research article

Attitudes and Beliefs of College Students towards Pain Management Modalities: Theory of Planned Behavior Approach

Rudi Safarudin1,2*, Mohammad Ikram1, Kent Marshal3, Nazneen Shaikh1, Nawar Attal4, Nilanjana Dwibedi5, Usha Sambamoorthi6

1Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA

2Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Tadulako University, Palu, Central Sulawesi, Indonesia

3West Virginia Clinical & Translational Science Institute, School of Medicine, West Virginia University, Morgantown, WV, USA

4Division of Exercise Physiology, School of Medicine, West Virginia University, Morgantown, WV, USA

5Neuroscience, The Janssen Pharmaceutical Companies of Johnson & Johnson, USA

6Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Sciences Center, Fort Worth, TX, USA

*Corresponding author: Rudi Safarudin, Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA

Received Date: 14 October 2022

Accepted Date: 15 November 2022

Published Date: 21 November 2022

Citation: Safarudin R, Ikram M, Marshal K, Shaikh N, Attal N, et al. (2022) Attitudes and Beliefs of College Students towards Pain Management Modalities: Theory of Planned Behavior Approach. Chron Pain Manag 6: 147. DOI: https://doi.org/10.29011/2576-957X.100047

Abstract

Background: Chronic pain exhibits a burdening onset and duration in young adults. It is critical to understand appropriate pain management decision-making. Objective: To investigate the associations of attitudes and beliefs of college students with their intention and behavior toward pain management modalities using the Theory of Planned Behavior (TPB). Methods: In this cross-sectional online survey study, we recruited college students (age≥18 years) at West Virginia University, Morgantown, West Virginia, United States. We examined four pain management modalities: Over-the-Counter (OTC) pain medications, prescription pain medications (RX), mindfulness therapy, and yoga/exercise. Likert scales were used to assess TPB constructs (attitude, Subjective Norm [SN], Perceived Behavior Control [PBC], intention, and behavior). We analyzed the associations of the TPB constructs with both intention and behavior toward pain management modalities using multiple linear regression. Results: Of the 364 returned surveys, 227 were completed and analyzed. Attitude was found to be significantly associated with the intention to use all pain management modalities, while PBC was significantly associated with the intentions to use RX, mindfulness, and yoga/exercise (RX: β = 0.38; 95%CI= 0.28, 0.84; p=<0.001, mindfulness: β=0.27; 95%CI=0.07, 0.76; p=0.019, and Yoga/exercise: β=0.35; 95%CI=0.25, 0.85; p=<0.001). Furthermore, the intention to use pain management modalities consistently predicted all behaviors (OTC: β=0.49; 95%CI=0.32, 0.76; p=<0.001, RX: β=0.47; 95%CI=0.17, 0.58; p=<0.001, Mindfulness: β=0.62; 95%CI=0.40, 0.72; p=<0.001, Yoga/Exercise: β=0.59; 95%CI=0.42, 0.84; p=<0.001). Conclusion: College students’ attitude and PBC were the top predictors of intention to choose pain management modalities, and intention predicted behavior. Research with robust study design is needed to confirm our study findings.

Keywords: Attitudes; OTC; Pain; Subjective norm; PBC;Theory of planned behavior

Introduction

Physical pain is an indiscriminate symptom that impacts the health and well-being of more than 20.4% of all ages and races in the United States. Globally, it affects almost half of the world’s population, regardless of sex and race [1,2]. Physical pain arises from many different etiologies and may have acute, chronic, or idiopathic presentations. Additionally, how pain is treated is immensely based on location, onset, intensity, and duration factors. The physical burden associated with pain is notoriously high. As many as 48.9 million individuals are classified as disabled due to chronic pain [3]. These disabilities could eventually lead to various healthcare-related concerns, including sedentary lifestyles and the potential inability to accomplish essential activities of daily life [4]. The loss of function and independence from pain can thus ultimately impact the quality of life of these individuals. It may harm the prognosis of other comorbidities and, in some people, reduce life expectancy [5]. Physical pain is not limited to clinical burden but also immensely impacts pain sufferers’ economic situation. For example, in the US alone, more than $560 billion are lost each year to managing pain and lost productivity [6].

Furthermore, patients who experience their pain at a younger age may expect the costs of managing this pain to grow as they age exponentially. However, despite these daunting statistics, many studies indicate that the early identification, diagnosis, and deployment of proper pain management strategies may reduce the burdens of pain [7].

A multitude of pain management modalities exist. However, not all these modalities carry the same benefit for all individuals. Some of them have been reported to be ineffective for some people. Moreover, some pain treatments (such as prescription pain medication) may result in harmful effects over time without proper clinician monitoring [8,9]. A handful of studies have established reasons for selecting specific modalities over others, but most of these trials were conducted in older patients and those receiving palliative care [10-13].

