Date of Award

2020

Degree Name

Doctor of Philosophy

Schools and Centres

Nursing and Midwifery

First Supervisor

Professor Jane Phillips

Second Supervisor

Associate Professor Toby Newton-John

Abstract

Background

Arthritic pain is a major cause of illness and disability among older people. As the use of smartphones and apps increases in the lives of older people, there is an opportunity to explore the role of these apps in helping older people better manage their arthritic pain.

Aim

To explore the feasibility and acceptability of older people using an arthritic pain selfmanagement app to improve their pain symptoms.

Methods

A parallel convergent, mixed methods design underpinned by Bandura’s Self-Efficacy Theory and the Technology Acceptance Model 2; comprising of the following five studies:

(i) Study 1a: an integrative review;

(ii) Study 1b: a systematic review;

(iii) Study 2a: a phase I feasibility study of pre–post-test design;

(iv) Study 2b: a qualitative sub-study involving participants of study; and

(v) Study 3: a qualitative interview study with primary care and allied health clinicians.

The data from these studies was integrated to answer the project’s research questions.

Results

Study 1a revealed paucity of evidence on use of apps for older people’s pain selfmanagement. Study 1b indicated that few publicly available pain self-management apps are based on robust evidence. Eighteen older people were recruited into Study 2a, 80% via snowballing. Over 59% of participants were provided face-to-face app download and use training, none had used a pain self-management app in the past. Telephone-based survey and interview data collection was found to be acceptable to older people. Almost 90% of study 2a participants (n=16) took part in study 2b sharing their experiences of using the intervention app. Following four themes emerged: (i) Apps are valuable selfmanagement tool, but they do have the potential for harm; (ii) pain self-management apps need to be strictly relevant to the user; (iii) Clinicians’ involvement is crucial; and (iv) pain self-management apps must be designed with the end user in mind. Study 3 recruited seventeen (n=17) primary care and allied health clinicians who shared their perceptions and attitudes regarding app use by their older patients for pain self-management. Four themes emerged: (i) self-management apps are a potentially useful tool but require careful consideration; (ii) clinicians’ involvement is crucial yet potentially onerous; (iii) no single app is right for every older person; and (iv) patient data access is beneficial but caution is needed for real-time data access. Meta-inference of the data from all five studies indicated that an app intervention involving older people was both feasible and acceptable, with the following caveats: snowballing recruitment may be required; and access to app download and use training is an important element to implement into the study design. Older people and primary care clinicians were keen to engage with pain self-management apps; however, they wanted these apps to offer high level usefulness, adaptability and information sharing features. Future pain self-management apps need to be underpinned by robust evidence, while providing appropriate support and resources to clinicians.

Conclusion

While older people and their clinicians welcomed the opportunity to use pain self-management apps, their engagement ought to be supported by systems level policies, and high-quality apps. Collaboration among clinicians, older people, researchers and app developers ought to be considered when developing, researching and integrating pain self-management apps.

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