A community health-coaching referral program following discharge from treatment for chronic low back pain – a qualitative study of the patient’s perspective

Abstract

Abstract Background: Global policy and guidelines for low back pain (LBP) management promote physical activity and self-management and yet adherence is poor and a decline in outcomes is common following discharge from treatment. Health coaching has been found to be effective at improving exercise adherence, self-efficacy, and social support in individuals with chronic conditions, and may be an acceptable, cost-effective way to support people in the community following discharge from treatment for LBP. Aim: This qualitative study aimed to understand the aspects of a community over-the-phone health-coaching program, that were liked and disliked by patients as well as their perceived outcomes of the service after being discharged from LBP treatment. Methods: A purposive sampling approach was used to recruit 12 participants with chronic LBP, from a large randomised controlled trial, who were randomly allocated to receive a health coaching program from the Get Healthy Service® in Australia. Semi structured interviews were conducted, and a general inductive content analysis approach was taken to create a framework from the data. Results: Participants discussed positive and negative aspects of the health coaching that they found to be empowering and confidence building or disappointing and frustrating. The main themes uncovered from the interviews included the importance of the health coach, the value of goal setting, the quality of the advice received, the benefits of feeling supported, the format of the coaching service, and LBP specific knowledge. The participants reported the health coach and the coaching relationship to be the primary factor that influenced the program outcomes and the qualities of the coaching relationship they valued most were connection, communication, care, and competence. Clinical Implications: In an environment where self-management and self-care are becoming increasingly important, understanding the patient’s experience as part of a coaching program is likely to lead to improved quality of health coaching care, more tailored service delivery and potentially more effective and cost-effective community-based care for individuals with chronic LBP in the community after being discharged from treatment. Trial Registration: The GBTH trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000889954) on 10/9/2020. Ethical approval was prospectively granted by the Western Sydney Local Health District Human Research and Ethics Committee (2020/ETH00115). Written informed consent was obtained from all participants. The relevant sponsor has reviewed the study protocol and consent form.