Introduction Low back pain is a global health challenge with negative consequences for both individuals and healthcare systems. The Choosing Wisely initiative aims to improve communication between patients and clinicians to promote informed healthcare decisions while avoiding unnecessary tests and treatments. The objective of this project is to co-create an information resource in the form of a leaflet, to be distributed in clinical settings, websites or social media targeting people with low back pain.

Methods This multi-method study was conducted in four stages: literature search, input from practice consultants, program theory development, and think-aloud interviews with people experiencing low back pain. Each stage was followed by a consensus meeting in which the steering group refined the leaflet based on the emerging knowledge.

Results The literature search highlighted patients’ need for understandable information about diagnosis, treatment options, and self-management strategies. Practice consultants emphasized concise, relatable content. The program theory identified potential mechanisms and design targets for content creation, development, and implementation of the leaflet, such as addressing patient concerns, reducing diagnostic uncertainty, offering insights into management options, and validation. Think-aloud interviews with 18 people living with low back pain informed the iteration of the leaflet, enhancing language clarification and content comprehension.

Conclusion We co-created a new Choosing Wisely leaflet, created with end-users in mind, specifically focused on reducing unnecessary imaging for low back pain. Valuable feedback from end-users prompted significant revisions, underscoring the importance of involving multiple end-user viewpoints into the creation process.

All authors state no conflict of interest. MSH has received support from non-industrial professional, private, and scientific bodies (reimbursement of travel costs and speaker fees) for lectures on pain, and he receives book royalties from Gyldendal, Munksgaard Denmark, FADL, and Muusmann publications. Otherwise, none of the authors declare conflicts of interest.

This research received no specific grant or funding

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

North Denmark Region Committee on Health Research Ethics determined that this study was exempt from ethical approval because of its non-interventional design. Signed informed consent was obtained from all participants during the think-aloud interviews. All data were stored on a secure server hosted at Aalborg University and North Denmark Region.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data will be available upon reasonable request to corresponding author. For copies of the Choosing Wisely leaflet, see the appendix or contact the corresponding author.