Young adults (15-34 years), primarily college-aged individuals, are known to be physically active, making them more prone to injuries, such as localized musculoskeletal pain and back/ spinal pain [7]. This age group may have different attitudes and beliefs in treating their aches compared to older adults. Moreover, acute injuries in college-age students can develop into chronic pain disorders [14]. Appropriate pain management in early adulthood can improve clinical outcomes and overall well-being later in life.

Therefore, this study aims to examine college students’ attitudes and beliefs toward their intention and behavior in pain management modalities. This information may help effectively minimize the physical, emotional, mental, and financial burdens of physical pain young adults suffer. The findings may also be used to target effective pain management strategies among college students experiencing pain.

Methods

Theoretical framework

Our study utilized the Theory of Planned Behavior framework by Ajzen [15] to assess college students’ attitudes, beliefs, intentions, and behaviors of using specific pain management modalities. In this theoretical framework, Perceived Behavioral Control (PBC), attitude, and Subjective Norm (SN) can predict an individual’s intention to use pain management modalities. Also, individuals are believed to be capable of acting on their intentions (behavior, in our case: use of pain management modalities) when they have adequate PBC. This theory also postulates that intention (in our case: intention to use pain management modalities) is a predictor of behavior [15-17].

Study Design, Participants, and Procedures

We adopted a cross-sectional study design with convenient sampling using an online survey. The survey consisted of structured questions on demographics, education, healthcare provider (pain specialist and Primary Care Physician) visits, pain interference in the past 30 days, and experience of pain more than 30 days. Attitude, SN, and PBC were assessed using Likert scales for intention and behavior toward pharmacological pain treatments (over-the-counter (OTC) and prescription pain medications) and non-pharmacological (mindfulness therapy and yoga/exercise).

As there is no standard TPB questionnaire available [16], we developed a set of questions based on standard methods and procedures for TPB measures designed by Fishbein and Ajzen [18]. In this study, all items of TPB constructs were measured on four pain management modalities: (1) Over-The-Counter pain medication; (2) prescription pain medication (any medication prescribed by a physician and controlled and filled by a pharmacist); (3) mindfulness therapy; and (4) yoga/exercise. On the front page of our survey, we defined pain as physical discomfort or suffering caused by illness or injury.

The questionnaire was developed using Qualtrics service (an online survey development and dissemination software suite). The questionnaire readability was determined to be on an 8th-9th grade level with an approximate score of 60 based on the Flesch-Kincaid readability scale [19]. The ethics of our study was approved by WVU’s Institutional Review Board (IRB) as exempt (protocol #1902448962).

We recruited college students 18 years of age and older who were able to read and write in English by posting the link to the Qualtrics questionnaire on WVU listserves and social media sites. We obtained online informed consent from each respondent before they started the survey.

Measures

Dependent variables

Intention to use pain management modalities: We measured the intention to use the pain management modalities by asking 1 question: “Do you intend to use any of the following modality/ (ies) to manage your pain in the future?” with a five Likert-type response scale from 1 (“definitely not”) to 5 (“definitely yes”).

Behavior of using pain management modalities: We assessed the behavior utilizing three items inquiring how often the respondents had used the pain management modality/(ies) to manage their pain in the past 4 weeks, 6 months, and 12 months. The answers were categorized as “Never”, “Rarely”, “Sometimes”, “Often”, and “Always”. Key explanatory variables (predictors).

Key Indipendent Variables (Predictors of Interaction andBehavior)

Predictors of intention: Attitude, subjective norm, and perceived behavior control were investigated as intention predictors. Originally, the attitude construct was measured with 6 items/ questions, the subjective norm 4 items, and the PBC 4 items (Appendix). Respondents were expected to choose one of the five Likert scale Answers. During the analysis phase, we had to drop 2 question items since they did not satisfy the psychometric properties tests using Principal Component Analyses.

Predictors of behavior: PBC and Intention (Items: listed under the PBC and Intention constructs).

List of items/questions of attitude, subjective norms, and perceived behavioral control from the survey.

A. Attitude (4 items were taken; 2 were dropped)

  1. It is wise to always use the following pain management strategy/(ies) whenever I feel pain.

  2. The following pain management strategy(ies) will relieve my pain (dropped)
  3. The following pain management strategy (ies) is/are necessary for managing my pain.
  4. I don’t think the following pain management strategy/(ies) will help manage my pain. (dropped)
  5. The following strategy/(ies) are at least somewhat helpful for managing pain, if it does not relieve it completely.
  6. Using the following strategy/(ies) to manage my pain is convenient for me

B. Subjective Norm (All items were taken)

  1. My family thinks that the following pain management strategies are acceptable for managing pain.
  2. My spouse/partner thinks that the following pain management strategies are acceptable for managing pain. (If applicable)
  3. My friends think that the following pain management strategies are acceptable for managing pain.
  4. My peers/classmates think that the following pain management strategies are acceptable for managing pain.

