Searching for the Silver Bullet(s) - exploring user visions for modelling mHealth towards supporting patient-parent-clinician collaboration when treating adolescent knee pain in general practice: A workshop study. (Preprint)

BACKGROUND Longstanding knee pain is one of the most common reasons for adolescents (age 10-19) to consult general practice. One in two adolescents will continue to experience pain after 2 years, but exercises and self-management education can improve the prognosis. However, adherence to exercises and self-management education interventions remain poor. Mobile health (mHealth) applications hold potentials for supporting adolescents’ self-management, enhancing treatment adherence, and fostering patient-centered approaches. Still, it remains unclear how mHealth apps should be designed to act as tools for supporting individual- and collaborative management of adolescents’ knee pain in a general practice setting. OBJECTIVE The aim of the study was to extract design principles for designing mHealth core-features which were both robust enough to support adolescents’ everyday management of their knee pain, yet flexible enough to act as enablers for enhancing patient-parent-collaboration and shared decision-making. METHODS Three future workshops were conducted with young adults with chronic knee pain since adolescence, parents, and general practitioners. Each workshop followed similar procedures, utilizing case vignettes and design-cards to stimulate discussions and elicit visions for mHealth designs. Data was transcribed and analyzed thematically using NVivo coding software. Extracted themes were synthesized in a matrix to map tensions in the collaborative space and identify design principles which informed development of the conceptual model for mHealth core-features. RESULTS Nine young adults with chronic knee pain since adolescence, six parents and nine general practitioners participated in the workshops. The data analysis revealed how adolescents, parents and clinicians took on different roles within the collaborative space, with different, tasks, challenges, and information needs. Five themes were identified; “adolescents as explorers of pain and social rules”, “parents as advocates, mediators and enforcers” and “GPs as guides, gatekeepers and navigators or systemic constraints” describing participants roles, “collaborative barriers and tensions” referred to the contextual elements, while “visions for an mHealth application” identified beneficial core-features. The synthesis informed a conceptual model, outlining three principles for consolidating mHealth core-features as enablers for supporting role negotiation, to limit collaborative tensions and facilitating shared decision-making. CONCLUSIONS An mHealth app for treating adolescents with knee pain should be designed to accommodate multiple users, enabling them to shift between individual management decision-making, taking charge and engage in role negotiation to inform shared decision-making. We identified three silver-bullet principles for consolidating mHealth core-features as enablers for negotiation by supporting patient-GP collaboration, supporting transitions, and cultivating the parent-GP alliance. CLINICALTRIAL A study protocol was submitted to the regional board of Research Ethics in Northern Jutland, who deemed the project was exempt from registration based on national guidelines.