Currently accepted at: JMIR Formative Research
Date Submitted: Dec 8, 2025
Date Accepted: Mar 4, 2026
This paper has been accepted and is currently in production.
It will appear shortly on 10.2196/89206
The final accepted version (not copyedited yet) is in this tab.
Warning: This is an author submission that is not peer-reviewed or edited.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.
Agile Development of a Digital Graded Exposure Treatment for Youth with Chronic Pain: An examination of acceptability and preliminary usability
ABSTRACT
Background:
Pediatric chronic pain affects up to one-third of youth and significantly disrupts social, emotional, and behavioral functioning. Although behavioral treatments are effective, access is limited due to geographic, financial, and systemic barriers. Digital behavioral health interventions offer scalable solutions, however many lack user-centered design, agile refinement, and implementation-focused development. Integrating implementation science with iterative digital development may enhance both usability and sustainability.
Objective:
To develop and refine iGET Living, a digital graded exposure intervention for youth with chronic pain, using a combined user-centered and implementation-informed framework, and to evaluate its preliminary acceptability, feasibility, and user-perceived success.
Methods:
Guided by the Consolidated Framework for Implementation Research (CFIR) and the mHealth Agile Development and Lifecycle model, this study proceeded through three phases. Phase 0 translated an in-person graded exposure treatment into a digital prototype. Phase 1 involved iterative user-centered refinement through three cycles of qualitative interviews with youth with chronic pain (N = 15), focusing on content clarity, tone, structure of the content. Phase 2 piloted the refined intervention with a new sample of youth (N = 38) to assess feasibility, acceptability, and perceived functional improvements. Quantitative outcomes (treatment credibility, expectancy, satisfaction) were summarized descriptively. Qualitative data were analyzed using rapid qualitative analysis mapped to CFIR domains.
Results:
User-centered refinement yielded substantive improvements in the clarity, tone, and interactivity of the intervention content (e.g., animated videos). Pilot testing demonstrated moderate-to-high treatment credibility (M = 19.71 out of 30) and expectancy (M = 17.96 out of 30), as well as high satisfaction (M = 46.12 out of 60). Exit interviews emphasized iGET Living’s role in helping youth make meaningful functional improvements.
Conclusions:
Using a combined CFIR and agile development approach, iGET Living emerged as feasible, engaging, and acceptable digital graded exposure intervention for youth with chronic pain. Findings demonstrate the importance of embedding implementation science and user-centered design early in digital intervention development and support further evaluation in a preliminary efficacy trial. Clinical Trial: This trial is registered at clinicaltrials.gov (NCT05079984)
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