Media campaign for improving Knowledge, Attitude and Practice in low back pain - an evaluation of the “Active Back” project

This thesis is a scientific evaluation of an implementation project of the Norwegian Guidelines on acute back pain in two Norwegian counties, Aust-Agder and Vestfold, during 2002 to 2005. The project consisted of specific interventions towards the general public, the professional health care providers, and 6 cooperating work places. The aim of this study was to investigate whether these interventions had any influence on knowledge, attitudes, and practices held by the target groups of the interventions. The data from the two counties were compared with similar data from a neighbouring county (Telemark). Low Back Pain is a significant health problem for the individuals and to the society. The lifetime prevalence in Western Europe is estimated to 84%, and the point prevalence up to 33%. People experiencing back pain get frustrated by the lack of consistency among the professionals regarding treatment and understanding of the problem. In Norway, the total cost of sick leave, disability and health care consumption due to LBP is calculated to NOK 13-15 billion per year. The intervention of this project was a delivery of positive messages about LBP reflecting the actual knowledge and guidelines on the management of back pain. A mass media campaign in Australia in 1997-99 reported significant effects on attitudes and sick leave. Our intervention towards the general public consisted of a similar media campaign, although on a smaller scale. In addition, the health care professionals received written materials and posters for their waiting rooms. In six cooperating companies, the project provided training of peer advisers among the employees. The data on knowledge and attitudes in the general public were collected by telephone interviews with 500 randomly selected persons in each of the three counties. All 1100 doctors, physiotherapists and chiropractors in primary care in the three counties were asked to answer a postal questionnaire. Similarly, the 3500 employees in the six companies were asked to answer a written questionnaire. These data collections were performed three times, before, during, and at the conclusion of the project. As measurements of practices, data on sick leave was collected from The National Insurance Administration reflecting the total and the back pain related sick leave of the general public and in the six cooperating companies. In addition, data on surgery rates and imaging examination on LBP were collected from the health institutions in the area. These data were collected for the year before the campaign began (2001), during the campaign (2003), and at the end of the campaign (2005), from the intervention counties and the control county. In paper # 1 (before the campaign) we found that people that had experienced back pain previously had more optimistic beliefs about LBP than those who currently had back pain when interviewed, or those who never had experienced any back pain. We also found significant differences between the groups of health care providers, particularly that chiropractors had less belief in spontaneous recovery from an episode of back pain than doctors and physiotherapists. The study also demonstrated a relationship between beliefs held by the individual and the profession they had chosen at their last episode of LBP. The results of the media campaign presented in paper # 2 showed a small, but statistically significant improvement in beliefs held by the public exposed to the campaign as opposed to those in the control county. However, this did not lead to any corresponding change in sickness behaviour. Paper # 3 presents an attention rate to the campaign close to 100% among the providers in the intervention counties. However, although there was an improvement in beliefs held by the professionals during the campaign period, we found the same improvement also in the control county and were therefore unable to relate this to the campaign. Furthermore, the differences between the provider groups previously reported in paper #1 actually seemed to increase during the period. In the six cooperating companies, where a specific on-site intervention was added to the campaign, there was a significant improvement in beliefs accompanied by a total sickness absence decrease by 27% and LBP related work absence by 49% (paper #4). These findings have thus led us to the conclusions that the scale of our media campaign may have been too small to produce sufficient changes in attitudes in the general public to influence sickness behaviour. The addition of a peer support at the work place seemed to make the additional effect needed to reduce sickness absence