Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders - ‘eHealth: It’s TIME’: a study protocol

Marie Kelly; Brona Fullen; Denis Martin; Colin Bradley; Billy O'Mahony; Joseph G. McVeigh

doi:10.12688/hrbopenres.13611.1

Home Browse Design and development of an eHealth intervention to support self-management...

ALL Metrics

Views

100

Downloads

Get PDF

Get XML

Export

▬

✚

Study Protocol

Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders - ‘eHealth: It’s TIME’: a study protocol

[version 1; peer review: 2 approved with reservations]

Marie Kelly ^1,2, Brona Fullen³, Denis Martin⁴, Colin Bradley⁵, Billy O'Mahony⁶, Joseph G. McVeigh¹

Marie Kelly ^1,2, Brona Fullen³, [...] Denis Martin⁴, Colin Bradley⁵, Billy O'Mahony⁶, Joseph G. McVeigh¹

PUBLISHED 14 Nov 2022

Author details Author details

¹ Discipline of Physiotherapy, University College Cork, Cork, Ireland
² Department of Physiotherapy, Mercy University Hospital, Cork, Ireland
³ School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
⁴ School of Health and Social Care, Teesside University, Middlesbrough, UK
⁵ Department of General Practice, University College Cork, Cork, Ireland
⁶ School of Computer Science and Information Technology, University College Cork, Cork, Ireland

Marie Kelly
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing

Brona Fullen
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Writing – Review & Editing

Denis Martin
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Writing – Review & Editing

Colin Bradley
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Writing – Review & Editing

Billy O'Mahony
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Software, Writing – Review & Editing

Joseph G. McVeigh
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background: Musculoskeletal disorders (MSDs) are a leading cause of global morbidity, with the burden expected to increase in the near future. Self-management, with the support of healthcare professionals, is recommended for many MSDs. However, frequent clinical contact is not feasible. Previous research has highlighted the need for a co-designed eHealth-mediated self-management follow-up support intervention which integrates remote monitoring and behavioural change. Thus, the current study aims to develop and design a user-centred, eHealth-mediated self-management support prototype for people with MSDs.
Methods: A three-step, iterative system development cycle will be utilised to develop and design the “eHealth: It’s TIME prototype”. The three-step process will include creating website features and content using two sequential focus groups with people with MSDs (n = 6 – 8); heuristic testing using the 10 heuristic principles of Nielsen (n = 5); and usability testing through in-person 60-minute interviews with people with MSDs (n = 3 – 5) and musculoskeletal physiotherapists (n = 3 – 5).
Conclusion: The eHealth: It’s TIME prototype will be a systematically developed, follow-up self-management support intervention guided by behavioural change theory and the preferences of end users.

Keywords

eHealth, self-management, intervention development, musculoskeletal pain, user-centred design approach

Corresponding author: Marie Kelly

Competing interests: No competing interests were disclosed.

Grant information: Health Research Board (Fulbright Irish Scholar Award to Professor Colin Bradley).

Copyright: © 2022 Kelly M et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Kelly M, Fullen B, Martin D et al. Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders - ‘eHealth: It’s TIME’: a study protocol [version 1; peer review: 2 approved with reservations]. HRB Open Res 2022, 5:73 (https://doi.org/10.12688/hrbopenres.13611.1) First published: 14 Nov 2022, 5:73 (https://doi.org/10.12688/hrbopenres.13611.1) Latest published: 10 Aug 2023, 5:73 (https://doi.org/10.12688/hrbopenres.13611.2)

Introduction

Globally, musculoskeletal disorders (MSDs) are the leading contributor to the need for rehabilitation¹, with this intervention essential in maximising a person’s function and quality of life². Despite these individual and societal benefits, rehabilitation services remain under-resourced, and this, together with the high demand for such services, has created an enormous musculoskeletal (MSK) care gap¹. While this divide continues to widen, solutions to this challenge are urgently needed³; solutions which deliver person-centred care and empower people with MSDs to self-manage their condition are critical³.

eHealth interventions are increasingly being viewed as the answer to improving MSK care access and supporting self-management^4–6. However, while their use has been growing, with the coronavirus disease 2019 (COVID-19) pandemic being seen as a significant catalyst⁷, sustaining this has remained elusive⁸. A lack of user (i.e. people with MSDs) involvement is considered a major contributing factor to this⁹, resulting in usability issues and high dropout rates, and ultimately eHealth interventions that are “high tech-with-a-low impact”^10–14.

A recent scoping review reported only 22% (14/63) of the 63 eHealth-mediated self-management support interventions were co-designed¹⁵, despite numerous calls to utilise a more user-centred design approach^16–18. User-centred design is an approach that involves users in the development and decision-making process¹⁹, resulting in interventions which demonstrate greater effectiveness, satisfaction and usability than traditionally developed (i.e., linear, often top-down) interventions²⁰.

This study is part of a larger project, ‘eHealth: It’s TIME’, which aims to develop an eHealth-mediated self-management support intervention for people with MSDs. For development processes and eHealth interventions to be successful, a holistic focus, encompassing the habits and rituals of the end users, intervention setting and context, is required^14,21. This involves identifying barriers and facilitators and exploring implementation challenges at the intervention planning stage^22,23. Hence, this study is informed by our earlier research utilising a systematic scoping approach to chart the current literature base¹⁵ and establish stakeholder perceptions towards eHealth-mediated self-management support for people with MSDs²⁴. People with MSDs and MSK physiotherapists reported concerns about assessment and diagnosis and establishing a therapeutic relationship and felt that eHealth interventions may be best reserved for follow-up care²⁴. Considering these findings, this study in the ‘eHealth: IT’s TIME’ project aims to co-develop and design a prototype of an intervention that facilitates follow-up self-management support via integrated remote monitoring and behavioural change. This work will likely contribute to the development and design of a more easy-to-use, worthwhile intervention that can potentially improve treatment outcomes for people living with MSDs^14,17,25. The ‘eHealth: It’s TIME’ project is guided by the Medical Research Council (MRC) framework²⁶ and the CeHReS (Center for eHealth Research) Roadmap^14,27.

Methods

Study aims

The present study aims to systematically develop and design a user-centred web-based prototype for adults with MSDs to enhance follow-up self-management support via integrated remote monitoring and behavioural change

Study design

The eHealth: It's TIME prototype will be co-developed and designed using a three-step system development cycle^28,29 which includes the creation of website features and content (Step 1); heuristic testing (Step 2); and usability testing (Step 3) (Figure 1). The CeHRes Roadmap¹⁴ will inform the development and design process of the eHealth-mediated follow-up self-management support intervention. This evidence-based roadmap¹⁴ provides practical guidance on how to execute the participatory eHealth development process, fulfilling the MRC framework criteria²⁶, with the latter framework providing limited information on how to design complex interventions³⁰.

Figure 1. Study overview.

The CeHRes Roadmap has been utilised for eHealth development in numerous settings^31–34 and complex contexts¹⁴, such as MSK healthcare. This study relates to the development and design of an eHealth intervention, with emphasis on the first three phases of the Roadmap: contextual inquiry, value specification and design.

Ethical approval has been granted by the Clinical Research Ethics Committee (CREC) of the Cork Teaching Hospitals (REF: ECM 4 (f) 20/09/2022). The study will be performed in accordance with the Declaration of Helsinki.

Step 1: Creation of website features and content

Study participants

Using purposive sampling, individuals with a MSD will be eligible to participate in this study if they are English speaking (judged by researcher MK during pre-interview communication); 18 years or older; and able to provide informed consent. Participants with pain of specific pathological origin (e.g. infection, malignancy, inflammatory disease or fracture); those that are pregnant; or have had surgery within the past six months; will be excluded. Initial eligibility screening for individuals with a MSD will be undertaken through the online platform Qualtrics. For those that do not have access to a computer or the internet, the screening will be conducted via post.

Recruitment

Individuals with MSDs will be recruited through various methods:

Primary and secondary care: The researcher MK will email physiotherapy managers and General Practices in Cork City outlining the details of the study and request that information about the study be circulated to all their staff to distribute to their patients with a MSD. A poster for display in waiting rooms will be included. At one hospital site (Mercy University Hospital), potential participants will be identified by MSK physiotherapy staff. Eligibility screening will be completed by the researcher (MK). Potentially eligible participants will be informed about the study by the lead researcher (MK) and will receive a participant information leaflet. Following a reflection period of 24h, the researcher will telephone the individual with the MSD to confirm their interest in participation.
Professional Organisation: The call for participants along with the poster will be sent to physiotherapists via the Irish Society of Chartered Physiotherapists (ISCP) mailing list.
Patient support groups: An email request will also be sent out to people with MSDs via gatekeepers in Arthritis Ireland and Chronic Pain Ireland.
University staff: An email request will also be sent out to all academic, research and administrative staff in UCC, targeting those with a MSD via a gatekeeper.
Social media: The study will also be advertised on social media (Twitter). Interested participants will be asked to contact the researcher MK.

