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Background: Recurrences of low back pain (LBP) are frequent and associated with high levels of disability and medical costs. Regular exercise practice may be an effective strategy to prevent recurrences of LBP, however, the promotion of this behaviour by physiotherapists seems to be challenging. This study aims to explore physiotherapists' perceived barriers and facilitators to the implementation of a behaviour change-informed exercise intervention to promote the adoption of regular exercise practice by patients at risk of recurrence of low back pain. Methods: Two focus groups with primary healthcare physiotherapists were conducted, based on a semi-structured interview schedule informed by the Behaviour Change Wheel, including the Capability, Opportunity, Motivation–Behaviour (COM-B) model and the Theoretical Domains Framework (TDF). All focus groups were held through videoconference, audio and video recorded and transcribed verbatim. A deductive content analysis, using a coding matrix based on the COM-B and TDF, was performed by two independent researchers. A third researcher was approached to settle disagreements. Results: In total, 14 physiotherapists participated in the focus groups. The analysis revealed a total of 13 barriers (4 COM-B components and 7 TDF domains) and 23 facilitators (5 COM-B and 13 TDF) to physiotherapists' implementation of a behaviour change-informed exercise intervention. The most common barriers were the lack of skills and confidence to implement the proposed intervention. These were explained by the fact that it differs from the usual practice of most participants and requires the learning of new skills applied to their contexts. However, for those who had already implemented other similar interventions or whose rationale is aligned with the new intervention, there seemed to exist more positive determinants, such as potential benefits for physiotherapists and the profession, improvement of quality of care and willingness to change clinical practice. For others who did not previously succeed in implementing these types of interventions, more context-related barriers were mentioned, such as lack of time to implement the intervention, schedule incompatibilities and lack of material and human resources. Conclusions: This study identified modifiable barriers and facilitators to physiotherapists' implementation of a behaviour change-informed exercise intervention for patients at risk of recurrence of LBP in primary healthcare. The findings of this study will allow the systematic and theory-based development of a behaviour change-informed training programme, aimed at physiotherapists and supporting the successful implementation of the exercise intervention. [ABSTRACT FROM AUTHOR]

The long-term success of health intervention programs for self-management is often compromised by the difficulties felt by participants to maintain adherence to prescribed behavioral changes. Mixed methods research can expand understanding and the insights of complex health research problems such as self-management in chronic conditions. The purpose of this paper is to share key contents of a symposium focusing on the application of mixed methods research in the context of person-centered education, held during the 6th World Conference on Qualitative Research. More specifically, it aims at: 1) exploring examples of implementing mixed methods research in health interventions for self-management of chronic conditions and other health risks; 2) promoting insights and knowledge on the ‘why and how of combinations’ in mixed methods studies; and 3) exploring the valuable role of qualitative strands in mixed methods in the wider context of health research. Three studies are explored as examples of application of mixed methods in self-management programs, considering the experiences of participants for changing selfcare behaviors and challenges faced for maintaining such changes. Convergent and explanatory sequential designs have been used, combining questionnaires and semistructured interviews for data collection. Data analysis included procedures such as thematic analysis and descriptive statistics (examples 1 and 3), and thematic analysis and descriptive/inferential statistics (example 2). Results show how mixed methods designs can contribute to develop self-management strategies, to be considered in planning future interventions, and to expand understanding about their impact as well. Likewise, these examples emphasize why mixed methods can bring added value both to process and results of health research. Thus, exploring the application of mixed methods into a wider context is of utmost importance since the complexity of health phenomena is growing and requires equally complex research designs to capture them. [ABSTRACT FROM AUTHOR]