Contemporary media campaigns for musculoskeletal pain: A systematic review and meta-analysis with social marketing benchmarking.

Musculoskeletal pain is a global public health problem. Social marketing aims to increase adoption of desired behaviours in target audiences and may uncover new strategies to improve uptake of helpful pain-related behaviours at the population-level. We systematically evaluated effects of contemporary mass media campaigns targeting musculoskeletal pain and used social marketing benchmarking to explore strategies associated with campaign success. Published evaluations of campaigns involving an online/digital component and a comparator/control condition were eligible. The primary outcome was population beliefs; secondary outcomes were healthcare provider beliefs, behavioural (e.g., healthcare-related, work-related), clinical (e.g., pain), and economic outcomes. Decision-rules and meta-analyses (random-effects models) were used to synthesise findings. Eight databases and grey literature were searched from inception to May-2024. Thirteen eligible publications evaluated eight campaigns (N=5 back pain, N=2 rheumatic pain; N=1 work-related pain) from eight Western/high-income countries. All evaluations reported historical control data (interrupted time-series/before-and-after designs); three also compared selected outcomes to an unexposed geographical region (quasi-experimental designs). Risk of bias was weak-moderate for all evaluations. Population beliefs improved from baseline vs. final follow-up (1.5-10yrs) for items related to 'staying active' [RR=1.38 (95%CI: 1.14-1.67), N=4 campaigns, n=12,568 participants] and 'rest' [RR=1.35 (95%CI: 1.14-1.60), N=5 campaigns, n=14,571 participants] for pain management, however, certainty of evidence was very low. Other outcomes were not pooled due to heterogeneity, and evidence was mixed. Greater numbers of social marketing benchmarks were associated with successful campaign outcomes. Future campaigns should implement social marketing strategies beyond education alone, including behaviour change support, to facilitate adoption of desired pain-related behaviours. REGISTRATION: PROSPERO registration number: CRD42023400456; Open Science Framework (detailed Social Marketing Benchmarking analysis plan): https://osf.io/npyck/ PERSPECTIVE: We systematically evaluated contemporary mass media campaigns targeting musculoskeletal pain. Promising improvements in population beliefs about pain supports continued investment into campaigns. Our review provides critical new information including social marketing strategies to ensure future campaign efforts shift population-level pain-related behaviours, towards reducing the societal burden of pain.