DEVELOPMENT OF BACK-ON-LINE<SUP>TM</SUP>, DIGITAL INTERVENTION TO SUPPORT SELF-MANAGEMENT OF LOW BACK PAIN IN WORKPLACE, USING CO-PRODUCTION AND NORMALISATION PROCESS THEORY

H. Amery¹, A. James², M. Madhav³, P. Eslambolchilar³, K. Huysamen⁴, J. Hawkins¹, L. Sheeran²

¹Cardiff University, School of Social Sciences, Cardiff, United Kingdom, ²Cardiff University, School of Healthcare Sciences, Cardiff, United Kingdom, ³Cardiff University, School of Computer Sciences, Cardiff, United Kingdom, ⁴Rail Safety and Standards Board, London, United Kingdom

Background: Low back pain (LBP) is a global leading cause of disability. With prevalence around 52% in workers, LBP is associated with substantial loss of work productivity. Self-management involving physical activity and exercise (PA&E) along with education is the core component of management for the most encountered non-specific LBP. However, integrating self-management to help people adopt PA&E behaviours within workplace is challenging. With employee and employer representatives in Transport for London, we developed, and feasibility tested a work-based digital intervention called BACK-on-LINE^TMto empower workers to adopt PA&E behaviours designed to alleviate back pain in work.

Purpose: To adapt design and features of BACK-on-LINE^TMto ensure implementation and scale-up across the whole of the rail industry in Great Britain (GB rail).

Methods: We applied the first stage of co-production methodology in the form of stakeholder consultation workshops. Participants were recruited via Rail Safety and Standards Board (RSSB) spanning the entire GB rail sector. Two 2-hour online workshops were conducted with: i) GB rail employer representatives in occupational health, human factors, health & wellbeing, line management and union representative and ii) GB rail employees with low back pain. Normalisation Process Theory (NPT) informed discussions to maximise BACK-on-LINE^TMimplementation and scale-up. The workshops explored occupational health pathways, access, and digital resources for self-managing LBP in work. They were facilitated by the same researcher (LS), and were audio-recorded, transcribed, and analysed independently. Thematic analysis was conducted in NVivo with findings from the workshop with employers informing the subsequent workshop with employees.

Results: Workshop participants (n=15) were from across six large GB rail organisations. They included RSSB Musculoskeletal Disorders Group representatives (n=7; occupational health physiotherapists (n=2), nurses (n=2), senior human factors specialist (n=1), union representative (n=1), project safety officer (n=1)), and GB rail employees with LBP (n=9). Several themes were identified, some common and some unique to the employer and employee groups. Both groups recognised LBP as a significant problem in the rail industry and an unmet need for interventions empowering workers to manage LBP in work. Discussions of barriers to self-management involving PA&E led to co-producing technological solutions acceptable to employers and employees. BACK-on-LINE^TMwas subsequently adapted and will be delivered for the next stage of co-production involving usability testing.

Conclusions: This study reports a process of integrating co-production with normalisation process theory to ensure implementation and scale-up of a digital intervention for LBP self-management in work. Engaging with employers and employees separately and across several organisations facilitated an open and unthreatening forum that harnessed knowledge and feedback around individual and organisational barriers and solutions necessary to adapt work-based interventions earlyfor successful implementation, scalability and impact.

Implications: The study findings informed technological adaptation of BACK-on-LINE^TMto maximise its implementation and scalability within GB rail sector and informed outcomes for the next evaluation phase. With ageing populations and high rates of sickness absence, interventions supporting people’s health in workplace are in sharp focus. This research demonstrated value of partnership- and theory-based approaches to develop such interventions allowing for early focus on barriers and co-production of solutions acceptable both to employers and employees.

Funding acknowledgements: Higher Education Funding Council Research Wales Innovation Fund, Impact Catalyst Award

Keywords:
Work based low back pain self-management
Co-production
Normalisation process theory

Topics:
Health promotion & wellbeing/healthy ageing/physical activity
Innovative technology: information management, big data and artificial intelligence
Musculoskeletal: spine

Did this work require ethics approval? Yes

Institution: Cardiff University

Committee: The School Of Healthcare Sciences Research Ethics Committee (SREC), Cardiff University

Ethics number: SREC reference: REC848