Background
Conceptual framework
Methods
Study design
Setting
Approach
Phase 1: estimating patient activation (quantitative data)
Participants
Data collection
Study instrument
Level | Description |
---|---|
Level 1 | Individuals tend to be passive and feel overwhelmed by managing their own health. They may not understand their role in the care process. |
Level 2 | Individuals may lack the knowledge and confidence to manage their health |
Level 3 | Individuals appear to be taking action but may still lack the confidence and skill to support their behaviours. |
Level 4 | Individuals have adopted many of the behaviours needed to support their health but may not be able to maintain them in the face of life stressors |
Procedures
Sample size and data analysis
Phase 2: identifying barriers and enablers (qualitative data)
Participants
Data collection
Interview guide
Procedures
Data analysis
Phase 3: intervention design
Participants
Procedure
Results
Phase 1—PAM survey
Variable | Mean (SD), N (%) |
---|---|
Age | 49.4 (14.1) |
Gender, women | 125/219 (57.1%) |
Duration of Spine Pain: < 1 year | 44/219 (20.1%) |
> 1 year | 175/219 (79.9%) |
Received Previous Chiropractic Care (yes) | 169/219 (77.2%) |
Medical conditions beside back/neck pain (yes) | 138/218 (63.3%) |
PAM score | 64.5 (12.9) |
PAM Activation Levels: Level 1 | 19/219 (8.7%) |
Level 2 | 33/219 (15.1%) |
Level 3 | 103/219 (47%) |
Level 4 | 64/219 (29.2%) |
Phase 2—interviews
Characteristics of participants interviewed
Key themes identified within relevant domains
Phase 3—intervention design
Self-management-TDF barriers (BCTs) | KT Intervention | Actions |
---|---|---|
Knowledge - Patients believe that they know enough about SMS
Behavioural change techniques:
Information regarding behaviour, outcome.
| - Standardized materials as tools to introduce the concept of SMS | - Context: the majority of patients believe that exercise is the core component of self-management strategies (SMS) - Aim: to introduce and maximize the patients’ knowledge on SMS - Opportunities: • Distribute educational materials to patients summarizing the components of SMS, and emphasizing ways to initiate/sustain life style changes • Webinar to provide information on SMS • Provide information on SMS on social media (e.g. Facebook) |
Environmental Context and Resources - Lack of time to use self-management among patients - Not receiving educational materials
Behavioural change techniques:
(Environmental Changes; Time management)
| - Standardized electronic or printed materials as tools for facilitating the use of SMS - Persuasive communication | - Context: Lack of time is a barrier to using SMS - Aim: helping patients better manage their time to use SMS - Opportunity: • Encouraging patients to seek advice from clinicians/interns on ways to manage their time to be able to use SMS (before going to work/school, at lunch time, going to the gym …) • Provide patients with educational materials (paper based and e-pamphlets) summarizing the key components of self-management • Webinar and videos to provide information on SMS |
Emotion - Feeling of anxiety/ frustrating regarding use SMS
Behavioural change techniques:
(Stress Management, Social support (emotional); Coping strategies)
| - Modeling, demonstration of behaviour by others | - Context: patients stated that they have some anxiety and concern regarding performing therapeutic exercises improperly - Aim: minimizing the anxiety among patients by providing them with materials summarizing the prescribed exercises - Opportunities: • Webinar and videos to provide information about the SMS and to demonstrate home exercises • Having them speak to other patients who have been successful ✓ create a patient video to share stories on successful strategies on how to integrate SMS into daily schedule |
Memory, attention & decision making - Few patients were not involved in the decision making - Remembering to do SMS is challenging
Behavioural change techniques:
planning/implementation; Prompts/Triggers/Cues; Motivational Interviewing
| - Persuasive communication and information regarding behavioural outcomes - Provision of information - Instructions - Reminders | - Context: Some patients were not involved in the decision making process. Many patients have difficulty in remembering the SMS components - Aim: to facilitate the involvement of patients in the decision making process, and to remind patients about the use of SMS - Opportunities: • Distribute educational/instructional materials to patients to facilitate the shared decision making • Encourage patients to be actively involved in the decision making process by using the principles of BAP • Webinar to provide suggestions on ways of implementing SMS • Social media to provide information on SMS • Send patients reminders to use SMS via: ▪ E-mail ▪ Phone call (ex. when confirming next appointment) |
Behavioural Regulation - Some patients don’t use SMS as much as they should
Behavioural change techniques:
planning/implementation; Prompts/Triggers/Cues
| - Reminders - Persuasive communication | - Context: Some patients do not use SMS as often as they should - Aim: to understand why they don’t and motivate patients to use SMS more regularly - Opportunities: • Encourage clinicians/interns to help patients form a SMART plan to self-manage • Encourage patients to put Post-it notes near their computer, automated recalls on their cell phone and/or lap-top • Send patients reminders to use SMS via: ▪ E-mail ▪ Phone call |
Key TDF domains (phase 2) and proposed KT intervention components (phase 3)
Self-management-TDF barriers | Description | Proposed KT intervention |
---|---|---|
Knowledge - Patients believe that they know enough about SMS | - Context: the majority of patients believe that exercise is the core component of self-management strategies (SMS) | • Distribute educational materials to patients summarizing the components of SMS, and emphasizing ways to initiate/sustain life style changes • Webinar to provide information on SMS • Provide information on SMS on social media (e.g. Facebook) |
Environmental Context and Resources - Lack of time to use self-management among patients - Not receiving educational materials | - Lack of time was a barrier to using SMS | • Encourage patients to seek advice from clinicians/interns on ways to manage their time to be able to use SMS (before going to work/school, at lunch time, going to the gym …) • Provide patients with educational materials (paper based and e-pamphlets) summarizing the key components of self-management • Webinar and videos to provide information on SMS |
Emotion - Feeling of anxiety/ frustration regarding use SMS | - Patients stated that they have some anxiety and concern regarding performing therapeutic exercises adequately | • Webinar and videos to provide information about the SMS and to demonstrate home exercises • Have patients speak to other patients who have been successful ✓ create a patient video to share stories on successful strategies on how to integrate SMS into daily schedule |
Memory, attention & decision making - Few patients were not involved in the decision making - Remembering to do SMS is challenging | - Some patients were not involved in the decision making process. Many patients had difficulty in remembering the SMS components | • Distribute educational/instructional materials to patients to facilitate the shared decision making • Encourage patients to be actively involved in the decision making process by using the principles of BAP • Webinar to provide suggestions on ways of implementing SMS • Social media to provide information on SMS • Send patients reminders to use SMS via: ▪ E-mail ▪ Phone call (ex. when confirming next appointment) |
Behavioural Regulation - Some patients don’t use SMS as much as they should | - Some patients did not use SMS as often as they should | • Encourage clinicians/interns to help patients form a SMART plan to self-manage • Encourage patients to put Post-it notes near their computer, automated recalls on their cell phone and/or lap-top • Send patients reminders to use SMS via: ▪ E-mail ▪ Phone call |