Patients' Needs and Requirements for eHealth Pain Management Interventions: Qualitative Study

Ingrid Konstanse Ledel Solem, Cecilie Varsi, Hilde Eide, Olöf Birna Kristjansdottir, Jelena Mirkovic, Elin Børøsund, Mette Haaland-Øverby, Karina Heldal, Karlein Mg Schreurs, Lori B Waxenberg, Karen Elizabeth Weiss, Eleshia J Morrison, Lise Solberg Nes, Ingrid Konstanse Ledel Solem, Cecilie Varsi, Hilde Eide, Olöf Birna Kristjansdottir, Jelena Mirkovic, Elin Børøsund, Mette Haaland-Øverby, Karina Heldal, Karlein Mg Schreurs, Lori B Waxenberg, Karen Elizabeth Weiss, Eleshia J Morrison, Lise Solberg Nes

Abstract

Background: A growing body of evidence supports the potential effectiveness of electronic health (eHealth) interventions in managing chronic pain. However, research on the needs and preferences of patients with chronic pain in relation to eHealth interventions is scarce. Eliciting user input in the development of eHealth interventions may be a crucial step toward developing meaningful interventions for patients for potentially improving treatment outcomes.

Objective: This study aimed to explore the experiences of patients with chronic pain with regard to information and communication technology, understand how an eHealth intervention can support the everyday needs and challenges of patients with chronic pain, and identify possible facilitators and barriers for patients' use of an eHealth pain management intervention.

Methods: Twenty patients living with chronic pain and five spouses participated in individual interviews. Semistructured interview guides were used to explore participants' needs, experiences, and challenges in daily life as well as their information and communication technology experiences and preferences for eHealth support interventions. Spouses were recruited and interviewed to gain additional insight into the patients' needs. The study used qualitative thematic analysis.

Results: The participants were generally experienced technology users and reported using apps regularly. They were mainly in favor of using an eHealth self-management intervention for chronic pain and considered it a potentially acceptable way of gathering knowledge and support for pain management. The participants expressed the need for obtaining more information and knowledge, establishing a better balance in everyday life, and receiving support for improving communication and social participation. They provided suggestions for the eHealth intervention content and functionality to address these needs. Accessibility, personalization, and usability were emphasized as important elements for an eHealth support tool. The participants described an ideal eHealth intervention as one that could be used for support and distraction from pain, at any time or in any situation, regardless of varying pain intensity and concentration capacity.

Conclusions: This study provides insight into user preferences for eHealth interventions aiming to address self-management for chronic pain. Participants highlighted important factors to be considered when designing and developing eHealth interventions for self-management of chronic pain, illustrating the importance and benefit of including users in the development of eHealth interventions.

Trial registration: ClinicalTrials.gov NCT03705104; https://ichgcp.net/clinical-trials-registry/NCT03705104.

Keywords: chronic pain; eHealth; intervention development; qualitative methods; self-management; user-centered design.

Conflict of interest statement

Conflicts of Interest: None declared.

©Ingrid Konstanse Ledel Solem, Cecilie Varsi, Hilde Eide, Olöf Birna Kristjansdottir, Jelena Mirkovic, Elin Børøsund, Mette Haaland-Øverby, Karina Heldal, Karlein MG Schreurs, Lori B Waxenberg, Karen Elizabeth Weiss, Eleshia J Morrison, Lise Solberg Nes. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 01.04.2019.

Figures

Figure 1
Figure 1
Overview of the main categories and subcategories from the analysis. ICT: information and communication technology.

