Capabilities, opportunities and motivations in implementing guideline-oriented biopsychosocial low back pain management: perceptions of occupational healthcare professionals after an educational intervention

Abstract

Background: We explored Finnish occupational healthcare professionals’ (HCP) perceptions of biopsychosocial (BPS) low back pain (LBP) management after an educational intervention. Methods: We conducted twelve group interviews of 51 physicians, physiotherapists and nurses from intervention units in a cluster randomized controlled trial (ISRCTN11875357). We used deductive and inductive content analysis to examine the data, and the Capability-Opportunity-Motivation-Behaviour (COM-B) model to identify the facilitators of and barriers to changes in three target behaviours: (A) forming a common BPS-based understanding with patients, (B) systematically using risk stratification tools, and (C) multidisciplinary collaboration in individualized care planning. Results: Facilitators and barriers were categorized into the following COM-B domains. Most of the facilitators were in the Capability and Motivation domains: increased confidence regarding managing treatment decisions, improved therapeutic alliance and renewed professional identity. Significant system-level barriers were mostly in the Opportunity domain: time constraints, limited resources and unclear treatment pathways. The HCPs reported improved individual skills and awareness after the training, but varying organizational policies and lacking incentives hindered the adoption of BPS methods in multidisciplinary teams. Initial resistance to change decreased as positive patient outcomes emerged. The perceived benefits were increased multidisciplinary collaboration and a shift toward holistic pain management. Those who embraced BPS management reported greater professional satisfaction and confidence when handling LBP patients. Conclusions: To effectively implement BPS management in occupational health services, organizational and system-level barriers must be addressed and HCPs’ skills and motivation enhanced. For sustained support through policy initiatives and reinforced multidisciplinary collaboration, future strategies should integrate BPS practices into routine workflows. Trial registration: The trial was retrospectively registered on 13.05.2019 ISRCTN11875357.