{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T19:25:11Z","timestamp":1793993111434,"version":"4.8.0"},"reference-count":70,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2022,12,29]],"date-time":"2022-12-29T00:00:00Z","timestamp":1672272000000},"content-version":"unspecified","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Chronic low back pain (CLBP) is associated with negative consequences in high and low\/middle-income countries. Pain beliefs are important psychosocial factors that affect the occurrence and progression of CLBP and may be influenced by the sociocultural context and interactions with healthcare professionals (HCPs). The pain beliefs of Ghanaian patients with CLBP are unknown and the factors influencing pain beliefs in African contexts are unclear.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To explore the pain beliefs of Ghanaian patients with CLBP, how they influence CLBP management\/coping and to identify the mechanisms influencing them.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Qualitative study using individual semistructured face-to-face interviews, situated within Straussian grounded theory principles and critical realist philosophy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>Thirty patients with CLBP accessing physiotherapy at two teaching hospitals in Ghana.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Participants suggested dominant biomedical\/mechanical beliefs (related to CLBP causes, posture and activity, and the belief of an endpoint\/cure for CLBP). Maladaptive beliefs and practices, in particular fear-avoidance beliefs, and dependence on passive management and coping, were common among participants. These beliefs and practices were mostly influenced by HCPs and sociocultural expectations\/norms. Although spirituality, pacing activity and prescribed exercises were commonly mentioned by participants, other active strategies and positive beliefs were expressed by a few participants and influenced by patients\u2019 themselves. Limited physiotherapy involvement, knowledge and awareness were also reported by participants, and this appeared to be influenced by the limited physiotherapy visibility in Ghana.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Participants\u2019 narratives suggested the dominant influence of HCPs and the sociocultural environment on their biomedical\/mechanical beliefs. These facilitated maladaptive beliefs and adoption of passive coping and management practices. Therefore, incorporation of more positive beliefs and holistic\/active strategies by Ghanaian patients and HCPs may be beneficial. Furthermore, patient empowerment and health literacy opportunities to address unhelpful CLBP\/sociocultural beliefs and equip patients with management options for CLBP could be beneficial.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2022-061062","type":"journal-article","created":{"date-parts":[[2022,12,29]],"date-time":"2022-12-29T18:00:16Z","timestamp":1672336816000},"page":"e061062","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":16,"title":["Understanding how patients\u2019 pain beliefs influence chronic low back pain management in Ghana: a grounded theory approach"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1752-2027","authenticated-orcid":false,"given":"Josephine Ahenkorah","family":"Ampiah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Moffatt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Diver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paapa Kwesi","family":"Ampiah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,12,29]]},"reference":[{"key":"2022122910000514000_12.12.e061062.1","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204428"},{"key":"2022122910000514000_12.12.e061062.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31460-X"},{"key":"2022122910000514000_12.12.e061062.3","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-018-2075-x","article-title":"An update on the prevalence of low back pain in Africa: a systematic review and meta-analyses","volume":"19","author":"Morris","year":"2018","journal-title":"BMC Musculoskelet Disord"},{"key":"2022122910000514000_12.12.e061062.4","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0127880","article-title":"Risk factors and disability associated with low back pain in older adults in low- and middle-income countries. results from the who study on global ageing and adult health (SAGE)","volume":"10","author":"Stewart Williams","year":"2015","journal-title":"PLoS One"},{"key":"2022122910000514000_12.12.e061062.5","first-page":"21","article-title":"Low back pain in underground gold miners in Ghana","volume":"41","author":"Bio","year":"2007","journal-title":"Ghana Med J"},{"key":"2022122910000514000_12.12.e061062.6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2014\/517259","article-title":"Occupational and personal determinants of musculoskeletal disorders among urban TAXI drivers in Ghana","volume":"2014","author":"Abledu","year":"2014","journal-title":"Int Sch Res Notices"},{"key":"2022122910000514000_12.12.e061062.7","doi-asserted-by":"publisher","DOI":"10.1590\/S0034-8910.2015049005432"},{"key":"2022122910000514000_12.12.e061062.8","doi-asserted-by":"publisher","DOI":"10.1136\/bjsm.2010.081638"},{"key":"2022122910000514000_12.12.e061062.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2007.10.005"},{"key":"2022122910000514000_12.12.e061062.10","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-15-50"},{"key":"2022122910000514000_12.12.e061062.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2013-004725"},{"key":"2022122910000514000_12.12.e061062.12","article-title":"Beliefs and attitudes about low back pain in Argentina: a cross-sectional survey using social media","volume":"49","author":"Pierobon","year":"2020","journal-title":"Musculoskelet Sci Pract"},{"key":"2022122910000514000_12.12.e061062.13","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-10664-5","article-title":"What do the general public believe about the causes, prognosis and best management strategies for low back pain? 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