Competences to self-manage low back pain among care-seeking adolescents from general practice - a qualitative study

Prior to seeking care many adolescents used over-the-counter pain medicine as a first step to self-manage their pain although this approach had short lasting or no effect on their pain. Over-the-counter pain medicine was used frequently and for long periods among the sport active adolescents which aligns with the findings in a recent review on the use of over-the-counter pain medicine among adolescents [17]. With problem solving being one of the 5 core-skills of self-management [12] our findings indicate that care-seeking adolescents with LBP need alternative strategies when trying to self-management.

This is important as we further uncovered a general desire among the adolescents to self-manage their condition with guidance from a health care provider. However, our findings indicate that poor communication and the feeling of not being taken seriously among the adolescents may severely hamper the possibility to form productive partnerships. The adolescents point to this as especially problematic in situations where their treatment courses are discontinued without being advised on a possible next step. In these situations, the adolescents felt that the health care providers gave up on them despite their young age. This reaction from the adolescents indicate that they did not have the required knowledge to make a decision for their future treatment course on their own. This is problematic as both being able to make a decision and forming partnerships with health care providers are vital components when self-managing a condition [12].

Communication barriers between adolescent patients and health care providers have previously been highlighted however, here the problem often relates to the adolescents’ underdeveloped abilities to communicate, make informed decisions, and assess potential threats [18]. Nevertheless, this standpoint is somewhat fixed and offers no solution. In a recent viewpoint by Pate and colleagues, the authors highlight the importance of not assessing adolescents LBP patients as adult patients [19]. The authors especially encourage health care providers to prioritize listening to the adolescents’ narrative and to ask open-ended questions such as “Tell me about why you have come to see me today?” [19]. With health care providers recognizing the need for an individually tailored approach to assessing adolescents with LBP, communication between the two parties is likely to improve [18, 19].

Acknowledging the importance of communication when managing LBP among care-seeking adolescents is vital to foster a mutually beneficial partnership between the health care provider and the adolescent. This may be especially true to prevent that some adolescents feel they are not being taken serious or in worst case experience distrust from their health care provider during the consultation. Also, it is important to recognizing adolescent LBP as more than a purely biomechanical conditions. The adolescent informants in the current study expressed both frustration and irritation towards their pain experience indicating the presence of a psychological component. This is in line with current evidence regarding the experience of adolescent LBP [20].

This study was initiated during the COVID-19 pandemic and therefore all interviews were undertaken online through Microsoft Teams or through telephone calls. This approach made it possible to interview adolescents from all of Denmark as transportation or COVID-19 was not a barrier for participating. However, the online format may have influenced the interview process due to the lack of physical presence between the adolescent and the interviewer. A counter argument would be that the online format gave the adolescents the possibility to participate from a remote location of their choosing, without the pressure of visiting a university or having to invite a foreign person (the interviewer) into their home. Instead, the adolescents could interact with interviewer at a distance through the computer or phone. One limitation is that two interviews were conducted over the phone. This approach was used as there was technical issues with using Microsoft Teams. From this alternative approach it was not possible to take field notes as described in the section of data collection instruments and technologies. As such, the conducting the two interviews in question over the phone was the best possible options at the time. As the duration of the interviews in general were short, this may pose and additional limitation. However, with a limited number of interview studies in this specific research area, is it difficult to estimate how long and interview should last. In a previous study by Lauridsen and colleagues, the authors recruited children between 9 and 12 years of age from two public schools in Denmark and interviews them about what they considered to be important consequences of having LBP [21]. In this study, the interviews lasted between 15 and 30 min [21]. As the informants in that study was younger than the once in the current study, the discrepancy between the duration of the interviews may reflect the age of the informants and the content of the interview guide. Lastly, the small number of informants may be considered a limitation of the current study. However, as previously described, data saturation was reached after the 8th interview as no new themes or sub-themes arose during the remaining two interviews. A similar approach in was used in the study by Lauridsen and colleagues [21]. In relation, based on the semantic and latent analysis we believe that the 10 adolescent informants were an adequate sample to answer the present research question. A major strength is the inclusion of adolescents who had recent contact with a health care provider and functional limitations as this made it possible for us to gain insight into the level of health literacy and self-management skills among care-seeking adolescents with LBP.