Beliefs, treatment use, preferences, and provider choice for low back pain among adults of Pakistani origin: A cross-sectional study

Background Decisions about low back pain (LBP) care are shaped by beliefs, perceived benefits, and healthcare access. Most studies originate from high-income settings, and few link belief profiles to both current care-seeking behaviour and future preferences within the same dataset. Objective This study examined how LBP-related beliefs and psychosocial factors relate to treatment behaviours and preferences among adults of Pakistani origin living in Pakistan or Australia. Methods A cross-sectional survey of adults with non-specific LBP captured measures of back beliefs, fear-avoidance, catastrophising, pain resilience, imaging beliefs, and pain intensity. Outcomes included treatments used for the most recent episode, preferred treatments for a future episode, and preferred healthcare professional. Associations were analysed using logistic regression models adjusted for demographic covariates, based on complete-case data. Results Of 461 participants, psychosocial and demographic factors were not independently associated with exercise use, within the adjusted models. Higher pain intensity was associated with medication use (OR = 1.13, 95% CI 1.02, 1.26). Compared to Australia, participants in Pakistan reported lower odds of rest (OR = 0.64, 95% CI 0.42, 0.97) and lower preference for massage (OR = 0.36, 95% CI 0.22, 0.57). Female gender predicted preference for medication (OR = 1.83, 95% CI 1.16, 2.87). In provider preferences, higher fear-avoidance was associated with preferring a medical specialist, catastrophising was associated with preference for alternative practitioners (e.g., herbal, homeopathic, or Unani), and lower education predicted self-management/ no care. Conclusion Beliefs were not significantly associated with exercise use, but specific constructs were associated with provider preferences away from physiotherapy/ exercise based care. Pain intensity was associated with medication use rather than beliefs.