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Title: Low Back Pain: Success of a Low Budget Media Campaign.

Authors and affiliation: Erik L. Werner, Hospital of Rehabilitation, Stavern, Norway; Camilla Ihlebæk, Norwegian Back Pain Network, Bergen; Marjon Wormgoor, Hospital of Rehabilitation, Stavern, Norway; Even Lærum, Norwegian Back Pain Network, Oslo; Aage Indahl, Hospital of Rehabilitation, Stavern, Norway.

Email address: loewern@online.no

Introduction: Previous studies have shown that health care providers to a large extent have attitudes and knowledges about back pain in concordance with current guidelines, while many myths are still alive in the general population. An Australian study of a media campaign in 1997-99 resulted in significant improvement in beliefs towards low back pain and a 20% decline in medical cost per claim for back problems. The results have recently shown to sustain three years after the campaign.

Objective: The aim of this study is to evaluate whether a low budget media campaign in two Norwegian counties, could change people’s beliefs about low back pain, in line with the Norwegian guidelines.

Methods: The Active Back (“Aktiv Rygg”) Project took place from April 2002 to June 2005 in two Norwegian counties, with a third county acting as a control. The project aimed itself at four target groups: the general public, the health care providers, the working places and social security officers. The media campaign consisted of advertising on local radio, TV, cinemas, newspapers, distribution of four special issues of back pain information papers to all households in the area, and posters on the providers’ waiting rooms.
A telephone survey was conducted before, during and after the campaign to a random sample of 500 individuals in each county. The respondents were asked about their degree of agreement to 7 statements reflecting beliefs about back pain, which were based on the main messages from the campaign.

Results: The proportions of respondents with own experiences of back pain were similar in all three counties, and constant throughout the study period (79%). The attention of the campaign increased from 34% in 2004 to a maximum of 41% in 2005, while 15% of the respondents in the control county also confirmed knowledge of the campaign.
For five of the seven statements, there was a positive significant shift in the project counties, which did not take place in the control county. While the attitudes towards the statement “Modern X-rays will usually find the cause of the back pain” did not change neither in the project nor the control county, the disagreement towards the statement “Everyone with back pain should have an spine X-ray” increased by 30% in the project counties (p=0.000).
The agreement with the statements “Back pain recovers best by itself” increases by 26% (p=0.005) and disagreement with “Bedrest is the mainstay of therapy” by 14% (p=0.000) to a support of 68% in the project counties, while it remained unchanged in the control county. The total sum-score of all statements showed a significant effect of the campaign over time (F=8,62, p=0.000), after controlling for potentially confounding factors.

Conclusion: The study demonstrates a shift towards more optimistic and active attitudes that is comparable to the extensive Australian study in a population exposed to a limited, low budget media campaign.