C. Perceived Behavioral Control (All item were taken)

  1. I am confident that I can manage my pain with the following strategy (ies).
  2. It is simple for me to handle my pain with the following pain management strategy (ies).
  3. If I am in pain, I would be able to financially afford to manage my pain by using the following pain management strategy (ies).
  4. If I am in pain, I would have sufficient time to manage my pain by using the following pain management strategy (ies).

Other explanatory variables

Sociodemographic and educational data about the participants’ sex, age, race, ethnicity, marital status, college level, health science field, and highest education earned were collected. Personal pain information was also included, such as pain interference in the past 30 days and experience of pain for more than 30 days, Primary Care Physician and pain specialist visits, and experiences using OTC, prescription medications, and nonmedication pain management.

Statistical analysis

The analyses were based on the statistical procedures recommended for the theory of reasoned action and TPB studies [20]. Since we adjusted the questionnaire items from the TPB questionnaire construction by Fishbein and Ajzen [18], we conducted the factorial analysis and internal reliability of our survey items. The resulting Cronbach’s alpha levels for internal consistency were appropriate for social research standards.

We conducted descriptive and correlation analyses to assess demographic, educational, and pain information and TPB construct correlations. All multi-question constructs were analyzed using means. Multiple linear regression models were performed to examine potential significant predictable associations between attitude, subjective norms, and PBC with intentions. Furthermore, a separate model was developed to observe if intention and PBC could predict the behavior of college students concerning the four pain management modalities. All statistics were evaluated with IBM SPSS Statistics 28.0 with a significance set at p≤0.05.

Results

Of the 364 returned surveys, 227 were completed and were included for analysis. Table 1 depicts the respondents’ demographics, educational characteristics, and pain information. Of all participants, the mean age was 24.8, and most respondents were female (69.2%), white (89.0%), and non-Hispanic (89.3%). A majority of the respondents (53.3%) were enrolled in undergraduate programs and had health insurance (98.2%). For a more comprehensive analysis in terms of controlling potentially confounding variables, we also collected other information related to the pain having been experienced before. An overwhelming majority of the study participants (77.5%) reported experiencing pain in the past 30 days before the time of survey administration. The intensity of pain experienced by this group was primarily mild (48.5%) and moderate (17.6%). As many as 37.9% of the respondents reported experiencing pain persisting for more than 30 days. From the data, we found that 90.3% of students have used OTC pain medication, only 38.8% have used prescription pain medications, and only 53.7% have tried non-medication pain treatment modalities.

Table 1: Descriptive of Demographics, Educational Degree, and Pain Information of Study’s College Students.

Frequency (N)

Percent (%)

Age

 

18-25

163

71.8

 

26-33

36

15.9

 

34-41

16

7.0

 

42-49

7

3.1

 

≥50

5

2.2

Sex

Male

70

30.8

Female

157

69.2

Race

White

202

89.0

Other

25

11.0

Ethnicity

Hispanic

8

3.5

Non-Hispanic

219

96.5

Marital Status

Married

40

17.6

Other

187

82.4

College Level

Undergraduate

121

53.3

Graduate

106

46.7

Health Sciences Field

Yes

67

29.5

No

160

70.5

Health Insurance

Yes

223

98.2

No

2

0.9

 

Unsure

2

0.9

Have experienced physical pain for more than 30 days

 

Yes

176

77.5

 

No

51

22.5

Frequency of pain interference with daily activity in the past 30 days

 

Not at all

45

19.8

 

A little bit

110

48.5

 

Moderately

40

17.6

 

Quite a bit

19

8.4

 

Extremely

7

3.1

Have experienced physical pain for more than 30 days

 

Yes

86

37.9

 

No

141

62.1

Rate of average pain for more than 30 days (if ever) experienced

 

Mild (1-3)

18

7.9

 

Moderate (4-6)

59

26.0

 

Severe (7-10)

9

4.0

Frequency of pain interference (if ever) with daily activity for more than 30 days

 

Not at all

7

3.1

 

A little bit

31

13.7

 

Moderately

28

12.3

 

Quite a bit

13

5.7

 

Extremely

7

3.1

Physical pain experienced can be very burdensome

 

Strongly disagree

36

15.9

 

 

Somewhat disagree

32

14.1

 

Neutral

41

18.1

 

Somewhat agree

91

40.1

 

Strongly agree

27

11.9

Physical pain experienced made unable to concentrate

 

Strongly disagree

24

10.6

 

Somewhat disagree

32

14.1

 

Neutral

40

17.6

 

Somewhat agree

107

47.1

 

Strongly agree

24

10.6

Physical pain experienced could prevent from doing daily activities

 

Strongly disagree

35

15.4

 

Somewhat disagree

43

18.9

 

Neutral

22

9.7

 

Somewhat agree

98

43.2

 

Strongly agree

29

12.8

Have used OTC pain medication

 

Yes

205

90.3

 

No

22

9.7

Have used prescription pain medication

 

Yes

88

38.8

 

No

139

61.2

Have used non-medication pain therapy in the past

 

Yes

122

53.7

 

No

105

46.3

Frequency of primary care physician visit or other healthcare providers for pain management

 

Never

90

39.6

 

Rarely

77

33.9

 

Sometimes

51

22.5

 

Very often

9

4.0

 

Always

0

0.0

Have been referred to a pain specialist

 

Yes

23

10.1

 

No

204

89.9

Note: Based on 227 eligible respondents aged 18 years or older completed the survey until the intention and behavior questions.

