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Abstract：
BACKGROUND: Low back pain is still the leading cause of disability and societal burden, with 619 million prevalent cases worldwide in 2020. Most countries produce clinical guidelines to support healthcare professionals in evidence-based care regarding low back pain. However, several studies have identified relatively poor uptake of guidelines. Tailored strategies to facilitate the implementation of guidelines have been argued to increase uptake. This study aimed to develop a contextually tailored implementation programme to enhance evidence-based low back pain care among Danish physiotherapists and chiropractors in primary care.
METHODS: A theory-driven implementation programme development study was conducted using the Behaviour Change Wheel, with high healthcare professional involvement. Data collection included four workshops with seven physiotherapists and six chiropractors from primary care clinics. The development process consisted of [1] establishing a theoretical frame, [2] involving participants, [3] understanding the behaviour, [4] designing the implementation programme, and [5] final implementation programme.
RESULTS: The target behaviours selected (guideline recommendations) for the implementation programme were (i) screening of psychosocial risk factors and (ii) offering patient education. The barriers and facilitators for the selected behaviours were described and linked to intervention functions and behavioural techniques. Finally, the implementation programme comprised five strategies: webinars, e-learning videos, communication exercises, peer learning, and group dialogue meetings. In addition, the programme consisted of implementation support: champions, a physical material folder, a weekly email reminder, a specially designed website and a visit from an implementation consultant. An essential element of the overall programme was that it was designed as a step-by-step implementation process consisting of 16 h of education and training distributed over 16 weeks.
CONCLUSIONS: A programme for implementing low back pain guideline recommendations was developed based on behaviour change theory and four co-design workshops involving healthcare professionals to overcome the contextually identified barriers. A theory-driven approach involving healthcare professionals was useful in identifying relevant target behaviours and tailoring the programme to consider contextual barriers and facilitators for implementation. The effectiveness of the final implementation programme will be evaluated in the project\'s next phase.
BACKGROUND: Central Denmark Region, Registered November 11, 2021, act no. 1-16-02-93-19.
METHODS: A theory-driven implementation programme development study was conducted using the Behaviour Change Wheel, with high healthcare professional involvement. Data collection included four workshops with seven physiotherapists and six chiropractors from primary care clinics. The development process consisted of [1] establishing a theoretical frame, [2] involving participants, [3] understanding the behaviour, [4] designing the implementation programme, and [5] final implementation programme.
RESULTS: The target behaviours selected (guideline recommendations) for the implementation programme were (i) screening of psychosocial risk factors and (ii) offering patient education. The barriers and facilitators for the selected behaviours were described and linked to intervention functions and behavioural techniques. Finally, the implementation programme comprised five strategies: webinars, e-learning videos, communication exercises, peer learning, and group dialogue meetings. In addition, the programme consisted of implementation support: champions, a physical material folder, a weekly email reminder, a specially designed website and a visit from an implementation consultant. An essential element of the overall programme was that it was designed as a step-by-step implementation process consisting of 16 h of education and training distributed over 16 weeks.
CONCLUSIONS: A programme for implementing low back pain guideline recommendations was developed based on behaviour change theory and four co-design workshops involving healthcare professionals to overcome the contextually identified barriers. A theory-driven approach involving healthcare professionals was useful in identifying relevant target behaviours and tailoring the programme to consider contextual barriers and facilitators for implementation. The effectiveness of the final implementation programme will be evaluated in the project\'s next phase.
BACKGROUND: Central Denmark Region, Registered November 11, 2021, act no. 1-16-02-93-19.
摘要：
背景：腰背痛仍然是导致残疾和社会负担的主要原因，2020年全球流行病例为6.19亿。大多数国家/地区都制定了临床指南，以支持医疗保健专业人员进行有关下腰痛的循证护理。然而,几项研究发现，指南的吸收相对较差。有人认为，为促进实施准则而制定的量身定制的战略可以增加吸收。这项研究旨在制定根据上下文量身定制的实施计划，以增强丹麦理疗师和初级保健脊医的循证下腰痛护理。
方法：使用行为变化轮进行了理论驱动的实施方案开发研究，具有高度的医疗保健专业参与。数据收集包括四个讲习班，有来自初级保健诊所的七名物理治疗师和六名脊医。发展过程包括[1]建立理论框架，[2]涉及参与者，[3]了解行为，[4]设计实施方案，和[5]最终实施方案。
结果：为实施计划选择的目标行为（指南建议）是（i）筛查心理社会危险因素和（ii）提供患者教育。描述了选定行为的障碍和促进者，并将其与干预功能和行为技术联系起来。最后,实施方案包括五项战略:网络研讨会，电子学习视频，交流练习,同伴学习，和小组对话会议。此外,该方案包括实施支持:冠军，物理材料文件夹，每周的电子邮件提醒，专门设计的网站和实施顾问的访问。总体方案的一个基本要素是，它被设计为一个逐步实施的过程，包括在16周内分发16小时的教育和培训。
结论：根据行为改变理论和四个由医疗保健专业人员参与的共同设计研讨会，制定了实施腰背痛指南建议的计划，以克服上下文确定的障碍。涉及医疗保健专业人员的理论驱动方法对于确定相关目标行为和调整计划以考虑背景障碍和实施促进者很有用。最终实施方案的有效性将在项目的下一阶段进行评估。
背景：丹麦中部地区，2021年11月11日注册，第号法案。1-16-02-93-19.
方法：使用行为变化轮进行了理论驱动的实施方案开发研究，具有高度的医疗保健专业参与。数据收集包括四个讲习班，有来自初级保健诊所的七名物理治疗师和六名脊医。发展过程包括[1]建立理论框架，[2]涉及参与者，[3]了解行为，[4]设计实施方案，和[5]最终实施方案。
结果：为实施计划选择的目标行为（指南建议）是（i）筛查心理社会危险因素和（ii）提供患者教育。描述了选定行为的障碍和促进者，并将其与干预功能和行为技术联系起来。最后,实施方案包括五项战略:网络研讨会，电子学习视频，交流练习,同伴学习，和小组对话会议。此外,该方案包括实施支持:冠军，物理材料文件夹，每周的电子邮件提醒，专门设计的网站和实施顾问的访问。总体方案的一个基本要素是，它被设计为一个逐步实施的过程，包括在16周内分发16小时的教育和培训。
结论：根据行为改变理论和四个由医疗保健专业人员参与的共同设计研讨会，制定了实施腰背痛指南建议的计划，以克服上下文确定的障碍。涉及医疗保健专业人员的理论驱动方法对于确定相关目标行为和调整计划以考虑背景障碍和实施促进者很有用。最终实施方案的有效性将在项目的下一阶段进行评估。
背景：丹麦中部地区，2021年11月11日注册，第号法案。1-16-02-93-19.