References

    1. Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006 May;10(4):287–333. doi: 10.1016/j.ejpain.2005.06.009.
    1. Carnes D. Patterns of chronic pain in the population. International Journal of Osteopathic Medicine. 2011 Sep 24;14(3):81–85. doi: 10.1016/j.ijosm.2011.07.004.
    1. Solberg Nes L, Roach AR, Segerstrom SC. Executive functions, self-regulation, and chronic pain: a review. Ann Behav Med. 2009 Apr;37(2):173–183. doi: 10.1007/s12160-009-9096-5.
    1. Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003 Aug;26(1):1–7. doi: 10.1207/S15324796ABM2601_01.
    1. Solberg Nes L, Carlson CR, Crofford LJ, de Leeuw R, Segerstrom SC. Self-regulatory deficits in fibromyalgia and temporomandibular disorders. Pain. 2010 Oct;151(1):37–44. doi: 10.1016/j.pain.2010.05.009.
    1. Bergeson SC, Dean JD. A systems approach to patient-centered care. JAMA. 2006 Dec 20;296(23):2848–2851. doi: 10.1001/jama.296.23.2848.
    1. Mann EG, Lefort S, Vandenkerkhof EG. Self-management interventions for chronic pain. Pain Manag. 2013 May;3(3):211–22. doi: 10.2217/pmt.13.9.
    1. Morley S, Eccleston C, Williams A. Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain. 1999 Mar;80(1-2):1–13.
    1. Williams ACDC, Eccleston C, Morley S. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2012 Nov 14;11:CD007407. doi: 10.1002/14651858.CD007407.pub3.
    1. Thurnheer SE, Gravestock I, Pichierri G, Steurer J, Burgstaller JM. Benefits of Mobile Apps in Pain Management: Systematic Review. JMIR Mhealth Uhealth. 2018 Oct 22;6(10):e11231. doi: 10.2196/11231.
    1. Vugts MAP, Joosen MCW, van der Geer JE, Zedlitz AMEE, Vrijhoef HJM. The effectiveness of various computer-based interventions for patients with chronic pain or functional somatic syndromes: A systematic review and meta-analysis. PLoS One. 2018;13(5):e0196467. doi: 10.1371/journal.pone.0196467.
    1. Buhrman M, Gordh T, Andersson G. Internet interventions for chronic pain including headache: A systematic review. Internet Interv. 2016 May;4:17–34. doi: 10.1016/j.invent.2015.12.001.
    1. Heapy AA, Higgins DM, Cervone D, Wandner L, Fenton BT, Kerns RD. A Systematic Review of Technology-assisted Self-Management Interventions for Chronic Pain: Looking Across Treatment Modalities. Clin J Pain. 2015 Jun;31(6):470–92. doi: 10.1097/AJP.0000000000000185.
    1. Wilson M, Roll JM, Corbett C, Barbosa-Leiker C. Empowering Patients with Persistent Pain Using an Internet-based Self-Management Program. Pain Manag Nurs. 2015 Aug;16(4):503–14. doi: 10.1016/j.pmn.2014.09.009.
    1. Mehta S, Peynenburg VA, Hadjistavropoulos HD. Internet-delivered cognitive behaviour therapy for chronic health conditions: a systematic review and meta-analysis. J Behav Med. 2018 Nov 01;:1–19. doi: 10.1007/s10865-018-9984-x.
    1. Dear BF, Gandy M, Karin E, Fogliati R, Fogliati VJ, Staples LG, Wootton BM, Sharpe L, Titov N. The Pain Course: 12- and 24-Month Outcomes From a Randomized Controlled Trial of an Internet-Delivered Pain Management Program Provided With Different Levels of Clinician Support. J Pain. 2018 Dec;19(12):1491–1503. doi: 10.1016/j.jpain.2018.07.005.
    1. European Comission. 2018. [2019-03-04]. eHealth: Digital health and care .
    1. Keogh E. Developments in the use of e-health for chronic pain management. Pain Manag. 2013 Jan;3(1):27–33. doi: 10.2217/pmt.12.70.
    1. Schneider LH, Hadjistavropoulos HD. When in doubt, ask the audience: potential users' perceptions of Internet-delivered cognitive behavioural therapy for chronic pain. Pain Res Manag. 2014;19(4):173–8.