Those with access to email that express interest in the study will be sent a participant information leaflet, and a Qualtrics link to the Consent form. For those that do not have access to a computer or the internet, the participant information leaflet and consent form will be sent via post with a prepaid return envelope.

Procedures

Questionnaires

Before the focus group, participants with a MSD will complete two questionnaires via Qualtrics: (1) demographic details and (2) the eHealth Literacy Scale (eHEALS). The eHEALS is an eight-item self-report measure assessing individuals’ perceived ability to locate, evaluate, and apply eHealth information³⁵. The overall scores range from 8 to 40, with higher scores indicating higher self-perceived levels of eHealth literacy³⁵.

Focus Groups

Two sequential focus groups, involving between six and eight participants, will be facilitated by MK (lead researcher) to elicit users’ views and preferences regarding the proposed features. Focus groups are considered an appropriate method for informing intervention development³⁶. The focus groups will take place in person but can be held remotely if necessary (e.g., for COVID health and safety reasons) via Microsoft Teams. Each focus group is expected to last 60 minutes. In situations where non-attendance or scheduling difficulties occur, one-to-one interviews will be conducted utilising the same topic guide. At the outset of each focus group interview, informed consent will be re-confirmed orally, and audio-recorded digitally.

Following the scoping review¹⁵ and qualitative study²⁴, a list of the individual with a MSD’s needs and requirements was formulated. Proposed eHealth intervention prototype elements to meet these needs will be built prior to the first focus group. While building these elements, the Web Content Accessibility Guidelines³⁷ will be followed, making content accessible to a wider range of people with disabilities³⁸. Microsoft Office software will be utilised to ensure readability recommendations are met (i.e., grade 6 or less on the Flesch-Kincaid Grade Level)³⁹.

Focus Group 1

This focus group will review paper prototypes of the visual feature concepts and the prioritised elements to be developed in further detail for the click-through prototype. Participants will utilise Monopoly Money to determine the value of the individual features. Questions will address adoption, accessibility, and overall strengths/weaknesses of the key features (Appendix A, Extended data).

Focus Group 2

This focus group will review the initial clickable prototype, with participants being asked to provide feedback on the proposed functional elements and website pages. Questions will focus on functional elements (e.g., checkboxes, drag and drop, and tailored features) and individual webpage presentation (e.g., missing items and clarity; Appendix B, Extended data). The interview guides for both focus groups will continue to be refined iteratively by research team members, software developers, and graphic designers.

Analysis

The focus groups will be audio recorded, transcribed verbatim and imported into NVivo⁴⁰. The lead researcher (MK) will complete a descriptive synthesis of the monopoly activity and focus group transcripts. The research team (MK, BF, DM, CB, BO’M & JMcV) will then review these findings, and refine the prototype as indicated.

Step 2: Heuristic testing

Five reviewers (a panel composed of three research team members, one graphic designer and one software developer) will evaluate the refined prototype on a computer and mobile device based on the 10 heuristic principles of Nielsen⁴¹. The areas of focus will include search, navigation, forms and data entry, information architecture, writing and content quality, trust and credibility, page layout and visual design.

The reviewers will independently rate each website page using the following criteria: +1 (complies), -1 (does not comply), or 0 (partially complies). Reviewers will provide comments to justify their scoring. For items deemed not relevant, reviewers will be advised to note ‘not applicable’. The reviewers will meet to discuss the ratings and reach a consensus regarding the items to be addressed before usability testing.

Step 3: Usability testing

Study participants

Participants involved in one-to-one interviews will include both individuals with a MSD and MSK physiotherapists.

Individuals with a MSD: Purposive sampling, using the same eligibility criteria and recruitment strategy will be used as described in Step 1. Potential participants will be naïve to the development of the eHealth intervention. Given approximately 80% of usability problems can be identified using a sample of three to five users⁴², we will recruit this number of individuals with a MSD⁴².

MSK Physiotherapists: A purposive sampling strategy will also be utilised for MSK physiotherapists. Physiotherapist eligibility criteria include physiotherapists working predominantly in the area of MSK therapy (at least 50% of their time) in either the public or private health setting. To recruit MSK physiotherapists working in the public sector, the researcher MK will contact physiotherapy managers, gatekeepers at these sites, to outline the details of the study; provide a participant information leaflet; and request that an email invitation is sent to all their staff. Email invitations will also be sent out via the ISCP mailing list. The study will also be advertised on social media (Twitter).

Interested participants will be asked to contact the researcher (MK). Those with access to email will be sent a participant information leaflet and consent form. For those that do not have access to a computer or the internet, the participant information leaflet and consent form will be sent via post with a prepaid return envelope. Three to five MSK physiotherapists will be recruited⁴².

Procedures

Questionnaires

Prior to the interviews, participants will complete the two questionnaires as outlined in Step 1. At the end of the interview, participants will complete the System Usability Scale (SUS) to evaluate user satisfaction⁴³, with this validated questionnaire the most frequently utilised within usability testing⁴⁴.

Interviews

The lead researcher (MK) will conduct the in-person one-to-one 60-minute interviews to identify problems with the prototype interface and paths and strategies that participants utilise, including time spent completing tasks. Participants will be interviewed in a private room within the university using their preferred devices (i.e., mobile phone, tablet, laptop and desktop) to review the prototype. At the outset of each interview, informed consent will be re-confirmed orally, and audio-recorded digitally.

Five usability scenarios for both people with a MSD (Appendix C, Extended data) and MSK physiotherapists (Appendix D, Extended data) have been developed by the research team, software developer and graphic designer. These scenarios will continue to be refined iteratively, as the prototype itself is refined. During the interview, participants will review the relevant five scenarios utilising the think-aloud method (i.e. participants think out aloud while performing a given task)⁴⁵ and will respond to a series of open-ended questions about the interface, content, features, and format⁴⁶. The think-aloud method is the most commonly utilised qualitative method of usability testing in eHealth intervention development⁴⁴, effective in exploring end-users' attitudes towards eHealth interventions^29,47.

Analysis

Interviews will be audio recorded and transcribed verbatim. The interview transcripts will be analysed utilising directed content analysis by MK applying a deductive approach to categorise what was useful and the areas to enhance⁴⁸. This list will then be utilised by software developers to further refine the eHealth: It’s TIME intervention prototype, with this iterative approach recommended^49,50.

Conclusions

eHealth interventions show potential in supporting self-management of people with MSDs. This study aims to develop and design an eHealth-mediated follow-up self-management support prototype for this cohort. It will be guided by the preferences of end-users, utilising a systematic iterative process. Once developed, the next phase of this project will be to complete a feasibility study to identify preliminary patient-reported outcomes (e.g., self-efficacy), to evaluate engagement with and the acceptability of the prototype and potential implementation considerations.

Data availability

Underlying data

No data are associated with this article.

Extended data

Figshare: Development and design of an eHealth intervention to support self-management in those with musculoskeletal disorders - ‘eHealth: It’s TIME’: a study protocol, https://doi.org/10.6084/m9.figshare.20713978⁵¹

This project contains the following extended data:

Interview Guide Focus Group 1,
Interview Guide Focus Group 2
Usability Scenarios for People with a Musculoskeletal Disorder – Usability Testing (Step 3)
Usability Scenarios for Musculoskeletal Physiotherapist – Usability Testing (Step 3)

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Faculty Opinions recommended

References

1. Cieza A, Causey K, Kamenov K, et al.: Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2021; 396(10267): 2006–17. PubMed Abstract | Publisher Full Text | Free Full Text
2. Seron P, Oliveros MJ, Gutierrez-Arias R, et al.: Effectiveness of telerehabilitation in physical therapy: A rapid overview. Phys Ther. 2021; 101(6): pzab053. PubMed Abstract | Publisher Full Text | Free Full Text
3. Chehade MJ, Yadav L, Kopansky-Giles D, et al.: Innovations to improve access to musculoskeletal care. Best Pract Res Clin Rheumatol. 2020; 34(5): 101559. PubMed Abstract | Publisher Full Text
4. World Health Organization: WHO guideline: recommendations on digital interventions for health system strengthening. World Health Organization; 2019. Reference Source
5. Slater H, Dear BF, Merolli MA, et al.: Use of eHealth technologies to enable the implementation of musculoskeletal Models of Care: Evidence and practice. Best Pract Res Clin Rheumatol. 2016; 30(3): 483–502. PubMed Abstract | Publisher Full Text
6. Slater H, Campbell JM, Stinson JN, et al.: End user and implementer experiences of mHealth technologies for noncommunicable chronic disease management in young adults: Systematic review. J Med Internet Res. 2017; 19(12): e406. PubMed Abstract | Publisher Full Text | Free Full Text
7. Wind TR, Rijkeboer M, Andersson G, et al.: The COVID-19 pandemic: The 'black swan' for mental health care and a turning point for e-health. Internet Interv. 2020; 20: 100317. PubMed Abstract | Publisher Full Text | Free Full Text
8. Nugent L, Kouyate RA, Jackson S, et al.: Development of a Digital Health Intervention for Rheumatoid Arthritis Symptom Management in a Biotechnology Industry Context: Protocol for the Application of a Human-Centered Design Framework. JMIR Res Protoc. 2022; 11(3): e16430. PubMed Abstract | Publisher Full Text | Free Full Text
9. Black N: Patient reported outcome measures could help transform healthcare. BMJ. 2013; 346: f167. PubMed Abstract | Publisher Full Text
10. Kelders SM, van Gemert-Pijnen JE, Werkman A, et al.: Usage and effect of a web-based intervention for the prevention of overweight; a randomized controlled trial. 2010 Second International Conference on eHealth, Telemedicine, and Social Medicine. IEEE, 2010. Publisher Full Text
11. Nijland N: Grounding eHealth: towards a holistic framework for sustainable eHealth technologies. 2011. Publisher Full Text
12. Verhoeven F: When staff handle staph: user-driven versus expert-driven communication of infection control guidelines. 2009. Publisher Full Text
13. Verhoeven F, Tanja-Dijkstra K, Nijland N, et al.: Asynchronous and synchronous teleconsultation for diabetes care: a systematic literature review. J Diabetes Sci Technol. 2010; 4(3): 666–84. PubMed Abstract | Publisher Full Text | Free Full Text
14. van Gemert-Pijnen JE, Nijland N, van Limburg M, et al.: A holistic framework to improve the uptake and impact of eHealth technologies. J Med Internet Res. 2011; 13(4): e111. PubMed Abstract | Publisher Full Text | Free Full Text
15. Kelly M, Fullen B, Martin D, et al.: eHealth Interventions to Support Self-Management in People With Musculoskeletal Disorders, "eHealth: It's TIME"-A Scoping Review. Phys Ther. 2022; 102(4): pzab307. PubMed Abstract | Publisher Full Text | Free Full Text
16. Kress HG, Aldington D, Alon E, et al.: A holistic approach to chronic pain management that involves all stakeholders: change is needed. Curr Med Res Opin. 2015; 31(9): 1743–54. PubMed Abstract | Publisher Full Text
17. Keogh E, Rosser BA, Eccleston C: e-Health and chronic pain management: current status and developments. Pain. 2010; 151(1): 18–21. PubMed Abstract | Publisher Full Text
18. Keogh E: Developments in the use of e-health for chronic pain management. Pain Manag. 2013; 3(1): 27–33. PubMed Abstract | Publisher Full Text
19. Bazzano AN, Martin J, Hicks E, et al.: Human-centred design in global health: a scoping review of applications and contexts. PLoS One. 2017; 12(11): e0186744. PubMed Abstract | Publisher Full Text | Free Full Text
20. Altman M, Huang TT, Breland JY: Design thinking in health care. Prev Chronic Dis. 2018; 15: E117. PubMed Abstract | Publisher Full Text | Free Full Text
21. Yardley L, Ainsworth B, Arden-Close E, et al.: The person-based approach to enhancing the acceptability and feasibility of interventions. Pilot Feasibility Stud. 2015; 1(1): 37. PubMed Abstract | Publisher Full Text | Free Full Text
22. Varsi C, Ekstedt M, Gammon D, et al.: Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res. 2015; 17(11): e262. PubMed Abstract | Publisher Full Text | Free Full Text
23. Varsi C, Nes LS, Kristjansdottir OB, et al.: Implementation strategies to enhance the implementation of eHealth programs for patients with chronic illnesses: realist systematic review. J Med Internet Res. 2019; 21(9): e14255. PubMed Abstract | Publisher Full Text | Free Full Text
24. Kelly M, Fullen BM, Martin D, et al.: eHealth Interventions to Support Self-Management: Perceptions and experiences of People with Musculoskeletal Disorders and Physiotherapists - 'eHealth: It's TIME': A Qualitative Study. Physiother Theory Pract. 2022; 1–11. PubMed Abstract | Publisher Full Text
25. Granja C, Janssen W, Johansen MA: Factors determining the success and failure of eHealth interventions: systematic review of the literature. J Med Internet Res. 2018; 20(5): e10235. PubMed Abstract | Publisher Full Text | Free Full Text
26. Craig P, Dieppe P, Macintyre S, et al.: Developing and evaluating complex interventions: the new Medical Research Council guidance. Int J Nurs Stud. 2013; 50: 587–92. PubMed Abstract | Publisher Full Text
27. Kip H, van Gemert-Pijnen LJ: Holistic development of eHealth technology.eHealth Research, Theory and Development: A Multi-Disciplinary Approach Abingdon-on-Thames, UK: Routledge. 2018; 151–86. Publisher Full Text
28. Kushniruk AW, Patel VL: Cognitive and usability engineering methods for the evaluation of clinical information systems. J Biomed Inform. 2004; 37(1): 56–76. PubMed Abstract | Publisher Full Text
29. Donald M, Beanlands H, Straus SE, et al.: A web-based self-management support prototype for adults with chronic kidney disease (my kidneys my health): co-design and usability testing. JMIR Form Res. 2021; 5(2): e22220. PubMed Abstract | Publisher Full Text | Free Full Text
30. French SD, Green SE, O’Connor DA, et al.: Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implement Sci. 2012; 7(1): 38. PubMed Abstract | Publisher Full Text | Free Full Text
31. Wentzel J, van Velsen L, van Limburg M, et al.: Participatory eHealth development to support nurses in antimicrobial stewardship. BMC Med Inform Decis Mak. 2014; 14(1): 45. PubMed Abstract | Publisher Full Text | Free Full Text
32. Kelders SM, Pots WT, Oskam MJ, et al.: Development of a web-based intervention for the indicated prevention of depression. BMC Med Inform Decis Mak. 2013; 13(1): 26. PubMed Abstract | Publisher Full Text | Free Full Text
33. Beerlage-de Jong N, van Gemert-Pijnen L, Wentzel J, et al.: Technology to support integrated antimicrobial stewardship programs: a user centered and stakeholder driven development approach. Infect Dis Rep. 2017; 9(1): 6829. PubMed Abstract | Publisher Full Text | Free Full Text
34. Moore G, Wilding H, Gray K, et al.: Participatory methods to engage health service users in the development of electronic health resources: systematic review. J Particip Med. 2019; 11(1): e11474. PubMed Abstract | Publisher Full Text | Free Full Text
35. Monkman H, Kushniruk AW, Barnett J, et al.: Are health literacy and eHealth literacy the same or different? Stud Health Technol Inform. 2017; 245: 178–82. PubMed Abstract | Publisher Full Text
36. Krueger RA: Focus groups: A practical guide for applied research. Sage publications; 2014. Reference Source
37. Caldwell B, Cooper M, Reid LG, et al.: Web content accessibility guidelines (WCAG) 2.0. WWW Consortium (W3C). 2008; 290: 1–34. Reference Source
38. Richardson S, Lawrence K, Schoenthaler AM, et al.: A framework for digital health equity. NPJ Digit Med. 2022; 5(1): 119. PubMed Abstract | Publisher Full Text | Free Full Text
39. Badarudeen S, Sabharwal S: Assessing readability of patient education materials: current role in orthopaedics. Clin Orthop Relat Res. 2010; 468(10): 2572–80. PubMed Abstract | Publisher Full Text | Free Full Text
40. NVivo: NVivo qualitative data analysis software. QSR International Pty Ltd Melbourne, Australia; 2015.
41. 10 Usability Heuristics for User Interface Design. Nielsen Norman Group. [accessed 10 Jul 22]. Reference Source
42. Nielsen J: Estimating the number of subjects needed for a thinking aloud test. Int J Hum Comput Stud. 1994; 41(3): 385–97. Publisher Full Text
43. Bangor A, Kortum PT, Miller JT: An empirical evaluation of the system usability scale. Int J Hum Comput Int. 2008; 24(6): 574–94. Publisher Full Text
44. Maramba I, Chatterjee A, Newman C: Methods of usability testing in the development of eHealth applications: a scoping review. Int J Med Inform. 2019; 126: 95–104. PubMed Abstract | Publisher Full Text
45. Eccles DW, Arsal G: The think aloud method: what is it and how do I use it? Qual Res Sport Exerc Health. 2017; 9(4): 514–31. Publisher Full Text
46. Weir CR, Nebeker JJ, Hicken BL, et al.: A cognitive task analysis of information management strategies in a computerized provider order entry environment. J Am Med Inform Assoc. 2007; 14(1): 65–75. PubMed Abstract | Publisher Full Text | Free Full Text
47. Ledel Solem IK, Varsi C, Eide H, et al.: A user-centered approach to an evidence-based electronic health pain management intervention for people with chronic pain: design and development of EPIO. J Med Internet Res. 2020; 22(1): e15889. PubMed Abstract | Publisher Full Text | Free Full Text
48. Hsieh HF, Shannon SE: Three approaches to qualitative content analysis. Qual Health Res. 2005; 15(9): 1277–88. PubMed Abstract | Publisher Full Text
49. Zapata BC, Fernández-Alemán JL, Idri A, et al.: Empirical studies on usability of mHealth apps: a systematic literature review. J Med Syst. 2015; 39(2): 1–19. PubMed Abstract | Publisher Full Text
50. Andersen TO, Bansler JP, Kensing F, et al.: Aligning concerns in telecare: three concepts to guide the design of patient-centred E-health. Comput Supported Coop Work. 2019; 28(6): 1039–72. Publisher Full Text
51. Kelly M: Study protocol supplementary material.figshare. Media. 2022. http://www.doi.org/10.6084/m9.figshare.20713978.v1

Comments on this article Comments (0)

Version 2

VERSION 2 PUBLISHED 14 Nov 2022

Author details Author details

Marie Kelly
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Project Administration, Writing – Original Draft Preparation, Writing – Review & Editing

Brona Fullen
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Writing – Review & Editing

Denis Martin
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Writing – Review & Editing

Colin Bradley
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Writing – Review & Editing

Billy O'Mahony
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Software, Writing – Review & Editing

Joseph G. McVeigh
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Supervision, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

Health Research Board (Fulbright Irish Scholar Award to Professor Colin Bradley).

Article Versions (2)

version 2

Revised

Published: 10 Aug 2023, 5:73

https://doi.org/10.12688/hrbopenres.13611.2

version 1

Published: 14 Nov 2022, 5:73

https://doi.org/10.12688/hrbopenres.13611.1

© 2022 Kelly M et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Download

Export To

metrics

VIEWS

1117

downloads

100

Citations

SEE MORE DETAILS

CITE

how to cite this article

Kelly M, Fullen B, Martin D et al. Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders - ‘eHealth: It’s TIME’: a study protocol [version 1; peer review: 2 approved with reservations]. HRB Open Res 2022, 5:73 (https://doi.org/10.12688/hrbopenres.13611.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

track

receive updates on this article

Track an article to receive email alerts on any updates to this article.

Open Peer Review

Version 1

VERSION 1

PUBLISHED 14 Nov 2022

Views

Reviewer Report 18 Jul 2023

Ingris Pelaez-Ballestas, Hospital General de Mexico Dr Eduardo Liceaga, Mexico City, Mexico City, Mexico

Approved with Reservations

https://doi.org/10.21956/hrbopenres.14880.r34398

I appreciate the opportunity to review this interesting and novel protocol “Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders-eHealth: It´s TIME: a study protocol”. Its implementation will provide support to health professionals and ... Continue reading

I have doubts about the process of participation in the development. Is it only through the focus groups, or did people with MSKD and physical therapists participate in the study design and construction of the interview guide?
It would be important to include a greater diversity of participants regarding gender, ethnicity, place of residence (rural/urban), and socioeconomic conditions.
I suggest describing the analysis in detail. Will there be any triangulation strategy?
I suggest a reflection on the potential limitations of this protocol or even a reflexivity on the part of the authors.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Rheumatology; Qualitative Study; Participatory Research

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

CITE

Report a concern

Author Response 29 Nov 2023

Marie Kelly, Discipline of Physiotherapy, University College Cork, Cork, Ireland

29 Nov 2023

Author Response

Thank you Ingris for your time in reviewing our protocol. We appreciate all your comments and suggested changes. We have addressed the points you raised and amended the protocol accordingly.
... Continue reading Thank you Ingris for your time in reviewing our protocol. We appreciate all your comments and suggested changes. We have addressed the points you raised and amended the protocol accordingly.

Comment 1: Process of participation
People with musculoskeletal disorders (MSDs) and musculoskeletal physiotherapists did not participate in the study design and construction of the interview guide. However, this study which is part of a larger project, ‘eHealth: It’s TIME’, is guided by the Medical Research Council framework (Craig et al., 2013) and the Center for eHealth Research (CeHReS) Roadmap (van Gemert-Pijnen et al., 2011, Kip and van Gemert-Pijnen, 2018). The Roadmap is based on five principles, one of which is that eHealth development should be a participatory process (van Gemert-Pijnen et al., 2011). This project relates specifically to the development and design of eHealth technology (and not the implementation or evaluation), hence, the focus is on the first three phases of the Roadmap: contextual inquiry [scoping review (Kelly et al., 2022a)(doi:10.1093/ptj/pzab307)], value specification [qualitative study (Kelly et al., 2022b)(doi: 10.1080/09593985.2022.2151334)] and design (current study).
In the value specification phase, users’ perceptions of eHealth-mediated supported self-management and their needs and requirements were explored via individual interviews with people with MSDs and physiotherapists that work in this clinical area (Kelly et al., 2022b). Following the scoping reviewand qualitative study, a list of the needs and requirements of individuals with a MSD’s was formulated. Proposed eHealth intervention prototype elements to meet these needs (Appendix A, Extended data) will be built prior to the first focus group. A figure has been added to illustrate the CeHReS Roadmap (Figure 2) and the value specification (Appendix A, Extended data) to improve clarity relating to the participatory approach.
This current study undertakes an iterative development approach with an emphasis on stakeholder participation. Step one involves two sequential focus groups with people with MSDs. Step two involves five reviewers (three research team members, one graphic designer and one software developer), and Step three involves usability testing with approximately five people with MSDs and five musculoskeletal physiotherapists.
The interview guides for both the focus groups and 1:1 usability testing interviews have been developed by the research team and will continue to be refined iteratively, as the prototype itself is refined. To improve transparency and clarity on the participatory approach, the new version has provided an overview of the research team members.

Comment 2: Greater diversity of participants
Thank you for your comment. Apologies for the confusion regarding this. Convenience sampling was undertaken; the recruitment of a more systematically diverse sample would have required more resources than were available. This has been amended in the updated version and acknowledged within the limitations section. To limit this bias, all study participants will only be involved in one aspect of the study, with no prior exposure to the development of the prototype, which will result in a larger overall study sample size. Furthermore, the purpose of this study is the initial development and design of a web-based prototype for people with MSDs to enhance follow-up self-management support. The next phase of this project will be to complete a feasibility study which will incorporate a purposive sampling strategy which will aim to include a diverse range of participant demographic characteristics such as age, ethnicity, place of residence (rural/urban), eHealth literacy etc.

Comment 3: More detail on the analysis
Thank you for your comment. Further detail has been provided in relation to the analysis. This study will employ data and methodological triangulation by collecting data from different sources (i.e., people with MSDs and physiotherapists) and using different methodologies (i.e., focus groups, interviews and questionnaires) (Denzin, 2017) (https://doi.org/10.4324/9781315134543). The protocol has been updated to improve clarity on the triangulation strategy.

Comment 4: Reflection on potential limitations of study protocol and reflexivity
Thank you for your comment. A section on the main strength of the study protocol with two limitations has been added to the revised version. Amendments have also been made to improve clarity with respect to reflexivity. To facilitate reflexivity, field notes and memos will be utilised. Regular research team meetings which are open and collegiate (Barry et al., 1999), will also serve to promote reflection on the analysis and results.
Thank you Ingris for your time in reviewing our protocol. We appreciate all your comments and suggested changes. We have addressed the points you raised and amended the protocol accordingly.

