Perceived barriers to and facilitators of physical activity, using the COM-B model for behavioural change, in people with chronic pain: a qualitative evaluation of patient and stakeholder perspectives

Background
Physical inactivity is a substantial public health concern and challenging problem to address. Physical activity (PA) is shown to be of therapeutic benefit to those living with chronic pain (CP), but intervention studies have often been unsuccessful in promoting sustainable engagement with PA in this population. To develop a more comprehensive understanding of the barriers to and facilitators of sustainable PA in people with CP and to frame the findings within the six COM-B constructs.

Method
This qualitative study was informed by behaviour change theory (the COM-B model), and participants were drawn from two settings. First, 36 adults living with moderate-severe CP were recruited from a specialist NHS pain service (‘patients’). Secondly, 15 stakeholders were recruited to represent a range of healthcare sectors involved in supporting people with CP. One-to-one semi-structured interviews, informed by the COM-B model, were conducted between May 2020 and October 2021. Interviews were conducted by telephone or using online conferencing software and were transcribed verbatim and anonymised. The Framework Method was used to analyse the data. First, two independent researchers conducted line-by-line coding and, using a consensus approach, collapsed the findings to produce subthemes. Secondly, these inductively identified subthemes were mapped to predetermined themes (i.e. the six COM-B constructs) using a consensus approach involving three researchers.

Results
Many patients reported prohibitive pain intensity, worsening symptoms and lack of motivation as barriers to physical activity and that effective pain management, personalised support and social interaction facilitated physical activity. The inclusion of stakeholder perspectives was valuable in developing a more comprehensive understanding of the barriers to PA encountered by people with CP and also of the facilitators that are successful in promoting sustainable PA in this population. For example, stakeholders highlighted additional barriers, such as people’s limited financial resources and their perceptions of physical activity being counterintuitive when experiencing pain.

Conclusions
The barriers to and facilitators of PA in people with CP are numerous and complex, and stakeholder perspectives can broaden this understanding. Barriers and facilitators were successfully mapped to the COM-B constructs in a way that could inform future PA intervention design.