Using behaviour change theory and preliminary testing to develop an implementation intervention to reduce imaging for low back pain

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Imaging is overused in the management of low back pain (LBP). Interventions designed to decrease non-indicated imaging have predominantly targeted practitioner education alone; however, these are typically ineffective. Barriers to reducing imaging have been identified for both patients and practitioners. Interventions aimed at addressing barriers in both these groups concurrently may be more effective. The Behaviour Change Wheel provides a structured framework for developing implementation interventions to facilitate behavioural change. The aim of this study was to develop an implementation intervention aiming to reduce non-indicated imaging for LBP, by targeting both general medical practitioner (GP) and patient barriers concurrently. Methods: The Behaviour Change Wheel was used to identify the behaviours requiring change, and guide initial development of an implementation intervention. Preliminary testing of the intervention was performed with: 1) content review by experts in the field; and 2) qualitative analysis of semi-structured interviews with 10 GPS and 10 healthcare consumers, to determine barriers and facilitators to successful implementation of the intervention in clinical practice. Results informed further development of the implementation intervention. Results: Patient pressure on the GP to order imaging, and the inability of the GP to manage a clinical consult for LBP without imaging, were determined to be the primary behaviours leading to referral for non-indicated imaging. The developed implementation intervention consisted of a purpose-developed clinical resource for GPS to use with patients during a LBP consult, and a GP training session. The implementation intervention was designed to provide GP and patient education, remind GPS of preferred behaviour, provide clinical decision support, and facilitate GP-patient communication. Preliminary testing found experts, GPS, and healthcare consumers were supportive of most aspects of the developed resource, and thought use would likely decrease non-indicated imaging for LBP. Suggestions for improvement of the implementation intervention were incorporated into a final version. Conclusions: The developed implementation intervention, aiming to reduce non-indicated imaging for LBP, was informed by behaviour change theory and preliminary testing. Further testing is required to assess feasibility of use in clinical practice, and the effectiveness of the implementation intervention in reducing imaging for LBP, before large-scale implementation can be considered.

LanguageEnglish
Article number734
Pages1-17
Number of pages17
JournalBMC Health Services Research
Volume18
Issue number1
DOIs
Publication statusPublished - 24 Sep 2018

Fingerprint

Low Back Pain
General Practitioners
Clinical Decision Support Systems
Delivery of Health Care
Patient Education
Medical Education
Referral and Consultation
Communication
Interviews
Education
Pressure

Bibliographical note

Copyright the Author(s) 2018. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

  • behaviour change wheel
  • diagnostic imaging
  • intervention development
  • low back pain, implementation intervention

Cite this

@article{fe0f45bfd2b94ac99117cdf037542675,
title = "Using behaviour change theory and preliminary testing to develop an implementation intervention to reduce imaging for low back pain",
abstract = "Background: Imaging is overused in the management of low back pain (LBP). Interventions designed to decrease non-indicated imaging have predominantly targeted practitioner education alone; however, these are typically ineffective. Barriers to reducing imaging have been identified for both patients and practitioners. Interventions aimed at addressing barriers in both these groups concurrently may be more effective. The Behaviour Change Wheel provides a structured framework for developing implementation interventions to facilitate behavioural change. The aim of this study was to develop an implementation intervention aiming to reduce non-indicated imaging for LBP, by targeting both general medical practitioner (GP) and patient barriers concurrently. Methods: The Behaviour Change Wheel was used to identify the behaviours requiring change, and guide initial development of an implementation intervention. Preliminary testing of the intervention was performed with: 1) content review by experts in the field; and 2) qualitative analysis of semi-structured interviews with 10 GPS and 10 healthcare consumers, to determine barriers and facilitators to successful implementation of the intervention in clinical practice. Results informed further development of the implementation intervention. Results: Patient pressure on the GP to order imaging, and the inability of the GP to manage a clinical consult for LBP without imaging, were determined to be the primary behaviours leading to referral for non-indicated imaging. The developed implementation intervention consisted of a purpose-developed clinical resource for GPS to use with patients during a LBP consult, and a GP training session. The implementation intervention was designed to provide GP and patient education, remind GPS of preferred behaviour, provide clinical decision support, and facilitate GP-patient communication. Preliminary testing found experts, GPS, and healthcare consumers were supportive of most aspects of the developed resource, and thought use would likely decrease non-indicated imaging for LBP. Suggestions for improvement of the implementation intervention were incorporated into a final version. Conclusions: The developed implementation intervention, aiming to reduce non-indicated imaging for LBP, was informed by behaviour change theory and preliminary testing. Further testing is required to assess feasibility of use in clinical practice, and the effectiveness of the implementation intervention in reducing imaging for LBP, before large-scale implementation can be considered.",
keywords = "behaviour change wheel, diagnostic imaging, intervention development, low back pain, implementation intervention",
author = "Jenkins, {Hazel J.} and Moloney, {Niamh A.} and French, {Simon D.} and Maher, {Chris G.} and Dear, {Blake F.} and Magnussen, {John S.} and Hancock, {Mark J.}",
note = "Copyright the Author(s) 2018. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",
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Using behaviour change theory and preliminary testing to develop an implementation intervention to reduce imaging for low back pain. / Jenkins, Hazel J.; Moloney, Niamh A.; French, Simon D.; Maher, Chris G.; Dear, Blake F.; Magnussen, John S.; Hancock, Mark J.

