Background Chronic knee and hip pain is very prevalent, causes disability and reduces mobility. Evidence-based guidelines recommend exercise and self-management. Enabling Self-management and Coping of Arthritic Pain through Exercise, ESCAPE-pain (www.escape-pain.org), is a rehabilitation programme that integrates self-management advice with exercise that reduces pain, improves physical and psychosocial function and well-being1. It is usually delivered as face-to-face programmes in clinical departments. Unfortunately this limits its “reach” so few people benefit. An online version could reach many more people. However, online programmes developed without input from potential users often produce unwanted, unusable, “high tech, low impact” and ineffective programmes with poor uptake.
Objectives We asked potential users what they considered were the important features of the content and design of an online ESCAPE-pain programme to maximise its uptake and effectiveness.
Methods The opinions and preferences 24 people with chronic knee/hip pain as potential users of an online ESCAPE-pain programme were gathered to co-design a prototype website. From those 24 participants a further of 8 people were purposively selected to participate in semi-structured “think aloud” evaluations of the prototype website, commenting on its content, aesthetics, quality, verbalising their thoughts, difficulties, (dis)likes and suggestions.
Their opinions and preferences were thematically analysed, then aligned to the behavioural change techniques taxonomy (BCTT)2 to see how the ESCAPE-pain online programme supported people to change their behaviour.
Results PParticipants had many different opinions and preferences, often mutually exclusive, about the content and format of the online programme. They wanted a simple, easy to navigate, engaging online resource, which was succinct, unambiguous, jargon free, and tailored to each person's needs (BCTT 4.Shaping knowledge; 5.Natural consequences). Descriptive videos of older people exercising were enthusiastically welcomed (BCTT 4.Shaping knowledge; 5.Natural consequences; 7.1Associations – cues and prompts). Entering pertinent information about exercise (number of repetitions, time) to enable people to chart and monitor progress was important (BCTT 2.Feedback/monitoring). Some people wanted to share this information with others and receive feedback to get a comparative overview of their situation and progression (BCTT 2.Feedback/monitoring; 3.Social support; 6.Comparison of behaviour). Support from peers and healthcare professionals (BCTT 3. Social support) via blogs/forums was popular with some, but not all participants. Endorsement by trusted, non-commercial organisations or healthcare professionals was strongly advocated (BCTT 9.Comparisons of outcomes - credible sources). Commercially-backed websites were treated with suspicion.
Conclusions People with chronic knee and hip pain helped us co-create an online version of the ESCAPE-pain programme which incorporates well recognised behavioural change techniques. It will be available as a mobile website and smartphone app from March 2016, enabling many more people to access and benefit from the ESCAPE-pain programme.
Hurley et al. Arth Care Res (2012) 64:238–247
Michie et al. Ann Behav Med (2013) 46:81–95
Acknowledgement The study was funded by Arthritis Research UK.
Disclosure of Interest None declared