Comment 1: Process of participation
People with musculoskeletal disorders (MSDs) and musculoskeletal physiotherapists did not participate in the study design and construction of the interview guide. However, this study which is part of a larger project, ‘eHealth: It’s TIME’, is guided by the Medical Research Council framework (Craig et al., 2013) and the Center for eHealth Research (CeHReS) Roadmap (van Gemert-Pijnen et al., 2011, Kip and van Gemert-Pijnen, 2018). The Roadmap is based on five principles, one of which is that eHealth development should be a participatory process (van Gemert-Pijnen et al., 2011). This project relates specifically to the development and design of eHealth technology (and not the implementation or evaluation), hence, the focus is on the first three phases of the Roadmap: contextual inquiry [scoping review (Kelly et al., 2022a)(doi:10.1093/ptj/pzab307)], value specification [qualitative study (Kelly et al., 2022b)(doi: 10.1080/09593985.2022.2151334)] and design (current study).
In the value specification phase, users’ perceptions of eHealth-mediated supported self-management and their needs and requirements were explored via individual interviews with people with MSDs and physiotherapists that work in this clinical area (Kelly et al., 2022b). Following the scoping reviewand qualitative study, a list of the needs and requirements of individuals with a MSD’s was formulated. Proposed eHealth intervention prototype elements to meet these needs (Appendix A, Extended data) will be built prior to the first focus group. A figure has been added to illustrate the CeHReS Roadmap (Figure 2) and the value specification (Appendix A, Extended data) to improve clarity relating to the participatory approach.
This current study undertakes an iterative development approach with an emphasis on stakeholder participation. Step one involves two sequential focus groups with people with MSDs. Step two involves five reviewers (three research team members, one graphic designer and one software developer), and Step three involves usability testing with approximately five people with MSDs and five musculoskeletal physiotherapists.
The interview guides for both the focus groups and 1:1 usability testing interviews have been developed by the research team and will continue to be refined iteratively, as the prototype itself is refined. To improve transparency and clarity on the participatory approach, the new version has provided an overview of the research team members.

Comment 2: Greater diversity of participants
Thank you for your comment. Apologies for the confusion regarding this. Convenience sampling was undertaken; the recruitment of a more systematically diverse sample would have required more resources than were available. This has been amended in the updated version and acknowledged within the limitations section. To limit this bias, all study participants will only be involved in one aspect of the study, with no prior exposure to the development of the prototype, which will result in a larger overall study sample size. Furthermore, the purpose of this study is the initial development and design of a web-based prototype for people with MSDs to enhance follow-up self-management support. The next phase of this project will be to complete a feasibility study which will incorporate a purposive sampling strategy which will aim to include a diverse range of participant demographic characteristics such as age, ethnicity, place of residence (rural/urban), eHealth literacy etc.

Comment 3: More detail on the analysis
Thank you for your comment. Further detail has been provided in relation to the analysis. This study will employ data and methodological triangulation by collecting data from different sources (i.e., people with MSDs and physiotherapists) and using different methodologies (i.e., focus groups, interviews and questionnaires) (Denzin, 2017) (https://doi.org/10.4324/9781315134543). The protocol has been updated to improve clarity on the triangulation strategy.

Comment 4: Reflection on potential limitations of study protocol and reflexivity
Thank you for your comment. A section on the main strength of the study protocol with two limitations has been added to the revised version. Amendments have also been made to improve clarity with respect to reflexivity. To facilitate reflexivity, field notes and memos will be utilised. Regular research team meetings which are open and collegiate (Barry et al., 1999), will also serve to promote reflection on the analysis and results.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 29 Nov 2023

Marie Kelly, Discipline of Physiotherapy, University College Cork, Cork, Ireland

29 Nov 2023

Author Response

Thank you Ingris for your time in reviewing our protocol. We appreciate all your comments and suggested changes. We have addressed the points you raised and amended the protocol accordingly.
... Continue reading Thank you Ingris for your time in reviewing our protocol. We appreciate all your comments and suggested changes. We have addressed the points you raised and amended the protocol accordingly.

Comment 1: Process of participation
People with musculoskeletal disorders (MSDs) and musculoskeletal physiotherapists did not participate in the study design and construction of the interview guide. However, this study which is part of a larger project, ‘eHealth: It’s TIME’, is guided by the Medical Research Council framework (Craig et al., 2013) and the Center for eHealth Research (CeHReS) Roadmap (van Gemert-Pijnen et al., 2011, Kip and van Gemert-Pijnen, 2018). The Roadmap is based on five principles, one of which is that eHealth development should be a participatory process (van Gemert-Pijnen et al., 2011). This project relates specifically to the development and design of eHealth technology (and not the implementation or evaluation), hence, the focus is on the first three phases of the Roadmap: contextual inquiry [scoping review (Kelly et al., 2022a)(doi:10.1093/ptj/pzab307)], value specification [qualitative study (Kelly et al., 2022b)(doi: 10.1080/09593985.2022.2151334)] and design (current study).
In the value specification phase, users’ perceptions of eHealth-mediated supported self-management and their needs and requirements were explored via individual interviews with people with MSDs and physiotherapists that work in this clinical area (Kelly et al., 2022b). Following the scoping reviewand qualitative study, a list of the needs and requirements of individuals with a MSD’s was formulated. Proposed eHealth intervention prototype elements to meet these needs (Appendix A, Extended data) will be built prior to the first focus group. A figure has been added to illustrate the CeHReS Roadmap (Figure 2) and the value specification (Appendix A, Extended data) to improve clarity relating to the participatory approach.
This current study undertakes an iterative development approach with an emphasis on stakeholder participation. Step one involves two sequential focus groups with people with MSDs. Step two involves five reviewers (three research team members, one graphic designer and one software developer), and Step three involves usability testing with approximately five people with MSDs and five musculoskeletal physiotherapists.
The interview guides for both the focus groups and 1:1 usability testing interviews have been developed by the research team and will continue to be refined iteratively, as the prototype itself is refined. To improve transparency and clarity on the participatory approach, the new version has provided an overview of the research team members.

Comment 2: Greater diversity of participants
Thank you for your comment. Apologies for the confusion regarding this. Convenience sampling was undertaken; the recruitment of a more systematically diverse sample would have required more resources than were available. This has been amended in the updated version and acknowledged within the limitations section. To limit this bias, all study participants will only be involved in one aspect of the study, with no prior exposure to the development of the prototype, which will result in a larger overall study sample size. Furthermore, the purpose of this study is the initial development and design of a web-based prototype for people with MSDs to enhance follow-up self-management support. The next phase of this project will be to complete a feasibility study which will incorporate a purposive sampling strategy which will aim to include a diverse range of participant demographic characteristics such as age, ethnicity, place of residence (rural/urban), eHealth literacy etc.

Comment 3: More detail on the analysis
Thank you for your comment. Further detail has been provided in relation to the analysis. This study will employ data and methodological triangulation by collecting data from different sources (i.e., people with MSDs and physiotherapists) and using different methodologies (i.e., focus groups, interviews and questionnaires) (Denzin, 2017) (https://doi.org/10.4324/9781315134543). The protocol has been updated to improve clarity on the triangulation strategy.

Comment 4: Reflection on potential limitations of study protocol and reflexivity
Thank you for your comment. A section on the main strength of the study protocol with two limitations has been added to the revised version. Amendments have also been made to improve clarity with respect to reflexivity. To facilitate reflexivity, field notes and memos will be utilised. Regular research team meetings which are open and collegiate (Barry et al., 1999), will also serve to promote reflection on the analysis and results.
Thank you Ingris for your time in reviewing our protocol. We appreciate all your comments and suggested changes. We have addressed the points you raised and amended the protocol accordingly.

Comment 1: Process of participation
People with musculoskeletal disorders (MSDs) and musculoskeletal physiotherapists did not participate in the study design and construction of the interview guide. However, this study which is part of a larger project, ‘eHealth: It’s TIME’, is guided by the Medical Research Council framework (Craig et al., 2013) and the Center for eHealth Research (CeHReS) Roadmap (van Gemert-Pijnen et al., 2011, Kip and van Gemert-Pijnen, 2018). The Roadmap is based on five principles, one of which is that eHealth development should be a participatory process (van Gemert-Pijnen et al., 2011). This project relates specifically to the development and design of eHealth technology (and not the implementation or evaluation), hence, the focus is on the first three phases of the Roadmap: contextual inquiry [scoping review (Kelly et al., 2022a)(doi:10.1093/ptj/pzab307)], value specification [qualitative study (Kelly et al., 2022b)(doi: 10.1080/09593985.2022.2151334)] and design (current study).
In the value specification phase, users’ perceptions of eHealth-mediated supported self-management and their needs and requirements were explored via individual interviews with people with MSDs and physiotherapists that work in this clinical area (Kelly et al., 2022b). Following the scoping reviewand qualitative study, a list of the needs and requirements of individuals with a MSD’s was formulated. Proposed eHealth intervention prototype elements to meet these needs (Appendix A, Extended data) will be built prior to the first focus group. A figure has been added to illustrate the CeHReS Roadmap (Figure 2) and the value specification (Appendix A, Extended data) to improve clarity relating to the participatory approach.
This current study undertakes an iterative development approach with an emphasis on stakeholder participation. Step one involves two sequential focus groups with people with MSDs. Step two involves five reviewers (three research team members, one graphic designer and one software developer), and Step three involves usability testing with approximately five people with MSDs and five musculoskeletal physiotherapists.
The interview guides for both the focus groups and 1:1 usability testing interviews have been developed by the research team and will continue to be refined iteratively, as the prototype itself is refined. To improve transparency and clarity on the participatory approach, the new version has provided an overview of the research team members.

