Challenges in Nurses' Use of Behaviour Change Techniques in Chronic Pain Management

Objective: Patient adherence to treatment recommendations is less than optimal within chronic pain management. Behaviour change techniques (BCTs) and frameworks can be used to maximise engagement with desired behaviours but are also underused. This study sought the perceptions of nurses to explore the perceived barriers and facilitators to utilising BCTs in clinical practice in chronic pain settings. Methods: Eight qualified nurses participated in semi-structured interviews. Reflexive thematic analysis was conducted to understand barriers and facilitators to the use of BCTs in practice. Results: Three themes were identified (1) behaviour change embedded in current practice, (2) complexities in chronic pain as barriers in implementing behaviour change and (3) from experience to expertise: training and supervision needs. Findings suggest that nurses engage in some BCTs (17 were discussed across all interviews), without explicit knowledge of specific BCTs and how to use them. The use of BCTs is restricted by patients' medical complexities, including mental health comorbidities, unhelpful biomedical beliefs about pain and opioid reliance. Furthermore, the opportunity to effectively utilise BCTs is impeded by a lack of training and clinical supervision. Conclusions: Improving nurses' capabilities by enhancing BCT training and clinical supervision is required. Furthermore, organisational change is recommended to create the opportunity for nurses to effectively utilise BCTs. Specifically, organisations should devote necessary resources, backed by effective implementation strategies, to enhance such engagement.