'TEXT4MYBACK' - the development process of a self-management intervention delivered via text message for low back pain

Abstract

Purpose: To systematically develop a bank of text messages designed to provide a lifestyle-focused intervention for people with low back pain seeking care from pharmacists. The intervention is based on the provision of advice, motivation, and behaviour change support. Methods: The iterative development process consisted of 3 phases: (i) Concept development phase: this first phase consisted of a pre-development meeting with researchers, consumer advocates and clinicians with specific knowledge of low back pain. The key domains considered to be important for this patient demographic, the sources of content for the key messages and the volume and timing of messages considered acceptable were identified in two 2-hour workshops. (ii) Content development phase: the second phase was completed by a team of writers and based on recent evidence (Lancet Series on Low Back Pain; the NICE guidelines for low back pain; Chartered Society of Physiotherapy consumer information; and the Manage your pain consumer guide developed by Musculoskeletal Australia). Six domains were identified: exercise, education, mood, sleep, use of care and medication. Moreover, each of them had one of three aims: education, motivation or behavioural change. (iii) Writing phase: a bank with 86 draft messages was developed and each message was meant to convey one of the six domains. The theoretical basis of the messages was the behaviour change technique, which included: provision of information and encouragement; prompting about consequences, intention formation, monitoring self-behaviour, and barrier identification; advice about setting graded tasks; and strategies aimed at relapse prevention and the use of prompting and cues. Results: After the bank was developed, all the messages were reviewed by a researcher with expertise in behavioural change and text messages. This was followed by 2 other review phases: (i) Expert review phase: the expert review panel members were identified by the investigators as key opinion leaders and clinicians in the field of low back pain. The review panel comprised a multidisciplinary team including researchers, pharmacists, physiotherapists, GP’s, nurses and clinical psychologist. Each of them reviewed 15 messages, scored them using a 5-item psychometric scale according to the appropriateness of content and likely clinical effectiveness and provided recommendations for improvement. This process ensured that every message was reviewed by a minimum of 2 experts and had an average from 2-10 points. It was established that those messages which received a sum score inferior than 8 points by any reviewer would be changed and improved according to the reviewers’ comments to maximize their quality and likelihood of effectiveness. After that, 29 messages, representing 34% of the bank of drafts, were modified accordingly. The mean score of the bank of messages was of 8.3/10 points. (ii) Consumer review phase: consumers with low back pain were identified by Musculoskeletal Australia and invited to review 15 messages. 12 consumers reviewed and scored the messages using a 5-item psychometric scale according to the utility and understanding of the text content and language acceptability. This process ensured that every message was reviewed by a minimum of 2 consumers and had an average from 3-15 points. They were also asked to provide recommendations for improvement. It was established that those messages receiving a sum score inferior than 12 points by any reviewer would be changed and improved even if their sum score was above 12. There were 36 messages, representing 42% of the bank of drafts, modified accordingly. The mean score of the bank of messages was of 12.5/15 points. Conclusions: A final bank of 86 text messages designed to support lifestyle-focused intervention for patients with low back pain has been developed through a multistep iterative process. The description of this process can provide a scientific support for future development of text message interventions within the musculoskeletal field of research.