Chronic pain is a public health priority that affects 18% of Dutch and 16% of German adults, representing a major societal burden. The Ems Dollart Region (EDR), which forms the northern part of the Dutch–German border area, is particularly characterised by lower incomes, more physically demanding jobs and lower health literacy, which are associated with higher pain prevalence. Individuals with lower socioeconomic status face greater pain-related disability and reduced quality of life. Public health campaigns underpinned by pain science education provide a strategy to improve understanding of pain among the wider public by addressing common misconceptions about its causes and management. However, large-scale population-level interventions and evaluations of such campaigns remain limited.

This protocol describes the design and implementation of a cross-border public health campaign in the EDR, aimed at improving public understanding of pain, changing attitudes and beliefs and promoting healthy behaviours. We will conduct a quasi-experimental before–after study in the EDR with a control group in Flanders (Belgium). The intervention is guided by behaviour change and biopsychosocial models. The campaign will deliver tailored content via social media, broadcast, print and online advertisements over a 24-month period. Two independent cross-sectional samples will be surveyed at baseline and at 2-year follow-up, comprising 3200 participants per measurement wave from three regions: the Netherlands and Germany as intervention regions, and Flanders, Belgium, as the control region. The primary outcome is the prespecified Pain Concepts Questionnaire ratio score, assessing pain-related knowledge, attitudes and beliefs. The primary analysis will use an adjusted difference-in-differences framework to estimate whether change in the primary outcome differs between the combined intervention regions and the control region. Secondary analyses will examine the Netherlands and Germany separately and will evaluate healthcare utilisation, medication use, health-related quality of life and work absenteeism.

This study protocol was reviewed by the Medical Ethics Review Board of the University Medical Center Groningen and the University of Oldenburg. The study was considered not subject to the Medical Research Involving Human Subjects Act (non-WMO declaration; reference number M24.345555, issued on 31 December 2024) and was approved by the University of Oldenburg Ethics Committee (reference number 2025–056, issued on 07 March 2025). Informed consent was obtained electronically by the research agency at the time of participants’ registration with the research panel. Study findings, regardless of outcome, will be disseminated through peer-reviewed publications and presentations at national and international conferences.

This study aimed to (1) examine if activity fluctuations over 1 week differ between two groups: individuals who have received fatigue management advice versus those who have not, (2) examine the associations between activity fluctuations and fatigue, engagement in pacing, perceived risk of overactivity, quality of life, self-regulation and physical activity (PA) and if they differ for the two groups and (3) explore whether there are distinct pacing patterns across the week in adults with chronic conditions.

Exploratory cross-sectional observational study.

Participants were recruited from a fatigue management clinic in the UK and through university networks.

29 adults with chronic conditions who experience fatigue (18 received fatigue management advice; 11 did not).

The primary outcome was activity fluctuations (SD of accelerometer-derived vector magnitude counts per minute), measured using the ActiGraph wGT3X-BT over 7 consecutive days. Secondary outcomes included fatigue (Fatigue Severity Scale), engagement in activity pacing, perceived risk of overactivity, quality of life (Functional Assessment of Cancer Therapy-General Instrument), self-regulation of PA (Physical Activity Self-Regulation scale) and self-reported PA (International Physical Activity Questionnaire-short form).

No difference in activity fluctuations during the day was found between groups. Associations between self-regulation of PA and device-based PA with activity fluctuations significantly differed between groups (respectively, standardised regression (β)=1686.14; p=0.006 and β=288.83; p=0.042). Five distinct activity pacing patterns were identified through visual inspection of individual activity profiles: (1) high fluctuations in the morning, (2) high fluctuations in the afternoon, (3) high fluctuations at two time points, (4) consistent pacing pattern and (5) varied pacing patterns.

Individuals who received fatigue management advice demonstrated significant associations between activity fluctuations and self-regulation, suggesting a goal-directed approach, which could indicate that tailored support and goal setting could help in balancing rest and activity. This study also identified five distinct activity pacing patterns in individuals with chronic conditions, emphasising the need for tailored fatigue management instead of a ‘one-size-fits-all’ approach.

NCT06001970.