The impact of animations to improve health-information recall in patients with lower back pain: a quasi-experimental study

Globally, low back pain (LBP) is the leading cause of years lived with disability. Clear communication between patients and health professionals is essential to improve health outcomes, lower the costs of health services, and plays a central role in avoiding fragmented LBP care. Commonly, patient information is provided verbally or in written text, which may require high health literacy. Research suggests animations can increase information acquisition in patients with low health literacy. This study was conducted to investigate the impact of animations in improving health information recall among patients with LBP across different healthcare sectors. The study uses a quasi-experimental pre- and post-cohort design. It included 502 adult patients with LBP recruited from 11 units across seven general practices, one hospital and three municipalities, of which 250 (49,8%) constituted the control cohort. The control cohort exclusively received the usual written and verbal information, whereas the intervention cohort watched two animations about LBP developed for the study, in addition to usual information. Data on sociodemographic characteristics and eHealth literacy competencies were collected. The primary outcome was information recall regarding LBP, measured using two questionnaires (5 items each, score range 0–5). Scores of < 4 were defined as poor recall and ≥ 4 as good recall. Secondary outcomes were pain perception, Tampa Scale of Kinesiophobia (TSK), and physical function, Oswestry Disability Index (ODI). All outcomes were collected through self-reported questionnaires. Outcomes were measured at 3, 12 and 26 weeks after inclusion. Effectiveness of the intervention was assessed using logistic and linear regression models. For patients in the primary sector, the intervention cohort showed improved health information recall at three weeks compared to the control cohort (55.3% vs. 41.8% with good recall; OR 2.2, CI 1.2–4.0). In the secondary sector, the intervention cohort showed lower recall at the 3-week follow-up (63.6% vs. 78.6%; OR 0.4, CI 0.2–0.8). At 6-months, differences persisted only in the secondary sector (68.0% vs. 83.7%; OR 0.4, CI 0.2–0.8). Regarding secondary outcomes, the intervention cohort in the secondary sector showed a small reduction in TSK scores at 6 months (mean difference − 1.5, CI -3.1 to -0.1, on a scale of 17–68), while ODI scores (scale 0-100) showed no significant between-group differences. In this non-randomised quasi-experimental study, animations showed varying effects on short-term health-information recall, with context in the form of primary and secondary sectors playing a pivotal role. The findings suggest that the impact of animations may differ across healthcare settings, and their effectiveness as an information delivery tool may depend on the specific healthcare context. Animations did not demonstrate clinically relevant impacts on health-related outcomes.