The effects of a media campaign on beliefs and utilization of imaging examinations in Norwegian patients with low back pain

Erik L. Werner, Douglas P. Gross


Aims: Several authors have reported an overuse of imaging examinations for unspecific low back pain conditions. In this study, we examined the influence of a media campaign for better understanding and management of back pain in the general population on utilization of imaging examinations. Methods: The media campaign Active Back ran for three years (2002-2005) in two Norwegian counties and the results were compared to the adjacent control county. Numbers of imaging examinations were collected manually from every radiology department in each of the three counties, while belief measures were collected through a telephone survey before, during and after the campaign. Beliefs of the health care providers were collected through questionnaires. Results: We observed a decrease of X-rays by 35% in the intervention counties and by 33% in the control county. The number of CT scans decreased by 51% and 57% respectively. The number of MRI scans increased by 152% in the intervention counties and by 596% in the control. Combining all modalities, the number of imaging examinations increased by 3% in the intervention counties and by 56% in the control county. There was a tendency both in the general public and among the health care providers towards less trust in the usefulness of X-rays in all counties during the study period. The health care providers in the control county seemed to recommend imaging more often than their colleagues in the intervention counties. Conclusion: Despite slightly increased scepticism among the general public and health care providers, we observed an overall increase in utilization of imaging modalities. The dramatically increased utilization in the control group was likely explained by an increased capacity for MRI examinations obtained by the opening of a new radiology clinic, and not as an effect of the media campaign.

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