JMIR Publications

ABSTRACT

Background:

Research regarding the effectiveness of digital health interventions (DHIs) for people living with chronic pain (PLwCP) is widely documented, though it is often measured against changes in clinical outcomes. To gain a comprehensive understanding of the full impact of DHIs, it is vital to understand the experience of individuals who are using them. An exploration of qualitative data regarding the experience of PLwCP engaging with DHIs could provide a more in-depth account of how individuals interact and engage with such tools, uncovering the overall impact DHIs can have on the lives of PLwCP.

Objective:

This qualitative systematic review and thematic synthesis aimed to appraise and synthesise relevant qualitative evidence on patients’ experiences of engaging with DHIs for the self-management of chronic pain symptoms.

Methods:

A systematic literature search of qualitative and mixed-methods studies published between 2013 and 2023 was conducted on six databases: MEDLINE, PubMed, Embase, CINAHL, PsycINFO, and Scopus. Eligible studies included adult patients aged 18 years or older with a chronic pain diagnosis (exceeding 12 weeks) reporting on the experience of engaging in a DHI for the self-management of chronic pain. The Critical Appraisal Skills Program (CASP) checklist for qualitative research was utilised to appraise each study. Following Thomas and Harden’s 3-step inductive thematic synthesis approach, the researcher performed line-by-line coding of each eligible article to identify descriptive themes. Through iterative evaluation of the descriptive themes, analytical themes that facilitates a deeper understanding of the data were derived.

Results:

Thirty-seven qualitative and mixed-methods studies were included in the review. Thematic synthesis revealed three overarching themes encompassing five sub-themes: (1) personal growth, with two subthemes “gaining new insights” and “renewed mindset”, (2) active involvement with three subthemes “motivation”, “improved access”, and “healthcare decision making” and (3) connectedness and support.

Conclusions:

A positive experience with DHIs amongst PLwCP is achieved through an improved understanding of their condition, greater self-awareness of how symptoms impact their lives, and an increase in motivation to play an active role in their healthcare. DHIs promote confidence and independence of PLwCP, as well as facilitate a sense of ongoing support between routine appointments. However, DHIs may disempower PLwCP by placing too much focus on their pain and should be used as an adjunct to existing care as opposed to replacing in-person appointments. Contrasting experiences in each of the themes highlights that a “one-size-fits-all” approach to intervention design and implementation is not adequate. In order to appropriately meet the needs of PLwCP, the content and features of DHIs should be personalised. Future research regarding the development and implementation of DHIs should employ a co-design approach, involving PLwCP and other key stakeholders, to ensure the needs of PLwCP are met. Clinical Trial: The protocol has been published and is registered on the Prospective Register of Systematic Reviews (PPROSPERO; CRD42023445100).