    1. McDermott MS, While AE. Maximizing the healthcare environment: a systematic review exploring the potential of computer technology to promote self-management of chronic illness in healthcare settings. Patient Educ Couns. 2013 Jul;92(1):13–22. doi: 10.1016/j.pec.2013.02.014.
    1. Salazar A, de Sola H, Failde I, Moral-Munoz JA. Measuring the Quality of Mobile Apps for the Management of Pain: Systematic Search and Evaluation Using the Mobile App Rating Scale. JMIR Mhealth Uhealth. 2018 Oct 25;6(10):e10718. doi: 10.2196/10718.
    1. de la Vega Rocío, Miró Jordi. mHealth: a strategic field without a solid scientific soul. a systematic review of pain-related apps. PLoS One. 2014;9(7):e101312. doi: 10.1371/journal.pone.0101312.
    1. Lalloo C, Jibb LA, Rivera J, Agarwal A, Stinson JN. "There's a Pain App for That": Review of Patient-targeted Smartphone Applications for Pain Management. Clin J Pain. 2015 Jun;31(6):557–63. doi: 10.1097/AJP.0000000000000171.
    1. Rosser BA, Eccleston C. Smartphone applications for pain management. J Telemed Telecare. 2011;17(6):308–12. doi: 10.1258/jtt.2011.101102.
    1. Cranen K, Groothuis-Oudshoorn CG, Vollenbroek-Hutten MM, IJzerman MJ. Toward Patient-Centered Telerehabilitation Design: Understanding Chronic Pain Patients' Preferences for Web-Based Exercise Telerehabilitation Using a Discrete Choice Experiment. J Med Internet Res. 2017 Dec 20;19(1):e26. doi: 10.2196/jmir.5951.
    1. Keogh E, Rosser BA, Eccleston C. e-Health and chronic pain management: current status and developments. Pain. 2010 Oct;151(1):18–21. doi: 10.1016/j.pain.2010.07.014.
    1. Reynoldson C, Stones C, Allsop M, Gardner P, Bennett MI, Closs SJ, Jones R, Knapp P. Assessing the quality and usability of smartphone apps for pain self-management. Pain Med. 2014 Jun;15(6):898–909. doi: 10.1111/pme.12327.
    1. Bender JL, Radhakrishnan A, Diorio C, Englesakis M, Jadad AR. Can pain be managed through the Internet? A systematic review of randomized controlled trials. Pain. 2011 Aug;152(8):1740–50. doi: 10.1016/j.pain.2011.02.012.
    1. Gogovor A, Visca R, Auger C, Bouvrette-Leblanc L, Symeonidis I, Poissant L, Ware MA, Shir Y, Viens N, Ahmed S. Informing the development of an Internet-based chronic pain self-management program. Int J Med Inform. 2017 Dec;97:109–119. doi: 10.1016/j.ijmedinf.2016.10.005.
    1. Brinkmann S, Kvale S. InterViews: learning the craft of qualitative research interviewing. Thousand Oaks, CA: Sage Publications; 2014.
    1. De Vito Dabbs A, Myers BA, Mc Curry KR, Dunbar-Jacob J, Hawkins RP, Begey A, Dew MA. User-centered design and interactive health technologies for patients. Comput Inform Nurs. 2009;27(3):175–83. doi: 10.1097/NCN.0b013e31819f7c7c.
    1. Stickdorn M, Schneider J. This Is Service Design Thinking: Basics, Tools, Cases. Hoboken, NJ: Wiley; 2012.
    1. Braun A, Clarke V. Using thematic analysis in psychology. Qualitative Research in Psychology. 2006 Jan;3(2):77–101. doi: 10.1191/1478088706qp063oa.
    1. Nowell LS, Norris JM, White DE, Moules NJ. Thematic Analysis. International Journal of Qualitative Methods. 2017 Oct 02;16(1):160940691773384–13. doi: 10.1177/1609406917733847.
    1. Macdonald GG, Koehn C, Attara G, Stordy A, Allerdings M, Leese J, Li LC, Backman CL. Patient Perspectives on the Challenges and Responsibilities of Living With Chronic Inflammatory Diseases: Qualitative Study. J Participat Med. 2018 Nov 21;10(4):e10815. doi: 10.2196/10815.