Summary statistics for each TPB construct are shown in Table 2. College students’ attitudes were the most favorable toward OTC pain medication (mean=3.54) across all pain modality groups. The same trend was also found in subjective norms, where OTC pain medications were the most preferable (mean=4.04), followed by yoga/exercise (mean=3.48). PBC was very favorable in OTC pain medication (mean=4.03) and moderately favorable in prescription medication and yoga/exercise (mean=3.35). Intention and behavior were very favorable for OTC pain medication (mean=4.26; mean=3.14), moderately favorable for yoga/exercise (mean=3.66; mean=2.60), and less favorable for mindfulness therapy (mean=2.98; mean=1.86). Regarding behavior, prescription pain medication was the least favorite of all pain treatment modalities (mean=1.51). All constructs were deemed reliable (intention excluded) based on internal consistency testing. Bivariate analysis results are shown in Appendices. A correlation was observed between attitude, subjective norms, and PBC with intention and behavior. All correlative interactions appeared to be significant.

Table 2: Summary Statistics (Mean) and Cronbach’s Alpha of Theory of Planned Behavior Construct Scales.

Mean

Cronbach’s Alpha

(Reliability test)

OTC Pain Medication

Attitude

3.54

0.720

Subjective Norms

4.04

0.698

Perceived Behavioral Control

4.03

0.809

Intention

4.26

-

Behavior

3.14

0.956

Prescription Medication

 

 

Attitude

2.58

0.739

Subjective Norms

3.18

0.760

Perceived Behavioral Control

3.00

0.746

Intention

2.53

-

Behavior

1.51

0.938

Mindfulness Therapy

 

 

Attitude

3.01

0.805

Subjective Norms

3.18

0.684

Perceived Behavioral Control

3.05

0.759

Intention

2.98

-

Behavior

1.86

0.970

Yoga/Exercise

 

 

Attitude

3.30

0.802

Subjective Norms

3.48

0.665

Perceived Behavioral Control

3.35

0.744

Intention

3.66

-

Behavior

2.60

0.960

Note: Based on 227 eligible respondents aged 18 years or older completing the survey until the intention and behavior questions. The intention construct has no reliability test/Cronbach’s alpha because there was only one question about college student's intention to use pain management strategies.




Multivariate analysis is shown in Tables 3 and 4. Attitude and PBC were the two significant predictors of intention, except in OTC pain medications. PBC was not significant in predicting the intention (β=0.04; 95%CI=-0.25, 0.35; p=0.742). Interestingly, the construct of subjective norms was only significant in the prescription pain medication (β=0.16; 95%CI=0.01, 0.44; p=0.045). In the second regression model, where behavior was the outcome, we revealed that intention consistently predicted pain management behaviors, and the PBC was only significant in predicting the behavior of yoga/exercise (β=0.33; 95%CI=0.23, 0.88; p=0.001). All models showed acceptable effect sizes with adjusted R2 values of 50-60%.

Table 3: Associations between TPB constructs with Intention using Multiple Linear Regression.

Predictors of Intention

Coefficient (β)

(95% CI)

p-value

Adjusted

R2

OTC Pain Medication

53.2%

Attitude

0.53        (0.42,0.92)

<0.001

Subjective Norms

0.01        (-0.28,0.31)

0.915

Perceived Behavioral Control

0.04        (-0.25,0.35)

0.742

Prescription Pain Medication (RX)

64.8%

Attitude

0.34        (0.22,0.83)

<0.001

Subjective Norms

0.16        (0.01,0.44)

0.045

Perceived Behavioral Control

0.38        (0.28,0.84)

<0.001

Mindfulness

54.6%

Attitude

0.58        (0.50,1.17)

<0.001

Subjective Norms

-0.10       (-0.50,0.18)

0.360

Perceived Behavioral Control

0.27        (0.07,0.76)

0.019

Yoga/Exercise

61.3%

Attitude

0.49        (0.40,0.97)

<0.001

Subjective Norms

0.02        (-0.23,0.28)

0.850

Perceived Behavioral Control

0.35        (0.25,0.85)

<0.001

Notes: Variables controlled: Sex, age, race, ethnicity, marital status, college level, health science field, highest education level earned, pain interference in the past 30 days and experience of pain more than 30 days, Primary Care Physician, and pain specialist visits, and having used to OTC, prescription medications, and non-medication pain management.


