Evaluating a primary prevention program in a multicultural population: The importance of representations of back pain

Objective. This study was carried out during 4 years of longitudinal research assessing back pain problems and the impact of a back pain primary prevention program on the employees of a food and non-food chain store. The impact of the teaching program was reevaluated in a secondary analysis, taking into account subjects' prior representations of back pain. Methods. Subjects were grouped according to their cultural origins and socioprofessional levels. Their representations were assessed by means of open questions before and after the teaching program. Results. The teaching program reinforced pre-existing representations in those participants socioculturally nearest the teachers; it had a weak or even disturbing impact on those furthest removed from the teachers in sociocultural terms. Conclusion. The differential impact of the teaching program in this study indicates that participants' prior representations play a role in the outcome of a Back School teaching program. Thus, the participants' representations should be taken into account when designing the program and when assessing participants' suitability for such programs, their adherence, and the outcome.