, dysfunctional patient behavior and biomedical practice on the part of clinicians. However, these programs had no influence on behavior or costs in three out of the four countries in which they were implemented. It is argued that one reason for the overall lack of success is that it is extremely difficult to alter the potentially disabling belief among the lay public that low back pain has a structural mechanical cause. An important reason for this is that this belief continues to be regularly reinforced by the conditions of care of a range of "hands-on" providers, for whom idiosyncratic variations of that view are fundamental to their professional existence.
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