Effect of information format on intentions and beliefs regarding diagnostic imaging for non-specific low back pain: A randomised controlled trial in members of the public

Sweekriti Sharma; Adrian C. Traeger; Mary O'Keeffe; Tessa Copp; Alexandra Freeman; Tammy Hoffmann; Chris G. Maher

doi:10.1016/j.pec.2020.08.021

Effect of information format on intentions and beliefs regarding diagnostic imaging for non-specific low back pain: A randomised controlled trial in members of the public

Sweekriti Sharma^*, Adrian C. Traeger, Mary O'Keeffe, Tessa Copp, Alexandra Freeman, Tammy Hoffmann, Chris G. Maher

^*Corresponding author for this work

Research output: Contribution to journal › Article › Research › peer-review

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Abstract

Objective: To evaluate the effects of information format on intentions to request diagnostic imaging for non-specific low back pain in members of the public.

Methods: We performed a three arm, 1:1:1, superiority randomised trial on members of the public. Participants were randomised to one of the three groups: a Standard Care Leaflet group (standard information on low back pain), a Neutral Leaflet group (balanced information on the benefits and harms of imaging) and a Nudge Leaflet group (with behavioural cues to emphasise the harms of unnecessary imaging). Our primary outcome was intention to request imaging for low back pain.

Results: 418 participants were randomised. After reading the leaflet, intention to request imaging (measured on an 11-point scale (0 = definitely would not request to 10 = definitely would request) was lower in the Nudge Leaflet group (mean = 4.6, SD = 3.4) compared with the Standard Care Leaflet group (mean = 5.3, SD = 3.3) and the Neutral Leaflet group (mean = 5.3, SD = 3.0) (adjusted mean difference between Nudge and Neutral, −1.0 points, 95%CI −1.6 to −0.4).

Conclusion: Framing information to emphasise potential harms from overdiagnosis reduced intention to request diagnostic imaging for low back pain.

Practice implications: Nudge leaflets could help clinicians manage patient pressure for unnecessary tests.

Original language	English
Pages (from-to)	595-602
Number of pages	8
Journal	Patient Education and Counseling
Volume	104
Issue number	3
Early online date	19 Aug 2020
DOIs	https://doi.org/10.1016/j.pec.2020.08.021
Publication status	Published - Mar 2021

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Effect of information format on intentions and beliefs regarding diagnostic imaging for non-specific low back pain: A randomised controlled trial in members of the publicAccepted author manuscript, 532 KBLicence: CC BY-NC-ND

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title = "Effect of information format on intentions and beliefs regarding diagnostic imaging for non-specific low back pain: A randomised controlled trial in members of the public",

abstract = "Objective: To evaluate the effects of information format on intentions to request diagnostic imaging for non-specific low back pain in members of the public. Methods: We performed a three arm, 1:1:1, superiority randomised trial on members of the public. Participants were randomised to one of the three groups: a Standard Care Leaflet group (standard information on low back pain), a Neutral Leaflet group (balanced information on the benefits and harms of imaging) and a Nudge Leaflet group (with behavioural cues to emphasise the harms of unnecessary imaging). Our primary outcome was intention to request imaging for low back pain. Results: 418 participants were randomised. After reading the leaflet, intention to request imaging (measured on an 11-point scale (0 = definitely would not request to 10 = definitely would request) was lower in the Nudge Leaflet group (mean = 4.6, SD = 3.4) compared with the Standard Care Leaflet group (mean = 5.3, SD = 3.3) and the Neutral Leaflet group (mean = 5.3, SD = 3.0) (adjusted mean difference between Nudge and Neutral, −1.0 points, 95%CI −1.6 to −0.4). Conclusion: Framing information to emphasise potential harms from overdiagnosis reduced intention to request diagnostic imaging for low back pain. Practice implications: Nudge leaflets could help clinicians manage patient pressure for unnecessary tests.",

author = "Sweekriti Sharma and Traeger, {Adrian C.} and Mary O'Keeffe and Tessa Copp and Alexandra Freeman and Tammy Hoffmann and Maher, {Chris G.}",

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Effect of information format on intentions and beliefs regarding diagnostic imaging for non-specific low back pain: A randomised controlled trial in members of the public. / Sharma, Sweekriti; Traeger, Adrian C.; O'Keeffe, Mary et al.
In: Patient Education and Counseling, Vol. 104, No. 3, 03.2021, p. 595-602.

Research output: Contribution to journal › Article › Research › peer-review

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T1 - Effect of information format on intentions and beliefs regarding diagnostic imaging for non-specific low back pain: A randomised controlled trial in members of the public

AU - Sharma, Sweekriti

AU - Traeger, Adrian C.

AU - O'Keeffe, Mary

AU - Copp, Tessa

AU - Freeman, Alexandra

AU - Hoffmann, Tammy

AU - Maher, Chris G.

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N2 - Objective: To evaluate the effects of information format on intentions to request diagnostic imaging for non-specific low back pain in members of the public. Methods: We performed a three arm, 1:1:1, superiority randomised trial on members of the public. Participants were randomised to one of the three groups: a Standard Care Leaflet group (standard information on low back pain), a Neutral Leaflet group (balanced information on the benefits and harms of imaging) and a Nudge Leaflet group (with behavioural cues to emphasise the harms of unnecessary imaging). Our primary outcome was intention to request imaging for low back pain. Results: 418 participants were randomised. After reading the leaflet, intention to request imaging (measured on an 11-point scale (0 = definitely would not request to 10 = definitely would request) was lower in the Nudge Leaflet group (mean = 4.6, SD = 3.4) compared with the Standard Care Leaflet group (mean = 5.3, SD = 3.3) and the Neutral Leaflet group (mean = 5.3, SD = 3.0) (adjusted mean difference between Nudge and Neutral, −1.0 points, 95%CI −1.6 to −0.4). Conclusion: Framing information to emphasise potential harms from overdiagnosis reduced intention to request diagnostic imaging for low back pain. Practice implications: Nudge leaflets could help clinicians manage patient pressure for unnecessary tests.

AB - Objective: To evaluate the effects of information format on intentions to request diagnostic imaging for non-specific low back pain in members of the public. Methods: We performed a three arm, 1:1:1, superiority randomised trial on members of the public. Participants were randomised to one of the three groups: a Standard Care Leaflet group (standard information on low back pain), a Neutral Leaflet group (balanced information on the benefits and harms of imaging) and a Nudge Leaflet group (with behavioural cues to emphasise the harms of unnecessary imaging). Our primary outcome was intention to request imaging for low back pain. Results: 418 participants were randomised. After reading the leaflet, intention to request imaging (measured on an 11-point scale (0 = definitely would not request to 10 = definitely would request) was lower in the Nudge Leaflet group (mean = 4.6, SD = 3.4) compared with the Standard Care Leaflet group (mean = 5.3, SD = 3.3) and the Neutral Leaflet group (mean = 5.3, SD = 3.0) (adjusted mean difference between Nudge and Neutral, −1.0 points, 95%CI −1.6 to −0.4). Conclusion: Framing information to emphasise potential harms from overdiagnosis reduced intention to request diagnostic imaging for low back pain. Practice implications: Nudge leaflets could help clinicians manage patient pressure for unnecessary tests.

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Effect of information format on intentions and beliefs regarding diagnostic imaging for non-specific low back pain: A randomised controlled trial in members of the public

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