Table 1 Learning goals and learning activities of the clinician course based on the COM-B model
COM-B TDF domains | Learning goals | Learning Activity (Interventions) | Evaluation tools |
|---|---|---|---|
Motivation | |||
Social/professional role and identity | Clinicians perceive their role in ensuring high-quality care as important | A ‘state-of-the-art’ lecture including an overview of the evidence on the burden of back pain, the prognosis of back pain and the call for non-pharmacological, non-surgical interventions in clinical guidelines (Ed) | DIBQ (Social influences) |
Beliefs about capabilities | Clinicians feel confident that they are able to deliver GLA:D Back | Reinforcement that most of the skills needed are pre-exiting among educated clinicians (Ed) Group exercises focused on practising delivery of key messages of the patient education. Participants take turns in playing the roles of the teaching clinician and mentor. A scoring guide (rubric) is used to facilitate feed-back (En, T) Clinicians receive the patient education content as a slideshow with manuscript, exercise programs and handouts containing examples of language to be used in delivering key messages (En) | Practitioner Confidence Scale DIBQ (Skills, Knowledge, Beliefs of capabilities) |
Optimism | Clinicians believe that GLA:D Back will add value | A recording of a patient interview providing a patient’s views on what was gained from taking part in GLA:D Back (P) Posters placed at the course venue with quotes from clinicians and patients who have experienced GLA:D Back (P) | DIBQ (Beliefs about consequences) |
Beliefs about consequences | Clinicians agree with a need for standardised evidence-based back pain care Clinicians have positive attitudes towards a behavioural model for back pain treatment | Presentation of facts about the adoption of GLA:D knee and hip and the achieved political agreements for integrating GLA:D in disease management programs with reduced out-of-pocket expenses (Ed, I, M) Lecture about ‘state-of-the-art’, pain mechanisms, the evidence-base for GLA:D Back and the hypothesised mechanisms of action (Ed) Presentation of patient outcomes and statements from clinicians about experiences with GLA:D Back (P, I) A recording of a patient interview providing a patient’s views on what was gained from taking part in GLA:D Back (P) | DIBQ (Beliefs about consequences, Patients, Innovation) The Pain Attitudes and Beliefs Scale |
Intentions | Clinicians intend to offer GLA:D Back in their clinics | Facilitated group discussion about practical organisation with examples of solutions from test-sites (M) Participants documenting a plan on when, where, who, and how to initiate the GLA:D Back-program in their clinic (P, En) | DIBQ (Behavioural regulation, Intentions) Intended time point for starting the first GLA:D Back-group |
Reinforcement | Clinicians are aware that GLA:D for hip and knee has been well received by physiotherapists, patients, general practitioners and politicians | Presentation of facts about the spread of GLA:D knee and hip, the patient outcomes, and the achieved political agreements for integrating GLA:D in disease management programs with reduced out-of-pocket expenses (Ed, I, M) | Not measured |
Emotion | Clinicians appreciate the value of being a GLA:D Back instructor | A recording of a patient interview providing a patient’s views on what was gained from taking part in GLA:D Back (I) | Not measured |
Capability | |||
Knowledge | Clinicians know current recommendations for treatment of back pain Clinicians know the GLA:D Back approach to support patients’ self-management Clinicians know why SMART value-based goals are used | A ‘state-of-the-art’ lecture including an overview of the content of clinical guidelines on treatment (Ed) A lecture on the patient education that links the content of GLAD Back to self-efficacy (Ed) A lecture about value-based goals, demonstration of web-tool for goal registration, examples from the pilot (Ed, T, I) | DIBQ: Knowledge |
Skills | Clinicians can identify relevant patients for the program Clinicians can deliver the key messages of the patient education Clinicians can support patients in identifying goals Clinicians know how to perform the exercises in the program Clinicians can apply knowledge of the non-structural pain model in the supervision of exercises Clinicians can supervise exercises in a manner that helps patients explore movement Clinicians can enter data in the database | Definition of the target group for the clinical intervention (Ed) Provision of examples of explaining back pain using the educational material (T) Provision of examples of questioning technique for identifying goals (T) Instructions on how to perform Texercises in the program (T) Group exercises focused on practising the delivery of central messages of the patient education. Participants take turns in playing the roles of the clinician teaching and the patients with diverse issues and worries (En) Exercise based on video cases to practice how messages from the patient education are used in the instruction of exercises. A scoring guide (rubric) is used to facilitate the evaluation of cases (En) A lecture on using the digital platform to enter data (Ed) | Enrolled patients report long-lasting or recurrent LBP and have similar profiles across clinicians Delivery of central messages (patient reported) Use of individual goals registration in the registry DIBQ: Skills, beliefs about capabilities Clinicians use the register |
Behavioural regulation (action planning, breaking habits) | Clinicians know how to get started with GLA:D Back | Clinicians documenting a plan for when, where and how to start their first GLA:D Back-group and discuss their plan in groups (En) A lecture on using the digital platform to enter data (Ed) Following the course, access to educational materials, exercise programs and instructions for clinical tests are available online. Clinicians have access to the technical support and to the research team for guidance when questions arise (En) | Patients are enrolled in and complete the GLAD programme |
Opportunity | |||
Environmental context and resources | Clinicians know that the programme does not require high-tech equipment | Emphasising the use of low-tech equipment while delivering the GLA:D programme throughout the course and demonstrating this when teaching the exercises (E, En) | DIBQ (knowledge) |
Clinicians see how the programme can fit into existing routines and payment structures | Workshop where clinicians share experiences with implementing back programs and are able to ask questions of expert clinician | DIBQ (knowledge) | |