Chronic pain is identified as a public health priority in the source population. Reported prevalence figures are approximately 18% of adults in the Netherlands and 16% in Germany. The Ems Dollart Region (EDR) forms the northern part of the Dutch–German border area and is described as having lower incomes, more physically demanding occupations and lower health literacy—factors associated with higher pain prevalence and greater pain-related disability. Individuals with lower socioeconomic status in the region experience reduced quality of life related to pain.
Public health campaigns grounded in pain science education are presented as a strategy to improve population-level understanding by addressing widespread misconceptions about pain causes and management. The protocol notes that large-scale, population-level interventions and evaluations of such campaigns remain limited, motivating the current cross-border initiative.
The project is designed as a quasi-experimental before–after study with a control region. The intervention regions are the Netherlands and Germany within the EDR. Flanders, Belgium, is selected as the control region. Two independent cross-sectional samples will be collected at baseline and at 2-year follow-up.
Each measurement wave will include 3,200 participants drawn across the three regions (the two intervention regions combined and the control region). The overall intent is to compare change over time in the intervention areas with change over time in the control area.
The campaign is guided by behaviour change theories and biopsychosocial models of pain. Its objectives are to improve public understanding of pain, change attitudes and beliefs, and promote healthy behaviours relevant to pain management.
Campaign content will be tailored for the target population and disseminated across multiple channels. Delivery methods specified in the protocol include social media, broadcast media, print and online advertisements. The planned duration of the campaign is 24 months.
Two independent cross-sectional samples will be surveyed: one at baseline and one at 2-year follow-up after the start of the campaign. Each wave will include 3,200 participants sampled from the three regions (Netherlands, Germany, and Flanders). Participant recruitment and consent were handled via a commercial research panel; informed consent was obtained electronically at the time of registration with that panel.
The protocol does not provide additional details in the source text about sampling frames, inclusion or exclusion criteria, or demographic quotas beyond the regional sampling and sample size per wave.
The prespecified primary outcome is the Pain Concepts Questionnaire ratio score, which measures pain-related knowledge, attitudes and beliefs. This instrument is central to the evaluation and will be used to determine whether the campaign achieved its primary aim of shifting public understanding of pain.
Secondary outcomes listed in the protocol include measures of healthcare utilisation, medication use, health-related quality of life and work absenteeism. The source text does not provide further detail about the specific instruments or time windows for these secondary measures.
The primary analysis will use an adjusted difference-in-differences framework to estimate whether the change in the primary outcome from baseline to 2-year follow-up differs between the combined intervention regions (Netherlands and Germany) and the control region (Flanders). Secondary analyses will examine the Netherlands and Germany separately.
No further modelling details, covariates for adjustment, or power calculations are reported in the provided source text.
The protocol was reviewed by the Medical Ethics Review Board of the University Medical Center Groningen and by the University of Oldenburg. The study was considered not subject to the Dutch Medical Research Involving Human Subjects Act (non-WMO declaration; reference number M24.345555, issued 31 December 2024). The University of Oldenburg Ethics Committee approved the study (reference number 2025 - 056, issued 07 March 2025). Informed consent was obtained electronically via the research agency at the time of participants' registration with the research panel.
The protocol states that study findings, irrespective of outcome, will be disseminated through peer-reviewed publications and presentations at national and international conferences. No additional dissemination formats or timelines are reported in the source text.