title: Association between beliefs and care-seeking behavior for low back pain.
abstract: METHODS
  Cross sectional population-based survey.
  
  
  OBJECTIVE
  To investigate the relationship between low back pain (LBP) beliefs and care seeking in LBP.
  
  
  BACKGROUND
  Not all people experiencing LBP seek care for their problem. Consistent predictors of care-seeking behavior seem to be female sex and high perceived disability; the role of beliefs about LBP has not been investigated sufficiently.
  
  
  METHODS
  A questionnaire booklet was mailed to a random sample of 2860 individuals otherwise participating in an epidemiological study of musculoskeletal health. It contained the Back Beliefs Questionnaire (BBQ), the Fear-Avoidance Beliefs Questionnaire (FABQ; physical activity and work scales), and questions about sociodemographics, LBP characteristics, and LBP-related care seeking in the last month ("yes" = visit to specialist, general practitioner, physiotherapist, or other health care practitioner; "no" = none of these). Logistic regression was used to identify whether beliefs made a significant contribution to care-seeking behavior, beyond known predictors conceptualized in the behavioral model of health services use.
  
  
  RESULTS
  A total of 2507 of 2860 (88%) individuals completed the questionnaire; 1071 (43%) reported current LBP, 301 (28%) of which had sought care. In univariate analyses the following were all significantly related to care seeking (all P < 0.01): female sex; increasing age; not working full time; lower income; greater LBP frequency, LBP intensity, and limitations in activities of daily living; worse general health; higher FABQ-Physical Activity, FABQ-Work, and Back Beliefs Questionnaire scores. In multiple regression, female sex (odds ratio [OR], 1.731; 95% confidence interval [CI], 1.174-2.551; P = 0.006), LBP frequency (OR, 1.492; 95% CI, 1.249-1.783; P < 0.0001), limitations in activities of daily living (OR, 1.010; 95% CI, 1.001-1.020; P = 0.037), and high FABQ-Work Scores (OR, 1.025; 95% CI, 1.005-1.044, P = 0.012) contributed significantly to the final model.
  
  
  CONCLUSIONS
  That the odds of seeking care are higher in fear-avoidant individuals, even when controlling for other established predictors, emphasizes the importance of addressing such beliefs during the consultation; public health education programs may serve to underpin the delivery of positive messages, ultimately reducing health care demands.
authors: *Department of Research and Development, Spine Center Division, Schulthess Klinik, Zürich, Switzerland †Winterthur Institute of Health Economics WIG, Zurich University of Applied Sciences, Winterthur, Switzerland; and ‡Department of Work and Organizational Psychology, University of Berne, Berne, Switzerland.
authors: Anne F
authors: AF
authors: Mannion
authors: Simon
authors: S
authors: Wieser
authors: Achim
authors: A
authors: Elfering
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000367:Age Factors; D000368:Aged; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003469:Culture; D005239:Fear; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D017116:Low Back Pain / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D010361:Patients / Q000523:psychology*; D010465:Perception; D012737:Sex Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires