A Realist Study of Self-management Apps to help People living with Chronic Low Back Pain

<b>Background</b><br/>For the majority of people with chronic low back pain (CLBP), there is<br/>no cure. Instead, clinical guidelines recommend supporting people to<br/>self-manage CLBP. Mobile health applications could help with this.<br/>However, studies to date do not explain why self-management apps<br/>may work for some people with CLBP, and not for others. The aim of<br/>this research was to understand what it is about a self-management<br/>app for CLBP that works, who it works for, why and under what<br/>circumstances.<br/><b>Method</b><br/>This research was conducted within the paradigm of scientific realism<br/>which uses a generative understanding of causation to explain<br/>programme outcomes. These causal explanations are expressed as<br/>programme theories. The research was designed in two parts, a realist<br/>synthesis followed by a realist evaluation.<br/><b>Realist Synthesis</b><br/>Six databases and several non-academic sources were searched.<br/>Sources were selected and appraised for relevancy, richness, and<br/>rigour. Nineteen realist interviews were conducted with stakeholders<br/>and also included in the review. Data was coded with analytical memos<br/>making retroductive inferences. Causal explanations were presented in<br/>context-mechanism-outcome configurations to form three programme<br/>theories under the themes of empowerment, self-management burden<br/>and timing. These were tested further in a realist evaluation.<br/>Nine people living with CLBP were recruited and used a commercially<br/>available self-management app for chronic pain (Curable) for twelve<br/>weeks. Afterwards, realist telephone interviews were conducted to test<br/>the CMOCs from the realist synthesis. Data was coded using abductive<br/>and retroductive logic to create 20 CMOCs. These propositions<br/>supported the initial three programme theories around empowerment,<br/>self-management burden and timing.<br/><b>Conclusion</b><br/>Three programme theories were created that identify how, why and in<br/>what circumstances a self-management app might support a person<br/>living with CLBP. Programme theory one suggests that, if introduced<br/>as adjunct to care, an app could be an empowering tool to self-manage<br/>CLBP. Programme theory two proposes that a mobile app can help<br/>reduce some of the self-management burden by providing people with<br/>CLBP a means of recording data that, with healthcare professional’s<br/>buy-in, could facilitate consultations. Finally, programme theory three<br/>identifies that a person with CLBP must feel believed and have<br/>accepted their condition before they are likely to use a self-management<br/>app.

Name dc:type.qualificationname

Doctor of Philosophy (awarded by UHI)

Level dc:type.qualificationlevel

Doctoral Thesis

Grantor dc:publisher.institution

University of the Highlands and Islands

Year dc:date.issued

2023

Author dc:creator

• Hunter, Rebecca Jane

Advisors dc:contributor.advisor

• Gorely, Trish
• Beattie, Michelle

Language dc:language

eng

Identifier

oai:pure.atira.dk:studenttheses/c6b2ab60-1322-4abe-a756-858820f9780f

OAI identifier oai:identifier

oai:pure.atira.dk:studenttheses/c6b2ab60-1322-4abe-a756-858820f9780f