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

BackgroundPhysical inactivity is a substantial public health concern and a particularly challenging problem to address. Physical activity is shown to be of therapeutic benefit to those living with chronic pain, but intervention studies have often been unsuccessful in promoting sustainable engagement with physical activity in this population. AimTo develop a more comprehensive understanding of the barriers to engaging with sustainable physical activity and the facilitators that promote this engagement in people with chronic pain. Design & settingThe study design was qualitative, informed by behaviour change theory (the COM-B model), and participants were drawn from two settings. First, 36 adults living with moderate-severe chronic pain were recruited from a specialist NHS pain service. Secondly, 15 stakeholders were recruited to represent a range of healthcare sectors involved in supporting people with chronic pain. MethodOne-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 interpret the data. ResultsThe barriers to sustainable physical activity engagement in people with chronic pain are expansive, and the inclusion of stakeholder perspectives is valuable in developing a more comprehensive understanding of these barriers and also of the facilitators that are successful in promoting sustainable physical activity in this population. ConclusionsThe COM-B model provides a robust theoretical framework for organising and understanding these barriers and facilitators in a way could that inform effective intervention design.