The influence of HCPs' beliefs and treatment orientations.

In attempting to evaluate the role of education within a self-management approach as a strategy for behaviour change, however, a further difficulty arises. Even assuming that we know what needs to be taught and what patient characteristics need to be addressed, there is clear evidence that HCPs’ beliefs, preferences, and expectations influence both intervention delivery and patient outcomes and recently, more attention has been directed at these factors.

The nature of HCPs' beliefs and treatment orientations

The characteristics of the HCP, such as their status as professionals, their therapeutic style, the words they use with patients, their beliefs about the problem, and their confidence or conviction in treatments have all been suggested as non-specific effects of treatment (Crow et al. 1999; Ernst 2001; Feinstein 2002). The beliefs, expectations, and preferences of HCPs therefore likely influence their choice of assessment methods, explanation to patients, and treatment approach.

There is evidence that HCPs, such as primary care doctors, physical therapists, and rheumatologists, hold a wide range of beliefs about pain that correlate with their recommendations to patients (Coudeyre et al. 2006; Poiraudeau et al. 2006). Studies have emphasized the predominance of biomedically (or structure) -orientated pain beliefs among HCPs (Ostelo et al. 2003; Daykin and Richardson 2004; Bishop and Foster 2005; Bishop et al. 2008). They have also shown that some HCP groups are more biomedical than others in their attitudes and their advice is characterized by advising patients to restrict activity, be vigilant about their backs and beliefs in a structural cause of back pain (Pincus et al. 2007).