Talkback: A co-designed educational resource for people with lower back pain


NICE recommends that people with back pain are provided with advice and information tailored to their needs and capabilities. However implementation of research evidence/guidelines into practice is not always successful.

Co-production using creative co-design methods offers a different approach to intervention development. It aims to produce, with all relevant stakeholders, contextually sensitive solutions that are more likely to be acceptable and implementable into practice.

This project aimed to co-design an educational resource for people with low back that would specifically facilitate positive thinking and behaviours to support their physiotherapy management.


The project was completed in 4 phases using the creative co-design approach developed by the translating knowledge into action theme of the National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care Yorkshire and Humber (NIHR CLAHRC YH).


Phase 1 - Literature review:

  • A review of current evidence for LBP education.
  • A review of the theories of belief and behavioural change literature
  • A review of currently available resources.


Phase 2 - Creative coproduction workshops:

Two stakeholder workshops using creative co-designs methods were held. In the first workshop, the lived experience of back pain was explored from both service user and service provider perspectives. In the second workshop, the collective learning from workshop 1 was used to facilitate idea generation and explore solutions that could be developed further.


Phase 3 - Prototype development:

The outputs of the workshops were synthesized with the knowledge from the literature. These ideas were iteratively developed into tangible prototype resources that were tested in the clinical setting.


Phase 4 - Creating Impact:

The final “Talkback” educational platform and supporting resources were presented to project stakeholders and key decision makers ready for implementation.


Outputs from the workshops were analysed and key themes identified. Taking into account the available resources within the service these themes were developed into the” Talkback” prototype.

“Talkback” is a series of linked resources that are available throughout the patient journey. Together they provide a logically consistent explanation of back pain that makes sense and has utility. The resources use active learning strategies, easy to understand explanations and provide opportunities for people to relate the information to their own circumstances and create a personal action plan. They will be available to use in physiotherapy sessions, online and in an education and peer support session.

The prototype resources and education session were trialled. Questionnaire feedback confirmed that this was something that patients wanted to engage with and staff wanted to provide.

The creative co-design process created practical, implementable solutions that were owned by all stakeholders. This enabled a systems based approach to a complex problem. The 'Talkback' concept meets the needs of the patients, the staff and the service. It is adaptable to context and personal situation, evidence based and easy to integrate into current standard practice.


This methodological approach is recommended for other complex health service issues looking for practical, context specific system based solutions.

Funding acknowledgements

The research was funded by the NIHR CLAHRC Yorkshire and Humber and Sheffield Teaching Hospitals Charitable Trust.

The views expressed are those of the author(s), and not necessarily those of the NIHR or the Department of Health and Social Care.

Additional notes

This work was presented at Physiotherapy UK 2019