Table 4: Associations between TPB constructs with Behavior using Multiple Linear Regression.

Predictors of Behavior

Coefficient* (95% CI)

p-value

Adjusted R2

OTC Pain Medication

55.2%

Perceived Behavioral Control

0.16        (-0.06, 0.53)

0.118

Intention

0.49        (0.32, 0.76)

<0.001

Prescription Pain Medication (RX)

51.8%

Perceived Behavioral Control

0.02        (-0.26, 0.30)

0.888

Intention

0.47        (0.17, 0.58)

<0.001

Mindfulness

67.2%

Perceived Behavioral Control

0.16        (-0.02, 0.47)

0.072

Intention

0.62        (0.40, 0.72)

<0.001

Yoga/Exercise

64.5%

Perceived Behavioral Control

0.33        (0.23, 0.88)

0.001

Intention

0.59        (0.42, 0.84)

<0.001

Note: Variables controlled: Sex, age, race, ethnicity, marital status, college level, health science field, highest education level earned, pain interference in the past 30 days and experience of pain more than 30 days, Primary Care Physician, and pain specialist visits, and having used to OTC, prescription medications, and non-medication pain management.

Discussion

The present study examined the attitude and beliefs of college students toward pain management modalities using the TPB. The main findings highlighted the most important predictors associated with the use of pain management modalities. Our research suggested that attitude was a key factor in predicting college students’ intention to use most of the pain management modalities, except for OTC. PBC was also a significant predictor of intention to use prescription pain medications, mindfulness therapy, and yoga/exercise.

In this study, a great number of students (77.5%) reported pain in the past 30 days prior to taking the survey. This number is consistent with the self-reported acute pain prevalence in other studies that range from 40% to 90% among college individuals. Some plausible explanations for this high number are that college-age students are prone to acute pain due to certain conditions, i.e., dysmenorrhea [21,22] and orofacial pain [23]. College individuals are known to be physically active [24], using a considerable amount of time on their phone [25] and computer [26], that makes them more vulnerable to musculoskeletal pain.

This study employed the TPB framework to assess how college students perceive pain management modalities because college students are regarded as mature and independent individuals capable of performing an action at a specific time and place [15]. The TPB explains the actions of pain management over which college students can exert self-control. The TPB framework postulates that three constructs can predict intentions: attitude toward a particular activity, subjective norm (subjective views of surrounding people on an

action), and Perceived Behavioral Control (PBC) (beliefs about the resourcefulness or capability of performing an activity). Also, this theory states that, together with intention, PBC may influence behavior directly [15-17].

Attitude in the TPB model refers to an individual’s positive or negative assessment of the intention to do a certain behavior [15]. It usually involves assessing the consequences of performing the behavior. According to our findings, college students are more likely to consider their personal assessment of the effectiveness of a specific pain management modality when intending to use it. Of all pain management modalities, we observed higher means of TPB constructs toward intention to use OTC and a statistically significant association between attitude and OTC use intention. These findings were consistent with a study that showed attitude as the most important predictor of OTC purchase intention [27].

Almalak and colleagues reported that 80.0% of students used OTC products to manage their pain [28]. This high percentage of OTC pain medication use can be attributed to the PBC regarding the OTC pain medication and individual pain experience, leading to intent to self-medicate [29]. Brabas and colleagues also reported that OTC users feel confident about their skills in effectively managing pain [30]. In our study, compared to the OTC medication, the constructs of TPB were less favorable to the prescription painkillers. Negative attitudes concerning prescription pain medications have arisen from apprehension and emotional distress. McCraken and colleagues found a strong association between concerns about prescription pain medications and measures of emotional distress and disability, suggesting that these concerns may add significantly to the pain burden [31]. Vargas-Schaffer reported that individuals had relatively higher negative attitudes (39.7%) compared to positive attitudes (32.2%) towards opioids (i.e., one of the commonly prescribed pain drugs) which might also partially explain the negative attitude towards prescription pain medication in college students responding to our study [32].

TPB constructs were also found to have a higher mean for yoga/exercise than mindfulness therapy. Williams and Hartvigsen found that yoga and exercise improved pain levels and reduced the need for OTC pain medication and prescription pain medication [33,34]. Previous studies have reported that a positive attitude can lead to engaging in healthy behaviors of yoga and exercise [35-37]. On the other hand, a negative attitude toward mindfulness therapy was found in WVU college students. A plausible explanation for this finding was due to the misconceptions about mindfulness, which included associating it with religious activities, meditation, prayer, or reminiscence [38].