Comment 2: Greater diversity of participants
Thank you for your comment. Apologies for the confusion regarding this. Convenience sampling was undertaken; the recruitment of a more systematically diverse sample would have required more resources than were available. This has been amended in the updated version and acknowledged within the limitations section. To limit this bias, all study participants will only be involved in one aspect of the study, with no prior exposure to the development of the prototype, which will result in a larger overall study sample size. Furthermore, the purpose of this study is the initial development and design of a web-based prototype for people with MSDs to enhance follow-up self-management support. The next phase of this project will be to complete a feasibility study which will incorporate a purposive sampling strategy which will aim to include a diverse range of participant demographic characteristics such as age, ethnicity, place of residence (rural/urban), eHealth literacy etc.

Comment 3: More detail on the analysis
Thank you for your comment. Further detail has been provided in relation to the analysis. This study will employ data and methodological triangulation by collecting data from different sources (i.e., people with MSDs and physiotherapists) and using different methodologies (i.e., focus groups, interviews and questionnaires) (Denzin, 2017) (https://doi.org/10.4324/9781315134543). The protocol has been updated to improve clarity on the triangulation strategy.

Comment 4: Reflection on potential limitations of study protocol and reflexivity
Thank you for your comment. A section on the main strength of the study protocol with two limitations has been added to the revised version. Amendments have also been made to improve clarity with respect to reflexivity. To facilitate reflexivity, field notes and memos will be utilised. Regular research team meetings which are open and collegiate (Barry et al., 1999), will also serve to promote reflection on the analysis and results.
Competing Interests: No competing interests were disclosed. Close
Report a concern

Views

Reviewer Report 27 Mar 2023

Sara Lundell, Department of Sociology, Umea Universitet, Umeå, Västerbotten County, Sweden

Approved with Reservations

https://doi.org/10.21956/hrbopenres.14880.r33542

This is a well-written protocol for a study with the aim to develop and design an eHealth self-management support for people with musculoskeletal disorders. The study will be conducted in three steps; 1) creation of website features and content with feedback from two focus groups, 2) heuristic testing by fiver reviewers, and 3) usability testing with people with musculoskeletal disorders and musculoskeletal physiotherapists. The study design seems highly relevant for the aim of the study.

Even though I think that the protocol includes most information I would have asked for, I have some suggestions that I think could improve the text even more.

I think the introduction gives a good and clear motivation on why this study is needed, but please provide a definition/description of self-management.
Figure 1 gives a great overview of the study, but in contrast to step 1 and 3, it is unclear who the participants, i.e., the five reviewers, in step 2 are. Please clarify that.
Methods: Please specify if you will have any strategy on who to recruit (beyond eligibility criteria), e.g., distribution between men and women, different ages, computer skills, etc.
Methods – study design: You state that your study relates to the first three phases of the Roadmap. Please elaborate on how you will do this and how these three steps that you have mentioned earlier in the text.
Methods – step 1 – study participants: Please specify if the informed consent is written or oral.
Methods – recruitment: For me it was unclear for me how the interested participants should come in contact with the study, until I read the social media recruitment. Please clarify in the beginning of the recruitment paragraph that interested participants from all these recruitment methods will be asked to contact researcher MK.
Methods – step 2: The three research team members, have they been part of the development i step 1? Please specify.
Methods – step 3 – study participants: Please, revise the sentence about purposive sampling of individuals with a MSD.
Methods – step 3 – study participants: The last sentence of the last paragraph should be moved to the paragraph about MSK Physiotherapists.
Methods – step 3 – procedures – questionnaire: Please look at the last sentence, I think it needs to be rephrased.
Methods – step 3 – procedures – interviews: I would prefer to get the information about the think-aloud method earlier in the text. Now several questions were raised before I got to that part. Please restructure this part.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: My area of expertise relevant for this review is conducting co-creation studies to develop eHealth tools for supporting self-management in people with chronic obstructive pulmonary disease (COPD).

CITE

Report a concern

Author Response 29 Nov 2023

Marie Kelly, Discipline of Physiotherapy, University College Cork, Cork, Ireland

29 Nov 2023

Author Response

Thank you Sara for your time in reviewing our protocol. We appreciate all your comments and suggested changes. We have addressed the points you raised and amended the protocol accordingly.
... Continue reading Thank you Sara for your time in reviewing our protocol. We appreciate all your comments and suggested changes. We have addressed the points you raised and amended the protocol accordingly.

Introduction, Comment 1:
Thank you for this comment. I have provided a description of self-management – See Introduction, paragraph 2 first and second sentence.

Comment 2, Figure 1:
Thank you for this comment. I have updated Step 2 of Figure 1 to clarify the 5 reviewers undertaking the heuristic testing. I have also updated the written text in the Step 2 section.

Comment 3, Methods:
Thank you for this comment. The sampling strategy has now been clarified as convenience sampling for Step 1 and 3. Please see the ‘Study Participants’ section for Step 1 and Step 3.

Comment 4, Methods (study design):
Thank you for this comment and apologies for the confusion – this has now been updated. The sentence was meant to relate to the entire project rather than this study alone.

Comment 5, Methods (Step 1, study participants):
Thank you for this comment. I have specified that informed consent was electronic or written.

Comment 6, Methods (Recruitment):
Thank you for this comment. I have clarified at the beginning of the recruitment paragraph that all interested participants were asked to contact researcher MK

Comment 7, Methods (Step 2):
Thank you for this comment. This has now been clarified as the three research team members were not involved in Step 1. Please see the analysis section for Step 1 and the Heuristic Testing section.

Comment 8, Methods (Step 3 – study participants):
Thank you for this comment. This sentence has been revised with a convenience sampling strategy specified.

Comment 9, Methods (Step 3 – study participants):
Thank you for this comment. The last sentence of the last paragraph for individuals with a MSD has now been moved as per the suggestion and is now the last sentence in this section above the Step 3 Procedures section.

Comment 10, Methods (Step 3 – Procedures – questionnaire):
Thank you for this comment. The last sentence has now been rephrased.

Comment 11, Methods (Step 3 – Procedures – interviews):
Thank you for this comment. This has now been restructured to ensure the information about the think-aloud protocol is earlier in the text.
Thank you Sara for your time in reviewing our protocol. We appreciate all your comments and suggested changes. We have addressed the points you raised and amended the protocol accordingly.

Introduction, Comment 1:
Thank you for this comment. I have provided a description of self-management – See Introduction, paragraph 2 first and second sentence.

Comment 2, Figure 1:
Thank you for this comment. I have updated Step 2 of Figure 1 to clarify the 5 reviewers undertaking the heuristic testing. I have also updated the written text in the Step 2 section.

Comment 3, Methods:
Thank you for this comment. The sampling strategy has now been clarified as convenience sampling for Step 1 and 3. Please see the ‘Study Participants’ section for Step 1 and Step 3.

Comment 4, Methods (study design):
Thank you for this comment and apologies for the confusion – this has now been updated. The sentence was meant to relate to the entire project rather than this study alone.

Comment 5, Methods (Step 1, study participants):
Thank you for this comment. I have specified that informed consent was electronic or written.

Comment 6, Methods (Recruitment):
Thank you for this comment. I have clarified at the beginning of the recruitment paragraph that all interested participants were asked to contact researcher MK

Comment 7, Methods (Step 2):
Thank you for this comment. This has now been clarified as the three research team members were not involved in Step 1. Please see the analysis section for Step 1 and the Heuristic Testing section.

Comment 8, Methods (Step 3 – study participants):
Thank you for this comment. This sentence has been revised with a convenience sampling strategy specified.

Comment 9, Methods (Step 3 – study participants):
Thank you for this comment. The last sentence of the last paragraph for individuals with a MSD has now been moved as per the suggestion and is now the last sentence in this section above the Step 3 Procedures section.

Comment 10, Methods (Step 3 – Procedures – questionnaire):
Thank you for this comment. The last sentence has now been rephrased.

