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W1.2

Title: Understanding the characteristics of effective public health interventions for back pain and methodological challenges in evaluating their effects

Authors and affiliation: Rachelle Buchbinder 1, Douglas Gross 2, Erik L. Werner 3, Jill Hayden 4

1 Department of Clinical Epidemiology at Cabrini Hospital and Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
2 Department of Physical Therapy, University of Alberta, Edmonton, Canada
3 Department of Research and Development, The Hospital of Rehabilitation, Stavern, Norway
4 Department of Health Policy, Management & Evaluation, University of Toronto, Institute for Work & Health, Toronto, Canada

Email address: rachelle.buchbinder@med.monash.edu.au

Introduction: Public health interventions designed to alter societal views about back pain may be a highly effective method for reducing the overall burden of illness associated with low back pain. For example a population-based media campaign that took place in Victoria, Australia between 1997 and 1999 resulted in significant improvements in both community and primary care physicians’ beliefs, accompanied by a decline in number of workers compensation back claims and health utilization over the duration of the campaign. These results have since encouraged other countries, including Canada, Norway and Scotland to adopt similar public health campaigns in their own settings. However, while mass media interventions are an established strategy for delivering preventive health messages, there is limited empirical understanding of the characteristics of effective (or ineffective) health campaigns and in many instances these have been implemented without inclusion of high quality evaluation strategies to guide others contemplating such an approach.
Objective: The aim of this workshop will be to 1) formulate a theoretical framework for designing public health interventions for back pain; 2) identify and discuss methodological issues that confront researchers in evaluating these interventions using the Cochrane Effective Practice and Organisation of Care Review Group (EPOC) checklist of items to consider when reviewing an evaluation; and 3) set priorities for future research in this area.

Methods / content: Specific discussion (and consensus) around a theoretical framework for designing public health interventions for back pain would include, for example, deliberation of what are the best messages/ messengers/ media (and additional interventions)?; what should the intensity, frequency and duration of the intervention be?; what is the rationale for the intended effect of the intervention?; who is the target audience?; what are the best outcomes?; and how applicable are public health interventions to different settings? Several of the authors have been involved in designing an evaluation strategy of a mass media campaign for back pain and descriptions of these campaigns will be used as a basis for opening the discussion. Based upon their experiences they will also identify the key methodological issues that they needed to addressed in planning their evaluations. For example, as mass media campaigns are typically undertaken at a population level, strict randomized control trials are not feasible and alternate evaluation strategies such as interrupted time series or other quasi-experimental methodologies are more relevant. The EPOC checklist which includes consideration of these strategies will be used as a basis for systematically considering standardised methods, where practical, for evaluating public health interventions for back pain and reporting the results. A draft discussion paper will be circulated to conference participants and/or selected international back experts prior to the conference for comments and presented at the workshop for discussion and revision. This workshop will provide a timely opportunity for researchers interested in the public health approach to back pain to further our understanding of the issues and set priorities for future research.