Department of Medical Rehabilitation, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria (Enugu Campus), Nsukka, Nigeria.
Department of Physiotherapy, Faculty of Life Sciences and Medicine, School of Population Health Sciences, King's College London, London, SE1 1UL, UK.
BMC Public Health. 2020 Mar 17;20(1):343. doi: 10.1186/s12889-020-8392-7.
Rural 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.
The 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.
The 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.
IM 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.
尼日利亚农村地区的腰痛负担最大，但针对该人群，目前尚无有效的循证干预措施。本文介绍了干预映射（IM）方法在开发一种复杂行为改变干预措施-“好背”计划中的应用，该计划旨在减少尼日利亚农村地区非特异性慢性腰痛（CLBP）的残疾。
应用干预映射的前四个步骤。对文献进行了批判性回顾，在尼日利亚农村进行了两项定性研究和一项基于人群的横断面研究，有助于确定两个关键的项目目标，以减少该人群的 CLBP 残疾：通过针对关于 CLBP 的不良疾病观念，减少疾病观念、回避恐惧信念、灾难化、焦虑和抑郁对疾病的影响；并促进采用运动和良好姿势来限制残疾。系统评价加上这些研究确定了个人和环境决定因素的表现目标，包括健康素养、自我意识、自我效能、个人偏好、健康专业技能、卫生设施结构和家庭/社区支持。还从这些研究中确定了改变个人和环境决定因素的理论、技术和策略。然后为实际应用制作了干预组件和材料。描述了最初开发的干预措施。
然后，在尼日利亚农村初级保健中心的一项小型实用非随机对照研究中，结合定性退出反馈访谈，测试了该计划的可行性和可接受性。当由一位受过高度训练的物理治疗师进行时，该计划似乎是可行且可接受的。在残疾、疼痛强度、疾病观念、回避恐惧信念和止痛药物使用方面，结果有了可喜的改善。对计划改进的建议包括更短但持续的课程、锻炼/良好姿势的视频演示、宽敞的锻炼/演示室，以及社区认可锻炼作为腰痛的治疗方法。随后描述了对计划内容和交付的修改。理论修改包括将社会认知理论的某些方面添加到莱文索尔的疾病认知自我调节模型中。
IM 似乎是为尼日利亚农村设计复杂行为改变干预措施的合适框架。强调了对干预措施进行进一步测试的必要性。
