Behaviour change: How we help people trust their recovery from all common MSK injuries and conditions

getUBetter provides digital self-management support for all common musculoskeletal (MSK) injuries and conditions and women’s pelvic health.

At the heart of what we do is giving people the knowledge, skills, and confidence to self- manage. This means they fundamentally trust their recovery and use healthcare resource appropriately. In this article we share the approach we take to do this.

From the very beginning we understood that for a digital platform to have a positive impact on people and the NHS, it had to be trusted and it had to help people change their behaviour. That’s why, getUBetter was designed with an underpinning COM-b behaviour change model as its foundation. How getUBetter has been developed around this model has been published in the JMIR Publications.

The research paper cites capability (individual’s ability participate in an activity), opportunity (external factors allowing for behaviour to occur), and motivation (conscious and unconscious cognitive patterns inspiring behaviour to occur) as three key factors capable of changing behaviour and outlines different methods of behaviour change on all stages of recovery to create a personalised and tailored app to enable true self-management of MSK conditions.

The Behaviour Change Wheel

getUBetter provides tailored holistic support to recover  from MSK injuries and conditions day-by-day. The support provided changes depending on how a person is feeling (improving, staying the same or getting worse), their symptoms, and the stage of their recovery journey. The type of content that is delivered is weighted to different stages of a person’s recovery. This means that people receive different behaviour change support between acute, sub-acute and long-term phases (new, almost new, and long-term). We change the messaging, content and behaviour change focus between knowledge and guidance, support and motivation and self-efficacy. This means that what people receive is personalised, tailored and relevant to them.

The content includes support to mitigate against negative behaviours and promote positive behaviour.  Supporting red, yellow, blue, and black flags that can influence recovery in areas, such as worrying signs and symptoms, bio-phycological aspects of recovery and behaviour, work related issues as well as social influences.

People can self-progress exercises, including exercises that can be done on the go to fit around people’s busy lives. getUBetter is provided at the earliest opportunity wherever somebody interacts with the health system and is also made available in non-traditional settings, such as libraries, care homes, community centres, and pharmacies. Having access to support 24 hours a day, 365 days per year means nobody should feel unsupported or alone.  In-built safety netting means people are navigated back into the system when appropriate and local configuration to an ICS means people can be signposted to local support services such as weight loss support, smoking cessation support or pain management support.

Because getUBetter is personalised and configured to local pathways and services and branded to the local area, it is trusted by both patients and clinicians. The whole pathway approach means that self-management support is consistent and standardised, further promoting trust. Other important factors that increase trust include our approach to

• User centred co-design
• Evidence based design and evaluation
• Clinical safety including medical device registration
• Reducing digital exclusion

Importantly, getUBetter doesn’t block access to normal health services so people don’t feel fobbed off.  Instead, it sits alongside routine care, helping to guide people through their recovery.

As important as the platform itself is how it is implemented. How it is provided as part of routine care and how the service availability is communicated to the local population is crucial.  In our next blog we will be sharing some of the novel ways that ICSs have used communication and behaviour change techniques to drive adoption of getUBetter. Ultimately, are real world evaluations of getUBetter have proven that you can use digital self-management support to change people’s behaviour. Therefore, driving adoption leads to greater benefits for each ICS and their population.

As adoption of getUBetter across the NHS grows, we continue to look at new ways to drive adoption, provide support for more conditions and deliver behaviour change at scale.  As an example, we have started work with the NHS behaviour change team to improve messaging used in texts for patients – a mechanism used by many ICS as a to promote the adoption of getUBetter

As well as helping the population and the NHS, we believe providing evidence based digital self-management support at scale will also help people stay in or return to work. – MSK injuries and conditions are one of the leading causes of economic inactivity.

Through our real world evaluations, we have seen the following benefits:

• 20% less physiotherapy referrals
• 13% less MSK GP appointments
• 50% less MSK prescriptions
• 66% less Urgent Care attendance
• 50% of patients on the physiotherapy waiting list no longer needed
  an appointment
• 40% less physio appointments
• 38% less secondary care referrals

This data has led to NICE early value assessment and approval for use in the NHS for non-specific low back pain and we continue to evaluate the impact of getUBetter across all conditions with the 17 ICSs we are currently working with.