Accepted for/Published in: JMIR Pediatrics and Parenting
Date Submitted: Sep 2, 2022
Date Accepted: Jan 17, 2023
The mediating role of treatment perceptions in the relationship between individual characteristics and engagement with a digital psychological intervention for pediatric chronic pain: a secondary data analysis.
ABSTRACT
Background:
One potential factor involved in predicting benefit from self-managed treatments is engagement, which is an important concern in digital interventions, with over 50% of patients being non-adherent to interventions in chronic conditions such as chronic pain. However, little is known about the individual characteristics that contribute to engagement with a digital self-management treatment.
Objective:
This study tested the mediating role of treatment perceptions (difficulty and helpfulness) in the association between individual baseline characteristics (treatment expectancies and readiness to change) and treatment engagement (online and offline) with a digital psychological intervention for adolescents with chronic pain.
Methods:
A secondary data analysis of a single arm trial of WebMAP, a self-guided internet intervention developed for the management of chronic pain in adolescents, was conducted. Survey data were collected at baseline (T1), mid-treatment (i.e., 4 weeks after the treatment started; T2) and post-treatment (T3). Online engagement was assessed using back-end information on the number of days adolescents accessed the treatment website, while offline engagement was assessed with the reported frequency of use of skills learned at the end of the treatment. Four parallel multiple mediator linear regression models, using ordinary least square regression incorporating the variables were tested.
Results:
Eighty-five adolescents with chronic pain (12 – 17 years old, 77% female) participated. Several mediation models were significant in predicting online engagement. A significant indirect effect was found for the path expectancies-helpfulness-online engagement (Effect = 0.125, SE = 0.098, 95%CI [0.013, 0.389]) and for the path precontemplation-helpfulness-online engagement (Effect = -1.027, SE = 0.650, 95%CI [-2.518, -0.054]). 14% of the variance of online engagement was explained by the model including expectancies as a predictor (F =3.521, P<0.05), whereas 15% was explained by the model where readiness to change was the predictor (F =3.934, P<0.05). Offline engagement was partially explained in the model including readiness to change as the predictor, but with marginal significance (F =2.719, R2 = 0.111, P=0.05).
Conclusions:
Treatment perceptions and readiness to change were both mediators of the pathway between treatment expectancies and online engagement with a digital psychological intervention for chronic pain. Assessing these variables at baseline and mid-treatment may help to determine the risk of non-adherence. Further work is needed to confirm these mediation pathways in larger samples. Clinical Trial: NCT04043962
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