Process evaluation of the SELFBACK trial – preliminary findings

Research Aim/Objective:
To evaluate the uptake and implementation of a digital health intervention to support self-management of non-specific low back pain (SELFBACK). We present the preliminary analyses of qualitative data to elucidate participants’ uptake and utilization of the SELFBACK app and project.
Research Methods:
The RE-AIM framework guided the analysis. The interview guide prompted participants to talk about experiences of enrollment (Reach), impact, satisfaction, motivation for participation and perceptions of self-management (Effectiveness), how and why participants had embedded and integrated selfBACK in daily life or not (Implementation), and intended future use beyond three months (Maintenance). Data were collected through semi-structured interviews face-to-face or via telephone. Participants from both the intervention and control arm of the SELFBACK trial were selected purposefully to represent women and men and all age groups. Participants from the intervention arm were subdivided into three groups based on their level of use of the app (high, moderate and low/none). All interviews were audio recorded and transcribed verbatim using software. Data were analysed thematically using framework analysis.
Results:
Thirty four interviews were conducted; eight with control group and 26 with intervention arm participants (8 low/none, 9 moderate, 9 high app users). All participants valued the endorsement of the project by healthcare professionals (HCP). In addition, app users appreciated research staffs’ help with app and
wristband installation. However, information overload at the set-up meeting led to limited app use as the introduction was too comprehensive. Many app users experienced positive effects on their LBP ascribed to performing strength and flexibility exercises or altered behaviour and thought patterns. Users liked the
support the app gave in between HCP visits, but some missed follow-up on app use from their HCP. Committing oneself to a research project as well as easy access and reminders on the home screen aided routine app use. Control group participants were motivated by helping future LBP sufferers.
Discussion:
Results are preliminary as rigorous analyses are scheduled for 2022. For the analyses, we will use the Normalization Process Theory framework to identify, characterize and explain mechanisms that influence uptake and utilization of the SELFBACK app to deepen our understanding of implementation processes. Findings from the selfBACK RCT will be enhanced by the process evaluation and provide important input for further development of the SELFBACK app and other digital health interventions.