Efeito de materiais digitais de educação em dor lombar nas crenças e atitudes sobre esta condição de indivíduos da comunidade: ensaio controlado aleatorizado

Abstract

Considering the great impact of low back pain (LBP) on the individual’s functioning and society's economy, addressing beliefs and attitudes in the community is one of the proposed actions to improve coping with this health condition. In accordance with the biopsychosocial model of pain care, beliefs constitute a modifiable factor that can aid in the pain and disability management, thereby favoring behavioral aspects as the deliberate utilization of health resources and self-management. Education can lead to changes in pain beliefs, and social networks can help disseminate reliable content, confronting misinformation about the topic. To the authors' knowledge, there is a gap in understanding the effect of digital LBP education material on changes in related beliefs and attitudes. This dissertation had the main objective to verify the effect of exposure to a set of evidence-based digital LBP education material on beliefs and attitudes about LBP in the community. All stages of this survey were conducted on electronic environment (REDCap®), with a convenience sample of 448 Brazilians, over 18, with or without LBP. The primary outcome was beliefs and attitudes about LBP (Back Pain Attitudes Questionnaire), and the secondary outcomes were self-efficacy to cope with pain (Pain Self-efficacy Questionnaire), and electronic health literacy (eHealth Literacy Scale). The research resulted in three products. Product 1 made it possible to registrate the randomized controlled trial protocol, describing methodology, statistical planning, and the project development on REDCap®. Product 2 described, on a cross-sectional design, the mean beliefs and attitudes about LBP among Brazilians (-10.8; ±13.9), and compared the means of those with and without LBP. The significant difference, favored the group without LBP. In a multiple regression model, having family income greater than two minimum wages (β standardized=0.42; 0.32; 0.40 related to different categories), being female (β standardized=0.26) and having higher eHealth literacy (β standiardized=0.23) were directly associated with beliefs and attitudes about LBP, while age was inversely associated (β standardized=-0.15). Product 3 demonstrated the trial findings. The digital LBP education material promoted favorable changes in beliefs and attitudes, immediately post-intervention, when compared with a digital education material on general health habits (MD=-7.94; Standard Error=1.84; p<0.001). However, this effect was not sustained after eight weeks (MD=-4.52; Standard Error=1.73; p=0.097). There was no effect of the material to change self-efficacy. Furthermore, the eHealth literacy and self-efficacy were not associated with the changes in beliefs immediately after the intervention. The results of this dissertation are innovative, as there were no data of beliefs and attitudes about LBP from the general Brazilian community, and as this was the first experimental study worldwide to verify the effect of a digital LBP education material for social media in beliefs and attitudes about LBP, encompassing individuals with and without LBP. The findings are limited to immediate effects, but it is possible to consider the implementation of integrated strategies involving the community, researchers, healthcare professionals and policymakers to explore the permanence of the effect and possible behavioral changes that reduce the burden of LBP on society.