    1. Castro EM, Van Regenmortel T, Vanhaecht K, Sermeus W, Van Hecke A. Patient empowerment, patient participation and patient-centeredness in hospital care: A concept analysis based on a literature review. Patient Educ Couns. 2016 Dec;99(12):1923–1939. doi: 10.1016/j.pec.2016.07.026.
    1. Creer TL, Holroyd KA. Self-management of chronic conditions: the legacy of Sir William Osler. Chronic Illn. 2006 Mar;2(1):7–14. doi: 10.1177/17423953060020010501.
    1. Coster S, Norman I. Cochrane reviews of educational and self-management interventions to guide nursing practice: a review. Int J Nurs Stud. 2009 Apr;46(4):508–28. doi: 10.1016/j.ijnurstu.2008.09.009.
    1. Henschke N, Ostelo RW, van Tulder MW, Vlaeyen JW, Morley S, Assendelft WJ, Main CJ. Behavioural treatment for chronic low-back pain. Cochrane Database Syst Rev. 2010 Jul 07;(7):CD002014. doi: 10.1002/14651858.CD002014.pub3.
    1. Dansie EJ, Turk DC. Assessment of patients with chronic pain. Br J Anaesth. 2013 Jul;111(1):19–25. doi: 10.1093/bja/aet124.
    1. Kristjánsdóttir OB, Fors EA, Eide E, Finset A, Stensrud TL, van Dulmen S, Wigers SH, Eide H. A smartphone-based intervention with diaries and therapist-feedback to reduce catastrophizing and increase functioning in women with chronic widespread pain: randomized controlled trial. J Med Internet Res. 2013 Jan 07;15(1):e5. doi: 10.2196/jmir.2249.
    1. Granja C, Janssen W, Johansen MA. Factors Determining the Success and Failure of eHealth Interventions: Systematic Review of the Literature. J Med Internet Res. 2018 May 01;20(5):e10235. doi: 10.2196/10235.
    1. Garg S, Garg D, Turin TC, Chowdhury MFU. Web-Based Interventions for Chronic Back Pain: A Systematic Review. J Med Internet Res. 2016 Jul 26;18(7):e139. doi: 10.2196/jmir.4932.
    1. Macea DD, Gajos K, Daglia CYA, Fregni F. The efficacy of Web-based cognitive behavioral interventions for chronic pain: a systematic review and meta-analysis. J Pain. 2010 Oct;11(10):917–29. doi: 10.1016/j.jpain.2010.06.005.
    1. Beatty L, Lambert S. A systematic review of internet-based self-help therapeutic interventions to improve distress and disease-control among adults with chronic health conditions. Clin Psychol Rev. 2013 Jun;33(4):609–22. doi: 10.1016/j.cpr.2013.03.004.
    1. Sieverink F, Kelders SM, van Gemert-Pijnen JE. Clarifying the Concept of Adherence to eHealth Technology: Systematic Review on When Usage Becomes Adherence. J Med Internet Res. 2017 Dec 06;19(12):e402. doi: 10.2196/jmir.8578.
    1. Lin J, Faust B, Ebert DD, Krämer L, Baumeister H. A Web-Based Acceptance-Facilitating Intervention for Identifying Patients' Acceptance, Uptake, and Adherence of Internet- and Mobile-Based Pain Interventions: Randomized Controlled Trial. J Med Internet Res. 2018 Aug 21;20(8):e244. doi: 10.2196/jmir.9925.
    1. Andersson G. The Internet And Cbt: A Clinical Guide. Boca Raton, FL: CRC Press; 2014.
    1. Ludden GD, van Rompay TJL, Kelders SM, van Gemert-Pijnen JEWC. How to Increase Reach and Adherence of Web-Based Interventions: A Design Research Viewpoint. J Med Internet Res. 2015 Jul 10;17(7):e172. doi: 10.2196/jmir.4201.
    1. Gremeaux V, Coudeyre E, Givron P, Hérisson C, Pélissier J, Poiraudeau S, Bénaïm C. Qualitative evaluation of the expectations of low back pain patients with regard to information gained through semi-directed navigation on the Internet. Ann Readapt Med Phys. 2007 Jul;50(6):348–355. doi: 10.1016/j.annrmp.2007.03.017.
    1. Guba EG, Lincoln Y. Naturalistic Inquiry. Thousand Oaks, CA: SAGE Publications; 1985.

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