In: BMC Health Services Research, Vol. 18, No. 1, 734, 24.09.2018, p. 1-17.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Using behaviour change theory and preliminary testing to develop an implementation intervention to reduce imaging for low back pain

AU - Jenkins,Hazel J.

AU - Moloney,Niamh A.

AU - French,Simon D.

AU - Maher,Chris G.

AU - Dear,Blake F.

AU - Magnussen,John S.

AU - Hancock,Mark J.

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N2 - Background: Imaging is overused in the management of low back pain (LBP). Interventions designed to decrease non-indicated imaging have predominantly targeted practitioner education alone; however, these are typically ineffective. Barriers to reducing imaging have been identified for both patients and practitioners. Interventions aimed at addressing barriers in both these groups concurrently may be more effective. The Behaviour Change Wheel provides a structured framework for developing implementation interventions to facilitate behavioural change. The aim of this study was to develop an implementation intervention aiming to reduce non-indicated imaging for LBP, by targeting both general medical practitioner (GP) and patient barriers concurrently. Methods: The Behaviour Change Wheel was used to identify the behaviours requiring change, and guide initial development of an implementation intervention. Preliminary testing of the intervention was performed with: 1) content review by experts in the field; and 2) qualitative analysis of semi-structured interviews with 10 GPS and 10 healthcare consumers, to determine barriers and facilitators to successful implementation of the intervention in clinical practice. Results informed further development of the implementation intervention. Results: Patient pressure on the GP to order imaging, and the inability of the GP to manage a clinical consult for LBP without imaging, were determined to be the primary behaviours leading to referral for non-indicated imaging. The developed implementation intervention consisted of a purpose-developed clinical resource for GPS to use with patients during a LBP consult, and a GP training session. The implementation intervention was designed to provide GP and patient education, remind GPS of preferred behaviour, provide clinical decision support, and facilitate GP-patient communication. Preliminary testing found experts, GPS, and healthcare consumers were supportive of most aspects of the developed resource, and thought use would likely decrease non-indicated imaging for LBP. Suggestions for improvement of the implementation intervention were incorporated into a final version. Conclusions: The developed implementation intervention, aiming to reduce non-indicated imaging for LBP, was informed by behaviour change theory and preliminary testing. Further testing is required to assess feasibility of use in clinical practice, and the effectiveness of the implementation intervention in reducing imaging for LBP, before large-scale implementation can be considered.

AB - Background: Imaging is overused in the management of low back pain (LBP). Interventions designed to decrease non-indicated imaging have predominantly targeted practitioner education alone; however, these are typically ineffective. Barriers to reducing imaging have been identified for both patients and practitioners. Interventions aimed at addressing barriers in both these groups concurrently may be more effective. The Behaviour Change Wheel provides a structured framework for developing implementation interventions to facilitate behavioural change. The aim of this study was to develop an implementation intervention aiming to reduce non-indicated imaging for LBP, by targeting both general medical practitioner (GP) and patient barriers concurrently. Methods: The Behaviour Change Wheel was used to identify the behaviours requiring change, and guide initial development of an implementation intervention. Preliminary testing of the intervention was performed with: 1) content review by experts in the field; and 2) qualitative analysis of semi-structured interviews with 10 GPS and 10 healthcare consumers, to determine barriers and facilitators to successful implementation of the intervention in clinical practice. Results informed further development of the implementation intervention. Results: Patient pressure on the GP to order imaging, and the inability of the GP to manage a clinical consult for LBP without imaging, were determined to be the primary behaviours leading to referral for non-indicated imaging. The developed implementation intervention consisted of a purpose-developed clinical resource for GPS to use with patients during a LBP consult, and a GP training session. The implementation intervention was designed to provide GP and patient education, remind GPS of preferred behaviour, provide clinical decision support, and facilitate GP-patient communication. Preliminary testing found experts, GPS, and healthcare consumers were supportive of most aspects of the developed resource, and thought use would likely decrease non-indicated imaging for LBP. Suggestions for improvement of the implementation intervention were incorporated into a final version. Conclusions: The developed implementation intervention, aiming to reduce non-indicated imaging for LBP, was informed by behaviour change theory and preliminary testing. Further testing is required to assess feasibility of use in clinical practice, and the effectiveness of the implementation intervention in reducing imaging for LBP, before large-scale implementation can be considered.

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