In our analysis, the SN was only associated with the intention to use prescription pain management modality. Our findings are consistent with Sheeran, et al., who found that attitude predicts intention better than the subjective norm in the general context of college students’ decision-making [39]. Another possible explanation for this finding is that higher PBC tends to enhance the association between attitude and intention while decreasing the importance of subjective norms [40].

We examined whether PBC and intention predicted pain management modality behavior in a separate analysis. PBC was significant in predicting yoga/exercise behavior and was not associated with the other pain modalities. Furthermore, intention predicted pain management behavior across all modalities in college students. Thus, taken together, these findings confirmed that intention rather than PBC shaped the behavior [15,16].

This study has several strengths. Using a well-established theoretical framework and guided analytical methods guarantees robust findings. Our study showed that the TPB constructs performed well with outcomes. We also incorporated various explanatory factors in the analyses to purify the associations between the TPB constructs and the outcomes (intention and behavior). This exceptional step corroborated the models being tested. As pain is a subjective and multidimensional concept, we collected the pain information using valid survey intensity-pain scales [41]. This method of measurement is a common practice in pain-related survey studies [42-44]. However, limitations existed. Considering the nature of the survey study, there was a possibility of recall and social desirability biases. The study’s small sample size could decrease the effect size’s flexibility and statistical power [45]. Although reporting bias could be associated with the pain data collected, studies suggest that getting pain information from the individual experiencing the pain is still the best source of information [41,43]. Pain may be assessed using physiological markers; however, the objective assessment has a multitude of challenges and is impractical to be conducted in survey studies [46].

Conclusion

College students’ attitude and PBC were the top predictors of intention to choose pain management modalities, and intention predicted behavior. Research with robust study design is needed to confirm our study findings.

Acknowledgement

Research reported in this publication was supported by the National Institute on Minority Health and Health Disparities through the Texas Center for Health Disparities (NIMHD), 5U54MD006882-10 (Usha Sambamoorthi). The paper’s content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Ethics Approval

The ethics of our study was approved by West Virginia University’s Institutional Review Board (IRB) as exempt (protocol #1902448962).

