It’s About Me: Patients’ Experiences of Patient Participation in the Web Behavior Change Program for Activity in Combination With Multimodal Pain Rehabilitation

Abstract

BackgroundPatients’ participation in their health care is recognized as a key component in high-quality health care. Persons with persistent pain are recommended treatments with a cognitive approach from a biopsychosocial explanation of pain, in which a patient’s active participation in their rehabilitation is in focus. Web-based interventions for pain management have the potential to increase patient participation by enabling persons to play a more active role in rehabilitation. However, little is known about patients’ experiences of patient participation in Web-based interventions in clinical practice.ObjectiveThe objective of our study was to explore patients’ experiences of patient participation in a Web Behavior Change Program for Activity (Web-BCPA) in combination with multimodal rehabilitation (MMR) among patients with persistent pain in primary health care.MethodsQualitative interviews were conducted with 15 women and 4 men, with a mean age of 45 years. Data were analyzed with qualitative content analysis.ResultsOne theme, “It’s about me,” and 4 categories, “Take part in a flexible framework of own priority,” “Acquire knowledge and insights,” “Ways toward change,” and “Personal and environmental conditions influencing participation,” were developed. Patient participation was depicted as being confirmed in an individualized and structured rehabilitation framework of one’s own choice. Being confirmed was fundamental to patient participation in the interaction with the Web-BCPA and with the health care professionals in MMR. To acquire knowledge and insights about pain and their life situation, through self-reflection in the solitary work in the Web-BCPA and through feedback from the health care professionals in MMR, was experienced as patient participation by the participants. Patient participation was described as structured ways to reach their goals of behavior change, which included analyzing resources and restrictions, problem solving, and evaluation. The individual’s emotional and cognitive resources and restrictions, as well as health care professionals and significant others’ attitudes and behavior influenced patient participation in the rehabilitation. To some extent there were experiences of restrained patient participation through the great content of the Web-BCPA.ConclusionsPatient participation was satisfactory in the Web-BCPA in combination with MMR. The combined treatment was experienced to increase patient participation in the rehabilitation. Being confirmed through self-identification and finding the content of the Web-BCPA trustworthy was emphasized. Patient participation was experienced as a learning process leading to new knowledge and insights. Higher user control regarding the timing of the Web-BCPA and therapist guidance of the content may further increase patient participation in the combined treatment.

Barriers and Facilitators to eHealth Use in Daily Practice: Perspectives of Patients and Professionals in Dermatology

“…Patients’ participation in their health care is recognized as a key component in the quality of health care. Besides, as an end user of eHealth interventions, patient’s involvement at different levels in the implementation process gives valuable insights and may improve the implementation and use of eHealth interventions in daily practice [ 28 , 29 ]. Therefore, perspectives of patients with atopic dermatitis (AD) concerning the use of eHealth interventions were discussed in an online focus group.…”

Wishes and preferences for an online lifestyle program for brain health—A mixed methods study

“…In case of low adherence, it is possible that end-users were insufficiently engaged in the process of development. Involving users throughout development in a process of co-creation has a positive effect on user satisfaction and fitting user preferences [16] , [17] , [18] , [19] , [20] , [21] , [22] . The investigation of preferences, barriers, and facilitators that influence the use of a lifestyle intervention is more common in other clinical research fields (e.g., [23] , [24] ).…”

Patient Participation in Physical Medicine and Rehabilitation: A Concept Analysis

“…43 Patients can experience that they participate in the encounter when they can respond to the suggestions made by the RPs and when they are asked for opinions. 43,45,46 Moreover, patients feel that they participate when they are respected as unique persons 39,43,[45][46][47] and when their opportunities to participate are individually tailored. 5,36,37,39 In relation to patient participation there are two rehabilitation activities frequently used, namely goal planning and shared decisionmaking.…”

“…This is done either by considering patient participation and a person-centered approach as synonyms 47 or by considering patient participation as a prerequisite for and a vital part of person-centeredness. 6,51 Specifically, Nordin and colleagues 47 claim that in practice, patient participation can be described by the Person-Centered Medicine model, i.e. patient participation is about understanding the patient as a whole person, acknowledging the patient's expertise, shared decision-making and developing a patientprofessional relationship.…”

“…They must be respectful for and listen to the patient's unique situation and conditions 39,43,45,46 they must encourage and invite the patient to participate and proceed in his or her rehabilitation 37,39,42 and they must be flexible and allow individually tailored rehabilitation. 5,36,39,47 The RPs must also educate the patient about his or her condition 39,43,54 as well as the rehabilitation process 5,44,50,53,60 and the patient's role within it. 61 All patients may, however, not be ready or understand his or her central role.…”