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Barriers and facilitators to patient uptake and utilisation of digital interventions for the self-management of low back pain: a systematic review of qualitative studies.


Malene Jagd Svendsen

Karen Wood Wood

John Kyle


Louise Fleng Sandal

Mette Jensen Stochkendahl

Frances S. Mair

Barbara I. Nicholl


Objectives: Low back pain (LBP) is a leading contributor to disability globally. Self-management is a core component of LBP management. We aimed to synthesise published qualitative literature concerning digital health interventions (DHIs) to support LBP self-management to: (1) determine engagement strategies, (2) identify barriers and facilitators affecting patient uptake/utilisation and (3) develop a preliminary conceptual model of barriers and facilitators to uptake/utilisation. Design: Systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data sources: MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, DoPHER, TRoPHI, Web of Science and OT Seeker, from January 2000 to December 2018, using the concepts: LBP, DHI and self-management. Eligibility criteria: Peer-reviewed qualitative study (or component) examining engagement with, or barriers and/or facilitators to the uptake/utilisation of an interactive DHI for self-management of LBP in adults (community, primary or secondary care settings). Data extraction and synthesis: Standardised data extraction form was completed. COREQ (Consolidated criteria for Reporting Qualitative research) checklist was used to assess methodology. Data was synthesised narratively for engagement strategies, thematically for barriers/facilitators to uptake/utilisation and normalisation process theory was applied to produce a conceptual model. Results: We identified 14 191 citations, of which 105 full-text articles were screened, and five full-text articles from four studies included. These were from community and primary care contexts in Europe and the USA, and involved 56 adults with LBP and 19 healthcare professionals. There was a lack of consideration on how to sustain engagement with DHIs. Examination of barriers and facilitators for uptake/utilisation identified four major themes: IT (information technology) usability–accessibility; quality–quantity of content; tailoring–personalisation; and motivation–support. These themes informed the development of a preliminary conceptual model for uptake/utilisation of a DHI for LBP self-management. Conclusions: We highlight key barriers and facilitators that should be considered when designing DHIs for LBP self-management. Our findings are in keeping with reviews of DHIs for other long-term conditions, implying these findings may not be condition specific.


SVENDSEN, M.J., WOOD, K.W., KYLE, J., COOPER, K., RASMUSSEN, C.D.N., SANDAL, L.F., STOCHKENDAHL, M.J., MAIR, F.S. and NICHOLL, B.I. 2020. Barriers and facilitators to patient uptake and utilisation of digital intervientions for the self-management of low back pain: a systematic review of qualitative studies. BMJ open [online], 10(12), article ID e038800. Available from:

Journal Article Type Article
Acceptance Date Nov 23, 2020
Online Publication Date Dec 12, 2020
Publication Date Dec 31, 2020
Deposit Date Jan 5, 2021
Publicly Available Date Jan 5, 2021
Journal BMJ open
Print ISSN 2044-6055
Electronic ISSN 2044-6055
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 10
Issue 12
Article Number e038800
Keywords Back pain; Health informatics; Pain management; Qualitative research
Public URL