Applying the health belief model to understand the usage and experience of self-management techniques in knee osteoarthritis: A mixed-methods observational study

Background: Self-administered knee-massage (S-KM) has the potential to alleviate symptoms in individuals with knee osteoarthritis (OA). Previous studies have shown inconsistent results, highlighting the need for a theoretical framework to identify effective self-massage practices. This study aimed to identify the behavioral determinants related to S-KM by employing an augmented health belief model alongside the theory of planned behavior. Methods: A total of 268 participants with knee osteoarthritis completed an online survey assessing perceived susceptibility, severity, barriers, facilitators, task response self-efficacy, and cues to action, along with attitudes and intention. Structural equation modelling was used to evaluate the predictive validity of the proposed model. Thematic analysis was conducted to explore qualitative data regarding participants' experiences in self-managing knee pain. Results: < .001). Intention mediated the relationship between cues and behavior. Qualitative analysis indicated that many participants used techniques similar to Swedish massage, often due to familiarity from professional massages. Some also reported using massage devices, suggesting a potential shift toward incorporating technology in future self-massage research. Conclusions: Key predictors of knee massage performance included cues, perceived severity, and task self-efficacy. Interventions should enhance perceptions of OA severity and confidence in self-massage techniques, providing insights for future program development.