Comment 11, Methods (Step 3 – Procedures – interviews):
Thank you for this comment. This has now been restructured to ensure the information about the think-aloud protocol is earlier in the text.
Competing Interests: No competing interests were disclosed. Close
Report a concern
Respond or Comment

COMMENTS ON THIS REPORT

Author Response 29 Nov 2023

Marie Kelly, Discipline of Physiotherapy, University College Cork, Cork, Ireland

29 Nov 2023

Author Response

Thank you Sara for your time in reviewing our protocol. We appreciate all your comments and suggested changes. We have addressed the points you raised and amended the protocol accordingly.
... Continue reading Thank you Sara for your time in reviewing our protocol. We appreciate all your comments and suggested changes. We have addressed the points you raised and amended the protocol accordingly.

Introduction, Comment 1:
Thank you for this comment. I have provided a description of self-management – See Introduction, paragraph 2 first and second sentence.

Comment 2, Figure 1:
Thank you for this comment. I have updated Step 2 of Figure 1 to clarify the 5 reviewers undertaking the heuristic testing. I have also updated the written text in the Step 2 section.

Comment 3, Methods:
Thank you for this comment. The sampling strategy has now been clarified as convenience sampling for Step 1 and 3. Please see the ‘Study Participants’ section for Step 1 and Step 3.

Comment 4, Methods (study design):
Thank you for this comment and apologies for the confusion – this has now been updated. The sentence was meant to relate to the entire project rather than this study alone.

Comment 5, Methods (Step 1, study participants):
Thank you for this comment. I have specified that informed consent was electronic or written.

Comment 6, Methods (Recruitment):
Thank you for this comment. I have clarified at the beginning of the recruitment paragraph that all interested participants were asked to contact researcher MK

Comment 7, Methods (Step 2):
Thank you for this comment. This has now been clarified as the three research team members were not involved in Step 1. Please see the analysis section for Step 1 and the Heuristic Testing section.

Comment 8, Methods (Step 3 – study participants):
Thank you for this comment. This sentence has been revised with a convenience sampling strategy specified.

Comment 9, Methods (Step 3 – study participants):
Thank you for this comment. The last sentence of the last paragraph for individuals with a MSD has now been moved as per the suggestion and is now the last sentence in this section above the Step 3 Procedures section.

Comment 10, Methods (Step 3 – Procedures – questionnaire):
Thank you for this comment. The last sentence has now been rephrased.

Comment 11, Methods (Step 3 – Procedures – interviews):
Thank you for this comment. This has now been restructured to ensure the information about the think-aloud protocol is earlier in the text.
Thank you Sara for your time in reviewing our protocol. We appreciate all your comments and suggested changes. We have addressed the points you raised and amended the protocol accordingly.

Introduction, Comment 1:
Thank you for this comment. I have provided a description of self-management – See Introduction, paragraph 2 first and second sentence.

Comment 2, Figure 1:
Thank you for this comment. I have updated Step 2 of Figure 1 to clarify the 5 reviewers undertaking the heuristic testing. I have also updated the written text in the Step 2 section.

Comment 3, Methods:
Thank you for this comment. The sampling strategy has now been clarified as convenience sampling for Step 1 and 3. Please see the ‘Study Participants’ section for Step 1 and Step 3.

Comment 4, Methods (study design):
Thank you for this comment and apologies for the confusion – this has now been updated. The sentence was meant to relate to the entire project rather than this study alone.

Comment 5, Methods (Step 1, study participants):
Thank you for this comment. I have specified that informed consent was electronic or written.

Comment 6, Methods (Recruitment):
Thank you for this comment. I have clarified at the beginning of the recruitment paragraph that all interested participants were asked to contact researcher MK

Comment 7, Methods (Step 2):
Thank you for this comment. This has now been clarified as the three research team members were not involved in Step 1. Please see the analysis section for Step 1 and the Heuristic Testing section.

Comment 8, Methods (Step 3 – study participants):
Thank you for this comment. This sentence has been revised with a convenience sampling strategy specified.

Comment 9, Methods (Step 3 – study participants):
Thank you for this comment. The last sentence of the last paragraph for individuals with a MSD has now been moved as per the suggestion and is now the last sentence in this section above the Step 3 Procedures section.

Comment 10, Methods (Step 3 – Procedures – questionnaire):
Thank you for this comment. The last sentence has now been rephrased.

Comment 11, Methods (Step 3 – Procedures – interviews):
Thank you for this comment. This has now been restructured to ensure the information about the think-aloud protocol is earlier in the text.
Competing Interests: No competing interests were disclosed. Close
Report a concern

Comments on this article Comments (0)

Version 2

VERSION 2 PUBLISHED 14 Nov 2022

Open Peer Review

Reviewer Status

Reviewer Reports

	Invited Reviewers
	1	2
Version 2 (revision) 10 Aug 23	read	read
Version 1 14 Nov 22	read	read

Sara Lundell, Umea Universitet, Umeå, Sweden
Ingris Pelaez-Ballestas, Hospital General de Mexico Dr Eduardo Liceaga, Mexico City, Mexico

Comments on this article

All Comments(0)

Add a comment

Back to all reports

Reviewer Report

21 Views

04 Sep 2023 | for Version 2

Sara Lundell, Department of Sociology, Umea Universitet, Umeå, Västerbotten County, Sweden

21 Views Cite this report Responses(0)

Approved

I would like to thank the authors for their revisions, which improved the protocol.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

My area of expertise relevant for this review is conducting co-creation studies to develop eHealth tools for supporting self-management in people with chronic obstructive pulmonary disease (COPD).

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (0)

Back to all reports

Reviewer Report

23 Views

31 Aug 2023 | for Version 2

Ingris Pelaez-Ballestas, Hospital General de Mexico Dr Eduardo Liceaga, Mexico City, Mexico City, Mexico

23 Views Cite this report Responses(0)

Approved

I thank the authors for having heeded all the suggestions.
I believe that with this new version, the manuscript can be indexed.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Rheumatology; Qualitative Study; Participatory Research

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (0)

Back to all reports

Reviewer Report

37 Views

18 Jul 2023 | for Version 1

Ingris Pelaez-Ballestas, Hospital General de Mexico Dr Eduardo Liceaga, Mexico City, Mexico City, Mexico

37 Views Cite this report Responses(1)

Approved With Reservations

I have doubts about the process of participation in the development. Is it only through the focus groups, or did people with MSKD and physical therapists participate in the study design and construction of the interview guide?
It would be important to include a greater diversity of participants regarding gender, ethnicity, place of residence (rural/urban), and socioeconomic conditions.
I suggest describing the analysis in detail. Will there be any triangulation strategy?
I suggest a reflection on the potential limitations of this protocol or even a reflexivity on the part of the authors.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Rheumatology; Qualitative Study; Participatory Research

Respond to this report

Responses (1)

Author Response

29 Nov 2023

Marie Kelly, Discipline of Physiotherapy, University College Cork, Cork, Ireland

Thank you Ingris for your time in reviewing our protocol. We appreciate all your comments and suggested changes. We have addressed the points you raised and amended the protocol accordingly.

Comment 1: Process of participation
People with musculoskeletal disorders (MSDs) and musculoskeletal physiotherapists did not participate in the study design and construction of the interview guide. However, this study which is part of a larger project, ‘eHealth: It’s TIME’, is guided by the Medical Research Council framework (Craig et al., 2013) and the Center for eHealth Research (CeHReS) Roadmap (van Gemert-Pijnen et al., 2011, Kip and van Gemert-Pijnen, 2018). The Roadmap is based on five principles, one of which is that eHealth development should be a participatory process (van Gemert-Pijnen et al., 2011). This project relates specifically to the development and design of eHealth technology (and not the implementation or evaluation), hence, the focus is on the first three phases of the Roadmap: contextual inquiry [scoping review (Kelly et al., 2022a)(doi:10.1093/ptj/pzab307)], value specification [qualitative study (Kelly et al., 2022b)(doi: 10.1080/09593985.2022.2151334)] and design (current study).
In the value specification phase, users’ perceptions of eHealth-mediated supported self-management and their needs and requirements were explored via individual interviews with people with MSDs and physiotherapists that work in this clinical area (Kelly et al., 2022b). Following the scoping reviewand qualitative study, a list of the needs and requirements of individuals with a MSD’s was formulated. Proposed eHealth intervention prototype elements to meet these needs (Appendix A, Extended data) will be built prior to the first focus group. A figure has been added to illustrate the CeHReS Roadmap (Figure 2) and the value specification (Appendix A, Extended data) to improve clarity relating to the participatory approach.
This current study undertakes an iterative development approach with an emphasis on stakeholder participation. Step one involves two sequential focus groups with people with MSDs. Step two involves five reviewers (three research team members, one graphic designer and one software developer), and Step three involves usability testing with approximately five people with MSDs and five musculoskeletal physiotherapists.
The interview guides for both the focus groups and 1:1 usability testing interviews have been developed by the research team and will continue to be refined iteratively, as the prototype itself is refined. To improve transparency and clarity on the participatory approach, the new version has provided an overview of the research team members.

