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13 Effect of three types of information leaflets on intention to undergo diagnostic imaging for non-specific low back pain: a randomised controlled trial in patients and the general public
  1. Sweekriti Sharma1,2,
  2. Adrian Traeger1,2,
  3. Mary O’Keeffe1,2,
  4. Tessa Copp3,
  5. Alexandra Freeman4,
  6. Chris Needs5,
  7. Tammy Hoffman6,
  8. Bethan Richards5,
  9. Chris Maher1,2
  1. 1Institute for Musculoskeletal Health, Sydney, Australia
  2. 2Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
  3. 3The University of Sydney, Sydney, Australia
  4. 4Winton Centre for Risk and Evidence Communication, University of Cambridge, Cambridge, UK
  5. 5Royal Prince Alfred Hospital, Sydney, Australia
  6. 6Bond University, Queensland, Australia


Background Shared decision-making can reduce the uptake of some unnecessary tests and procedures. Although awareness of shared decision-making is increasing, overuse of diagnostic tests for common clinical conditions, such as low back pain, remains high. Recent public health campaigns, such as the ‘Choosing Wisely’ Initiative, attempt to persuade consumers to avoid unnecessary tests, rather than provide neutral information on benefits and harms. It is unclear whether persuasive information materials can influence perceptions of imaging tests more than neutral materials, and whether such public health approaches could have unintended consequences (e.g. decision regret).

Objective To evaluate the effect of different types of information leaflets on public perceptions of imaging for low back pain.

Design Randomised online experiment.

Setting Community (online) and 1 tertiary hospital.

Participants 360 members of the general public (recruited via Facebook) with or without low back pain, who have been asked to imagine they have experienced a severe episode of low back pain. Recruitment of the general public sample is due for completion in March 2019. We are also purposively sampling patients attending the back-pain outpatient clinic of a large tertiary hospital, who are being interviewed about the leaflets.

Intervention We are randomising participants to read one of the three leaflets on their computer screen, tablet, or smart phone: (i) Control leaflet: guideline information (ii) Neutral leaflet: balanced information on benefits/harms of imaging (iii) Persuasive leaflet: information biased towards harms of imaging. Immediately after reading the leaflet participants complete an online survey.

Outcome measures Intention to undergo imaging for low back pain (primary outcome measure). Secondary outcome measures include beliefs about necessity of imaging, usefulness of leaflet, knowledge, worry, harms, satisfaction with decision, decision regret.

Results The study is underway and due for completion in April 2019. We will present results in full at the conference.

Conclusion This study will be the first to compare the impact of information leaflets designed for a public health campaign about unnecessary imaging of low back pain. The data will inform future development of public health resources and shared decision-making interventions.

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