Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Feb 20, 2020
Open Peer Review Period: Feb 19, 2020 - Mar 20, 2020
Date Accepted: Apr 10, 2020
Date Submitted to PubMed: May 22, 2020
(closed for review but you can still tweet)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Evaluation of digital technologies tailored to support young people’s self-management of musculoskeletal pain: a mixed-methods design
ABSTRACT
Background:
Digital technologies connect young people with health services and resources supporting their self-care. The lack of accessible, reliable digital resources tailored to young people with persistent musculoskeletal pain, is a significant health services gap in Australia. Recognising the intense resourcing required to develop and implement effective eHealth interventions, adaptation of extant, proven digital technologies may support better access to pain care with cost- and time-efficiencies.
Objective:
To test the acceptability and need for adaptation of extant digital technologies, the painHEALTH website and iCanCope with Pain app, for use by young Australians with musculoskeletal pain.
Methods:
A 3-phased, mixed-methods evaluation was undertaken in Australia May 2019 to August 2019. Young people aged 15 to 25 years with musculoskeletal pain > 3-months duration were recruited. Phases were sequential: Phase 1. Remote participant testing (3 groups, each of n=5) of website prototype(s) co-designed with young people compared to a control website (painHEALTH), with user tasks mapped to eHealth quality and engagement criteria; Phase 2, participant week-long use of iCanCope with Pain app with engagement data captured using a real-time analytic platform (daily check-ins for pain, interference, sleep, mood, physical activity and energy levels; goal setting; accessing resources); for Phase 3, semi-structured interviews were conducted to gain insights into participants’ experiences of using these digital technologies.
Results:
Fifteen young people (80% female; mean age 20.5 (SD 3.3), range 15-25 years) participated in all 3 phases. Phase 1 aggregated group data informed recommendations used to guide rapid cycles of prototype iteration (3 cycles), moving from 2 initial prototypes (group 1) to a final version (group 3). Adaptations included optimizing navigation, improving usability (functionality) and enhancing content to better promote user engagement and acceptability. In Phase 2, all participants checked-in, with the highest frequency of full check-ins attributed by pain intensity (n=183; 100%), pain interference (n=175; 95.6%) and mood (n=152; 83.1%), respectively. Individual variability was evident for monitoring progress with highest frequency of history views for pain intensity (n=51; 32.3%), followed by pain interference (n=24; 15.2%). For the ‘goals set’ feature, thirteen participants (86.7%) set a total of 42 goals covering 5 areas, most frequently for activity (n=35; 83.3%). For Phase 3, meta-synthesis of qualitative data highlighted that these digital tools were perceived as youth-focused and acceptable. Four meta-themes emerged: 1. importance of user-centred design to leverage user engagement; 2. website design (features) promoting user acceptability and engagement; 3. app functionality supporting self-management; and 4. the role for wider promotion, health professional ‘digital prescriptions’ and strategies to ensure longer-term engagement.
Conclusions:
Leveraging extant digital tools, with appropriate user-informed adaptations, can help to build capacity tailored to support young people’s self-management of musculoskeletal pain.
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