Strengths and Limitations
pain
RECRUITMENT
Interventions in this study were delivered online to a community sample using hypothetical scenarios. We considered demonstrating the evidence of impact on cognitive and affective outcomes an important first step before moving to more intensive, costly, and burdensome effectiveness evaluations in clinical settings. This study design also allowed for targeted recruitment of people with lower health literacy and enabled us to randomly allocate a large sample of participants to achieve adequate statistical power to detect small differences in outcomes. Another strength was the blinded preplanned analysis.However, the generalizability of our findings may be limited due to the use of a hypothetical scenario, measuring intention rather than behavior, and the controlled conditions that meant that interventions were delivered in a way that diverges from how they would be delivered in the real world. Results may have also been influenced by the repeated measures, which could have led to a satisficing bias among participants, thus reducing group differences. Only 36% of participants reported a history of back pain, and so we may expect different results for clinical populations. Our study was further limited by recruiting through a social research panel. Although Dynata samples from a participant panel that is closely aligned with sociodemographic characteristics of the national population, it is possible that this sample would have had greater motivation to ask questions and be involved in health care decisions than people in the general community. Administering the interventions to assess their effectiveness in a more real-world setting may produce more accurate estimates of effect sizes.