References

  1. Dahlhamer J, Lucas J, Zelaya C, Nahin R, Mackey S, et al. (2018) Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults-United States, 2016. MMWR Morb Mortal Wkly Rep 67: 1001
  2. Gureje O, Von Korff M, Simon GE, Gater R (1998) Persistent pain and well-being: a World Health Organization Study in Primary Care. JAMA 280: 147-151.
  3. National Pain Strategy Report (2016) | IPRCC. Washington, DC: US Department of Health and Human Services, National Institutes of
  4. Jensen MP, Karoly P, Braver S (1986) The measurement of clinical pain intensity: a comparison of six methods. Pain 27: 117-126.
  5. Kawai K, Kawai AT, Wollan P, Yawn BP (2017) Adverse impacts of chronic pain on health-related quality of life, work productivity, depression and anxiety in a community-based study. Fam Pract 34: 656-661.s
  6. Institute of Medicine (US) Committee on Advancing Pain Research, Care, and Education (2011) Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US).
  7. Murray CB, de la Vega R, Murphy LK, Kashikar-Zuck S, Palermo TM (2022) The prevalence of chronic pain in young adults: a systematic review and meta-analysis. Pain 163: e972-e984.
  8. Lynch ME, Watson CPN (2006) The pharmacotherapy of chronic pain: A review. Pain Res Manag 11: 11-38.
  9. Miller GF, Guy GP, Zhang K, Mikosz CA, Xu L (2019) Prevalence of Nonopioid and Opioid Prescriptions among Commercially Insured Patients with Chronic Pain. Pain Med 20: 1948-1954.
  10. Pergolizzi J, Böger RH, Budd K, Dahan A, Erdine S, et al. (2008) Opioids and the management of chronic severe pain in the elderly: Consensus statement of an international expert panel with focus on the six clinically most often used world health organization step III opioids (Buprenorphine, Fentanyl, Hydromorphone, Methadone, Morphine, Oxycodone). Pain Pract 8: 287-313.
  11. Kaye AD, Baluch A, Scott JT (2010) Pain Management in the Elderly Population: A Review. Ochsner J 10: 179.
  12. Prostran M, Vujović KS, Vučković S, Medic S, Srebro D, et al. (2016) Pharmacotherapy of Pain in the Older Population: The Place of Front Aging Neurosci 8: 144.
  13. Sathornviriyapong A, Nagaviroj K, Anothaisintawee T (2016) The association between different opioid doses and the survival of advanced cancer patients receiving palliative care. BMC Palliat Care 15: 95.
  14. Mills SEE, Nicolson KP, Smith BH (2019) Chronic pain: a review of its epidemiology and associated factors in population-based studies. Br J Anaesth 123: e273-e283.
  15. Ajzen I (1991) The theory of planned behavior. Organ Behav Hum Decis Process 50: 179-211.
  16. Ajzen I (2020) The theory of planned behavior: Frequently asked Hum Behav Emerg Technol 2: 314-324.
  17. Bosnjak M, Ajzen I, Schmidt P (2020) The Theory of Planned Behavior: Selected Recent Advances and Applications. Eur J Psychol 16: 352
  18. Fishbein M, Ajzen I (2011) Predicting and Changing Behavior: The Reasoned Action Approach. Psychology Press.
  19. (2022) Flesch Reading Ease and the Flesch Kincaid Grade Level –
  20. Hankins M, French D, Horne R (2007) Statistical guidelines for studies of the theory of reasoned action and the theory of planned behavior. Psychol Health15: 151-161.
  21. Hu Z, Tang L, Chen L, Kaminga AC, Xu H (2020) Prevalence and Risk Factors Associated with Primary Dysmenorrhea among Chinese Female University Students: A Cross-sectional Study. J Pediatr Adolesc Gynecol 33: 15-22.
  22. Fernández-Martínez E, Onieva-Zafra MD, Laura Parra-Fernández M (2018) Lifestyle and prevalence of dysmenorrhea among Spanish female university students. PLoS One 13: e0201894.
  23. Smiljić S, Savic S, Stevanovic J, Kostic M (2016) Prevalence and characteristics of orofacial pain in university students. J Oral Sci 58: 7-13.
  24. Grasdalsmoen M, Engdahl B, Fjeld MK, Steingrímsdóttir OA, Nielsen CS, et al. (2020) Physical exercise and chronic pain in university PLoS One 15: e0235419.
  25. Al-Hadidi F, Bsisu I, AlRyalat SA, Al-Zubi B, Bsisu R, et al. (2019) Association between mobile phone use and neck pain in university students: A cross-sectional study using numeric rating scale for evaluation of neck pain. PLoS One 14: e0217231.
  26. Osama M, Ali S, Malik RJ (2018) Posture related musculoskeletal discomfort and its association with computer use among university J Pak Med Assoc 68: 639-641.
  27. Sehgal M, Mittal A (2019) Interplay between Attitude and Purchase Intention: An Empirical Survey on Over-the-Counter (OTC) Drugs Consumer Behaviour. Indian J Public Health Res Dev.
  28. Almalak H, Albluwi AI, Alkhelb DA, Alsaleh HM, Khan TM, et al. (2014) Students’ attitude toward use of over the counter medicines during exams in Saudi Arabia. Saudi Pharm J 22: 107-112.
  29. Pineles LL, Parente R. Using the theory of planned behavior to predict self-medication with over-the-counter analgesics. J Health Psychol 18: 1540-1549.
  30. Brabers AEM, Van Dijk L, Bouvy ML, De Jong JD (2013) Where to buy OTC medications? A cross-sectional survey investigating consumers’ confidence in over-the-counter (OTC) skills and their attitudes towards the availability of OTC painkillers. BMJ Open 3: e003455.
  31. McCracken LM, Hoskins J, Eccleston C (2006) Concerns about medication and medication use in chronic pain. J Pain 7: 726-734.
  32. Vargas-Schaffer G, Cogan J (2018) Attitudes Toward Opioids and Risk of Misuse/Abuse in Patients with Chronic Noncancer Pain Receiving Long-term Opioid Therapy. Pain Med 19: 319-327.
  33. Williams K, Abildso C, Steinberg L, Doyle E, Epstein B, et al. (2009) Evaluation of the effectiveness and efficacy of Iyengar yoga therapy on chronic low back pain. Spine (Phila Pa 1976) 34: 2066-2076.
  34. Hartvigsen J, Morsø L, Bendix T, Manniche C (2010) Supervised and non-supervised Nordic walking in the treatment of chronic low back pain: A single blind randomized clinical trial. BMC Musculoskelet Disord 11: 30.
  35. Rich SC, Rogers ME (2001) Stage of exercise change model and attitudes toward exercise in older adults. Percept Mot Skills 93:141
  36. Gnanendran A, Pyne DB, Fallon KE, Fricker PA (2011) Attitudes of medical students, clinicians and sports scientists towards exercise J Sports Sci Med 10: 426-431.
  37. Speed-Andrews AE, Stevinson C, Belanger LJ, Mirus JJ, Courneya K (2012) Predictors of adherence to an Iyengar yoga program in breast cancer survivors. Int J Yoga 5: 3-9.
  38. Felver JC, Doerner E, Jones J, Kaye NC, Merrell KW (2013) Mindfulness in school psychology: applications for intervention and professional practice. Psychol Sch 50: 531-547.
  39. Sheeran P, Norman P, Orbell S (1999) Evidence that intentions based on attitudes better predict behaviour than intentions based on subjective norms. Eur J Soc Psychol 29: 403-406.
  40. La Barbera F, Ajzen I (2020) Control Interactions in the Theory of Planned Behavior: Rethinking the Role of Subjective Norm. Eur J Psychol 16: 401-417.
  41. Ferreira-Valente MA, Pais-Ribeiro JL, Jensen MP (2011) Validity of four pain intensity rating scales. Pain 152: 2399-2404.
  42. Bishop PA, Herron RL (2015) Use and Misuse of the Likert Item Responses and Other Ordinal Measures. Int J Exerc Sci 8: 297-302.
  43. John MJ, Mitten D, Hammert WC (2017) Efficacy of PROMIS Pain Interference and Likert Pain Scores to Assess Physical Function. J Hand Surg Am 42: 705-710.
  44. Sullivan GM, Artino AR (2013) Analyzing and interpreting data from likert-type scales. J Grad Med Educ 5: 541-542.
  45. Serdar CC, Cihan M, Yücel D, Serdar M (2021) Sample size, power and effect size revisited: simplified and practical approaches in preclinical, clinical and laboratory studies. Biochem Med (Zagreb) 31:
  46. Cowen R, Stasiowska MK, Laycock H, Bantel C (2015) Assessing pain objectively: the use of physiological markers. Anaesthesia 70: 828

