Abstract

BackgroundRural Nigeria has one of the greatest burdens of low back pain but there are no effective evidence-based interventions to manage it in this population. This paper presents the application of the intervention mapping (IM) approach in the development of a complex behavior change intervention – The Good Back program, aimed at reducing non-specific chronic low back pain (CLBP) disability in rural Nigeria.MethodsThe first four steps of IM were applied. A critical review of the literature, 2 qualitative studies and a population-based cross-sectional study in rural Nigeria helped to identify two key program objectives in order to reduce CLBP disability in this population: reduce the impact of illness perceptions, fear avoidance beliefs, catastrophising, anxiety and depression by targeting maladaptive illness perceptions about CLBP; and facilitate the adoption of exercises and good posture to limit disability. A systematic review plus these studies, identified the personal and environmental determinants of the performance objectives including health literacy, self-awareness, self-efficacy, personal preference, health professional skills, health facility structure and family/community support. The theory, techniques and strategies for modifying personal and environmental determinants were also identified from these studies. Intervention components and materials were then produced for practical application. The initial developed intervention was described.ResultsThe feasibility and acceptability of the developed program was then tested using a small pragmatic non-randomised controlled study incorporating qualitative exit feedback interviews in a rural Nigerian primary health care centre. The program appeared feasible and acceptable when delivered by a highly trained physiotherapist. There were promising clinical outcomes in disability, pain intensity, illness perceptions, fear avoidance beliefs and pain medication use. Suggestions for program improvement included shorter but ongoing sessions, video demonstration of exercises/good posture, spacious exercise/demonstration rooms, and community legitimisation of exercise as treatment for back pain. Subsequent modifications to program content and delivery were then described. Theoretical modification included the addition of aspects of the social cognitive theory to the Leventhal’s self-regulatory model of illness cognitions.ConclusionsIM appears to be a suitable framework for designing complex behavior change interventions in rural Nigeria. The need for further testing of the intervention was highlighted.

Highlights

  • Rural Nigeria has one of the greatest burdens of low back pain but there are no effective evidencebased interventions to manage it in this population

  • intervention mapping (IM) appears to be a suitable framework for designing complex behavior change interventions in rural Nigeria

  • The usual care group did not receive any intervention and were allowed to take up treatments they would normally use without interference since the aim of the study was to compare the feasibility and outcome of the program when compared with usual care [45]

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Summary

Introduction

Rural Nigeria has one of the greatest burdens of low back pain but there are no effective evidencebased interventions to manage it in this population. Nigeria appears to have one of the greatest burdens of chronic low back pain (CLBP) in the world This is in rural Nigeria with a 1-year prevalence rate reaching up to 85%, a much higher figure than the 39% in urban Nigeria [7, 8]. Despite this significant burden and impact, there are no evidence-based interventions for the management of CLBP in rural Nigeria. Evidence-based clinical guidelines for CLBP recommend the adoption of a biopsychosocial framework incorporating self-management, exercises and psychological treatment such as cognitive behavioral therapy – CBT [9]

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