Table 1.

Overview of the public health campaign development and evaluation

Stage 1	This stage involved the design of a draft health promotion strategy in collaboration with a creative innovation agency. Researchers pitched the idea of raising awareness of the harms of unnecessary imaging for low back pain. A key goal of the strategy was to encourage community members to ask questions of their doctor and engage in the decision‐making process. The agency produced draft versions of 5 digital posters and one patient leaflet.
Stage 2	This stage involved revision of the health promotion strategy materials based on expert feedback. The experts included an orthopaedic surgeon, emergency physicians, physiotherapists and back pain researchers. During Stage 2 experts decided that the agency's initial preference to focus on the harms of radiation to deter patients from imaging could not be supported well enough by data (Appendix S1). Following this feedback, the agency shifted focus to the harms of overdiagnosis, including incidental findings that cause worry and increase the risk of unnecessary surgery. Revised versions of the 5 digital posters and patient leaflet were provided to researchers for further testing.
Stage 3	It involved conducting an online randomized trial of the patient leaflet with a sample of 418 community members in Australia. 19 Stage 3 testing revealed that the leaflet with messages about overdiagnosis could reduce intention to request imaging for low back pain compared with a control leaflet with neutral information about imaging. The patient leaflet also reduced the belief that everyone with low back pain should have imaging.
Stage 4	This stage is the focus of this study and was a qualitative study with 19 community members which aimed to gather their views of Stage 3 versions of the intervention materials which included five posters and a leaflet (Appendix S2).
Stage 5	This stage will be rigorous evaluation in large‐scale randomized trial in a real‐life clinical practice setting.