Appendices

Appendix 1: Pearson Correlations between the Constructs and Intention for Each Pain Management Modality.

 

A. OTC Pain Medication

 

 

 

Intention (OTC)

Attitude

Pearson Correlation

0.665**

Sig. (2-tailed)

<0.001

N

227

Subjective Norms

Pearson Correlation

0.345*c

Sig. (2-tailed)

<0.001

N

227

Perceived Behavioral Control

Pearson Correlation

0.511**

Sig. (2-tailed)

<0.001

N

227

**Correlation is significant at the 0.01 level (2-tailed).

 

 

 

B. Prescription Pain Medication (RX)

 

 

Intention (RX)

Attitude

Pearson Correlation

0.724**

Sig. (2-tailed)

<0.001

N

227

Subjective Norms

Pearson Correlation

0.512**

Sig. (2-tailed)

<0.001

N

227

Perceived Behavioral Control

Pearson Correlation

0.670**

Sig. (2-tailed)

<0.001

N

227

** Correlation is significant at the 0.01 level (2-tailed).

 

 

C. Mindfulness Thera

py

 

 

Intention (Mindfulness)

Attitude

Pearson Correlation

0.747**

Sig. (2-tailed)

<0.001

N

227

Subjective Norms

Pearson Correlation

0.442**

Sig. (2-tailed)

<0.001

N

227

Perceived Behavioral Control

Pearson Correlation

0.322**

C. Mindfulness Therapy

 

 

Intention (Mindfulness)

 

Sig. (2-tailed)

<0.001

N

227

**Correlation is significant at the 0.01 level (2-tailed).

 

D. Yoga/Exercise

 

 

 

Intention (Yoga/Exercise)

Attitude

Pearson Correlation

0.725**

Sig. (2-tailed)

<0.001

N

227

Subjective Norms

Pearson Correlation

0.374**

Sig. (2-tailed)

<0.001

N

227

Perceived Behavioral Control

Pearson Correlation

0.590**

Sig. (2-tailed)

<0.001

N

227

**Correlation is significant at the 0.01 level (2-tailed).

 

 

C. Mindfulness Thera

py

 

 

Behavior (Mindfulness)

Perceived Behavioral Control

Pearson Correlation

0.528**

Sig. (2-tailed)

<0.001

N

227








Appendix 2: Pearson Correlations between the Constructs and Intention for Each Pain Management Modality.

A. OTC Pain Medicati

on

 

 

Behavior (OTC)

Perceived Behavioral Control

Pearson Correlation

0.347**

Sig. (2-tailed)

<0.001

N

227

Intention

Pearson Correlation

0.690**

Sig. (2-tailed)

<0.001

N

227

**Correlation is significant at the 0.01 level (2-tailed).

 

 

B. Prescription Pain Medication (RX)

 

 

Behavior (RX)

Perceived Behavioral Control

Pearson Correlation

0.379**

Sig. (2-tailed)

<0.001

N

227

Intention

Pearson Correlation

0.615**

Sig. (2-tailed)

<0.001

N

227

**Correlation is significant at the 0.01 level (2-tailed).

 

C. Mindfulness Thera

py

 

 

Behavior (Mindfulness)

Intention

Pearson Correlation

0.726**

Sig. (2-tailed)

<0.001

N

227

**Correlation is significant at the 0.01 level (2-tailed).

 

 

D. Yoga/Exercise

 

 

 

Behavior (Yoga/Exercise)

Perceived Behavioral Control

Pearson Correlation

0.549**

Sig. (2-tailed)

<0.001

N

227

Intention

Pearson Correlation

0.743**

Sig. (2-tailed)

<0.001

N

227

**Correlation is significant at the 0.01 level (2-tailed).

 

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Chronic Pain & Management