Johansen Simon Kristoffer, Kanstrup Anne Marie, Haseli Kian, Stenmo Visti Hildebrandt, Thomsen Janus Laust, Rathleff Michael Skovdal
Center for General Practice (CAM-AAU), Department of Clinical Medicine, Aalborg University, Aalborg East, Denmark.
The Rectorate at Aalborg University, Aalborg University, Aalborg, Denmark.
JMIR Hum Factors. 2023 Apr 28;10:e44462. doi: 10.2196/44462.
Long-standing knee pain is one of the most common reasons for adolescents (aged 10-19 years) to consult general practice. Generally, 1 in 2 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 remains poor. Mobile health (mHealth) apps have the potential for supporting adolescents' self-management, enhancing treatment adherence, and fostering patient-centered approaches. However, 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.
The aim of the study was to extract design principles for designing mHealth core features, which were both sufficiently robust to support adolescents' everyday management of their knee pain and sufficiently flexible to act as enablers for enhancing patient-parent collaboration and shared decision-making.
Overall, 3 future workshops were conducted with young adults with chronic knee pain since adolescence, parents, and general practitioners (GPs). Each workshop followed similar procedures, using case vignettes and design cards to stimulate discussions, shared construction of knowledge and elicit visions for mHealth designs. Young adults and parents were recruited via social media posts targeting individuals in Northern Jutland. GPs were recruited via email and cold calling. Data were transcribed and analyzed thematically using NVivo (QSR International) coding software. Extracted themes were synthesized in a matrix to map tensions in the collaborative space and inform a conceptual model for designing mHealth core-features to support individual and collaborative management of knee pain.
Overall, 38% (9/24) young adults with chronic knee pain since adolescence, 25% (6/24) parents, and 38% (9/24) GPs participated in the workshops. Data analysis revealed how adolescents, parents, and clinicians took on different roles within the collaborative space, with different tasks, challenges, and information needs. In total, 5 themes were identified: adolescents as explorers of pain and social rules; parents as supporters, advocates and enforcers of boundaries; and GPs as guides, gatekeepers, and navigators or systemic constraints described participants' roles; collaborative barriers and tensions referred to the contextual elements; and visions for an mHealth app identified beneficial core features. The synthesis informed a conceptual model, outlining 3 principles for consolidating mHealth core features as enablers for supporting role negotiation, limiting collaborative tensions, and facilitating shared decision-making.
An mHealth app for treating adolescents with knee pain should be designed to accommodate multiple users, enable them to shift between individual management decision-making, take charge, and engage in role negotiation to inform shared decision-making. We identified 3 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.
长期膝关节疼痛是青少年（10 - 19岁）寻求全科医疗服务的最常见原因之一。一般来说，每2名青少年中就有1人在2年后仍会持续疼痛，但运动和自我管理教育可以改善预后。然而，对运动和自我管理教育干预措施的依从性仍然很差。移动健康（mHealth）应用程序有潜力支持青少年的自我管理，提高治疗依从性，并促进以患者为中心的方法。然而，尚不清楚mHealth应用程序应如何设计，才能在全科医疗环境中作为支持青少年膝关节疼痛个体和协作管理的工具。
本研究的目的是提取设计mHealth核心功能的设计原则，这些原则既要足够强大以支持青少年日常膝关节疼痛管理，又要足够灵活以促进患者与家长的协作及共同决策。
总体而言，对自青少年时期起患有慢性膝关节疼痛的年轻人、家长和全科医生（GPs）举办了3次未来研讨会。每次研讨会都遵循类似程序，使用病例 vignettes 和设计卡片来激发讨论、共同构建知识并引出mHealth设计的愿景。通过针对日德兰半岛北部个人的社交媒体帖子招募年轻人和家长。通过电子邮件和电话招募全科医生。使用NVivo（QSR International）编码软件对数据进行转录和主题分析。提取的主题在一个矩阵中进行综合，以映射协作空间中的紧张关系，并为设计支持膝关节疼痛个体和协作管理的mHealth核心功能的概念模型提供信息。
总体而言，38%（9/24）自青少年时期起患有慢性膝关节疼痛的年轻人、25%（6/24）的家长和38%（9/24）的全科医生参加了研讨会。数据分析揭示了青少年、家长和临床医生如何在协作空间中扮演不同角色，具有不同的任务、挑战和信息需求。总共确定了5个主题：青少年作为疼痛和社会规则的探索者；家长作为边界的支持者、倡导者和执行者；全科医生作为指导者、把关者以及参与者角色的导航者或系统约束的描述者；协作障碍和紧张关系指的是背景因素；mHealth应用程序的愿景确定了有益的核心功能。综合结果形成了一个概念模型，概述了巩固mHealth核心功能的3条原则，作为支持角色协商、限制协作紧张关系和促进共同决策的促成因素。
用于治疗青少年膝关节疼痛的mHealth应用程序应设计为能容纳多个用户，使他们能够在个体管理决策、负责以及参与角色协商之间转换，以促进共同决策。我们确定了3条关键原则来巩固mHealth核心功能，作为通过支持患者与全科医生协作、支持过渡以及培养家长与全科医生联盟来进行协商的促成因素。
