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Peer-reviewedCC BY-NCPublic Health Research & Practice

An integrated Healthy Lifestyle Program (HeLP) and physiotherapy care for low back pain: a mixed methods process evaluation

  • Emma K. Mudd1
  • Cassandra Lane2
  • Jenna L. Hollis2
  • Steven J. Kamper3
  • Rebecca Hodder2
  • Priscilla Viana Da Silva2
  • Simon R. E. Davidson
  • Connor Gleadhill4
  • Bruce Donald5
  • Damien Smith5
  • Christopher M. Williams6
6 affiliations
  1. 1ASchool of Health Sciences, University of Sydney, Camperdown, NSW 2050, Australia.BUniversity Centre for Rural Health, Lismore, NSW 2480, Australia.CHunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW 2287, Australia.
  2. 2CHunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW 2287, Australia.DSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia.EPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia.
  3. 3ASchool of Health Sciences, University of Sydney, Camperdown, NSW 2050, Australia.FNepean Blue Mountains Local Health District, Penrith, NSW 2750, Australia.
  4. 4DSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308, Australia.
  5. 5GJohn Hunter Hospital Outpatient Services, New Lambton Heights, NSW 2305, Australia.
  6. 6ASchool of Health Sciences, University of Sydney, Camperdown, NSW 2050, Australia.BUniversity Centre for Rural Health, Lismore, NSW 2480, Australia.HResearch and Knowledge Translation Directorate, Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia.
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Abstract

Objectives and importance of studyIntegrated lifestyle and low back pain care is a novel treatment approach. This study describes the fidelity and adoption; barriers and facilitators to engagement and delivery; acceptability, appropriateness and feasibility of the Healthy Lifestyle Program (HeLP) intervention.Study typeMixed-methods process evaluation.MethodsData were included from n = 174 adults with chronic low back pain randomised to HeLP, and delivering clinicians. The 26-week intervention included five consultations , information resources, and referral to telephone support services. We collected quantitative data via fidelity checklists, administrative records and surveys, and qualitative data via semi-structured interviews and focus groups with a subsample of participants and clinicians. We used descriptive statistics, thematic analyses and triangulation to identify meta-themes.ResultsIntervention fidelity was high (clinicians delivered >90% to protocol). Participants’ adoption was moderate attending a mean 3.2 consultations, 54% (referred) engaged with telephone services and 46% used online resources; however, adoption of smoking cessation services was low (6.5% of smokers completed ≥1 call). A total of 23% of participants discontinuted HeLP by 26 weeks. Clinicians and participants considered the intervention acceptable, and addressing lifestyle factors appropriate for low back pain.ConclusionHeLP was acceptable, although uptake varied across components. Improving clinicians’ behaviour change communication and personalising care may optimise implementation.

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Cite

BibTeXRIS
BibTeX
@article{mudd2026integrated,
  title = {{An integrated Healthy Lifestyle Program (HeLP) and physiotherapy care for low back pain: a mixed methods process evaluation}},
  author = {Emma K. Mudd and Cassandra Lane and Jenna L. Hollis and Steven J. Kamper and Rebecca Hodder and Priscilla Viana Da Silva and Simon R. E. Davidson and Connor Gleadhill and Bruce Donald and Damien Smith and Christopher M. Williams},
  journal = {Public Health Research \& Practice},
  year = {2026},
  month = oct,
  doi = {10.1071/pu25048},
  url = {https://doi.org/10.1071/pu25048},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - An integrated Healthy Lifestyle Program (HeLP) and physiotherapy care for low back pain: a mixed methods process evaluation
AU  - Emma K. Mudd
AU  - Cassandra Lane
AU  - Jenna L. Hollis
AU  - Steven J. Kamper
AU  - Rebecca Hodder
AU  - Priscilla Viana Da Silva
AU  - Simon R. E. Davidson
AU  - Connor Gleadhill
AU  - Bruce Donald
AU  - Damien Smith
AU  - Christopher M. Williams
PY  - 2026
DA  - 2026/10/28
JO  - Public Health Research & Practice
DO  - 10.1071/pu25048
UR  - https://doi.org/10.1071/pu25048
AB  - Objectives and importance of studyIntegrated lifestyle and low back pain care is a novel treatment approach. This study describes the fidelity and adoption; barriers and facilitators to engagement and delivery; acceptability, appropriateness and feasibility of the Healthy Lifestyle Program (HeLP) intervention.Study typeMixed-methods process evaluation.MethodsData were included from n = 174 adults with chronic low back pain randomised to HeLP, and delivering clinicians. The 26-week intervention included five consultations , information resources, and referral to telephone support services. We collected quantitative data via fidelity checklists, administrative records and surveys, and qualitative data via semi-structured interviews and focus groups with a subsample of participants and clinicians. We used descriptive statistics, thematic analyses and triangulation to identify meta-themes.ResultsIntervention fidelity was high (clinicians delivered >90% to protocol). Participants’ adoption was moderate attending a mean 3.2 consultations, 54% (referred) engaged with telephone services and 46% used online resources; however, adoption of smoking cessation services was low (6.5% of smokers completed ≥1 call). A total of 23% of participants discontinuted HeLP by 26 weeks. Clinicians and participants considered the intervention acceptable, and addressing lifestyle factors appropriate for low back pain.ConclusionHeLP was acceptable, although uptake varied across components. Improving clinicians’ behaviour change communication and personalising care may optimise implementation.
SN  - 2204-2091
ER  -