Comment 2: Greater diversity of participants
Thank you for your comment. Apologies for the confusion regarding this. Convenience sampling was undertaken; the recruitment of a more systematically diverse sample would have required more resources than were available. This has been amended in the updated version and acknowledged within the limitations section. To limit this bias, all study participants will only be involved in one aspect of the study, with no prior exposure to the development of the prototype, which will result in a larger overall study sample size. Furthermore, the purpose of this study is the initial development and design of a web-based prototype for people with MSDs to enhance follow-up self-management support. The next phase of this project will be to complete a feasibility study which will incorporate a purposive sampling strategy which will aim to include a diverse range of participant demographic characteristics such as age, ethnicity, place of residence (rural/urban), eHealth literacy etc.

Comment 3: More detail on the analysis
Thank you for your comment. Further detail has been provided in relation to the analysis. This study will employ data and methodological triangulation by collecting data from different sources (i.e., people with MSDs and physiotherapists) and using different methodologies (i.e., focus groups, interviews and questionnaires) (Denzin, 2017) (https://doi.org/10.4324/9781315134543). The protocol has been updated to improve clarity on the triangulation strategy.

Comment 4: Reflection on potential limitations of study protocol and reflexivity
Thank you for your comment. A section on the main strength of the study protocol with two limitations has been added to the revised version. Amendments have also been made to improve clarity with respect to reflexivity. To facilitate reflexivity, field notes and memos will be utilised. Regular research team meetings which are open and collegiate (Barry et al., 1999), will also serve to promote reflection on the analysis and results.

View more View less

Competing Interests

No competing interests were disclosed.

Back to all reports

Reviewer Report

54 Views

27 Mar 2023 | for Version 1

Sara Lundell, Department of Sociology, Umea Universitet, Umeå, Västerbotten County, Sweden

54 Views Cite this report Responses(1)

Approved With Reservations

I think the introduction gives a good and clear motivation on why this study is needed, but please provide a definition/description of self-management.
Figure 1 gives a great overview of the study, but in contrast to step 1 and 3, it is unclear who the participants, i.e., the five reviewers, in step 2 are. Please clarify that.
Methods: Please specify if you will have any strategy on who to recruit (beyond eligibility criteria), e.g., distribution between men and women, different ages, computer skills, etc.
Methods – study design: You state that your study relates to the first three phases of the Roadmap. Please elaborate on how you will do this and how these three steps that you have mentioned earlier in the text.
Methods – step 1 – study participants: Please specify if the informed consent is written or oral.
Methods – recruitment: For me it was unclear for me how the interested participants should come in contact with the study, until I read the social media recruitment. Please clarify in the beginning of the recruitment paragraph that interested participants from all these recruitment methods will be asked to contact researcher MK.
Methods – step 2: The three research team members, have they been part of the development i step 1? Please specify.
Methods – step 3 – study participants: Please, revise the sentence about purposive sampling of individuals with a MSD.
Methods – step 3 – study participants: The last sentence of the last paragraph should be moved to the paragraph about MSK Physiotherapists.
Methods – step 3 – procedures – questionnaire: Please look at the last sentence, I think it needs to be rephrased.
Methods – step 3 – procedures – interviews: I would prefer to get the information about the think-aloud method earlier in the text. Now several questions were raised before I got to that part. Please restructure this part.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

Yes
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

My area of expertise relevant for this review is conducting co-creation studies to develop eHealth tools for supporting self-management in people with chronic obstructive pulmonary disease (COPD).

Respond to this report

Responses (1)

Author Response

29 Nov 2023

Marie Kelly, Discipline of Physiotherapy, University College Cork, Cork, Ireland

Thank you Sara for your time in reviewing our protocol. We appreciate all your comments and suggested changes. We have addressed the points you raised and amended the protocol accordingly.

Introduction, Comment 1:
Thank you for this comment. I have provided a description of self-management – See Introduction, paragraph 2 first and second sentence.

Comment 2, Figure 1:
Thank you for this comment. I have updated Step 2 of Figure 1 to clarify the 5 reviewers undertaking the heuristic testing. I have also updated the written text in the Step 2 section.

Comment 3, Methods:
Thank you for this comment. The sampling strategy has now been clarified as convenience sampling for Step 1 and 3. Please see the ‘Study Participants’ section for Step 1 and Step 3.

Comment 4, Methods (study design):
Thank you for this comment and apologies for the confusion – this has now been updated. The sentence was meant to relate to the entire project rather than this study alone.

Comment 5, Methods (Step 1, study participants):
Thank you for this comment. I have specified that informed consent was electronic or written.

Comment 6, Methods (Recruitment):
Thank you for this comment. I have clarified at the beginning of the recruitment paragraph that all interested participants were asked to contact researcher MK

Comment 7, Methods (Step 2):
Thank you for this comment. This has now been clarified as the three research team members were not involved in Step 1. Please see the analysis section for Step 1 and the Heuristic Testing section.

Comment 8, Methods (Step 3 – study participants):
Thank you for this comment. This sentence has been revised with a convenience sampling strategy specified.

Comment 9, Methods (Step 3 – study participants):
Thank you for this comment. The last sentence of the last paragraph for individuals with a MSD has now been moved as per the suggestion and is now the last sentence in this section above the Step 3 Procedures section.

Comment 10, Methods (Step 3 – Procedures – questionnaire):
Thank you for this comment. The last sentence has now been rephrased.

Comment 11, Methods (Step 3 – Procedures – interviews):
Thank you for this comment. This has now been restructured to ensure the information about the think-aloud protocol is earlier in the text.

View more View less

Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

[1] 1. Cieza A, Causey K, Kamenov K, et al.: Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2021; 396(10267): 2006–17. PubMed Abstract | Publisher Full Text | Free Full Text

[2] 2. Seron P, Oliveros MJ, Gutierrez-Arias R, et al.: Effectiveness of telerehabilitation in physical therapy: A rapid overview. Phys Ther. 2021; 101(6): pzab053. PubMed Abstract | Publisher Full Text | Free Full Text

[3] 3. Chehade MJ, Yadav L, Kopansky-Giles D, et al.: Innovations to improve access to musculoskeletal care. Best Pract Res Clin Rheumatol. 2020; 34(5): 101559. PubMed Abstract | Publisher Full Text

[4] 4. World Health Organization: WHO guideline: recommendations on digital interventions for health system strengthening. World Health Organization; 2019. Reference Source

[5] 5. Slater H, Dear BF, Merolli MA, et al.: Use of eHealth technologies to enable the implementation of musculoskeletal Models of Care: Evidence and practice. Best Pract Res Clin Rheumatol. 2016; 30(3): 483–502. PubMed Abstract | Publisher Full Text

[6] 6. Slater H, Campbell JM, Stinson JN, et al.: End user and implementer experiences of mHealth technologies for noncommunicable chronic disease management in young adults: Systematic review. J Med Internet Res. 2017; 19(12): e406. PubMed Abstract | Publisher Full Text | Free Full Text

[7] 7. Wind TR, Rijkeboer M, Andersson G, et al.: The COVID-19 pandemic: The 'black swan' for mental health care and a turning point for e-health. Internet Interv. 2020; 20: 100317. PubMed Abstract | Publisher Full Text | Free Full Text

[8] 8. Nugent L, Kouyate RA, Jackson S, et al.: Development of a Digital Health Intervention for Rheumatoid Arthritis Symptom Management in a Biotechnology Industry Context: Protocol for the Application of a Human-Centered Design Framework. JMIR Res Protoc. 2022; 11(3): e16430. PubMed Abstract | Publisher Full Text | Free Full Text

[9] 9. Black N: Patient reported outcome measures could help transform healthcare. BMJ. 2013; 346: f167. PubMed Abstract | Publisher Full Text

[10] 10. Kelders SM, van Gemert-Pijnen JE, Werkman A, et al.: Usage and effect of a web-based intervention for the prevention of overweight; a randomized controlled trial. 2010 Second International Conference on eHealth, Telemedicine, and Social Medicine. IEEE, 2010. Publisher Full Text

[11] 11. Nijland N: Grounding eHealth: towards a holistic framework for sustainable eHealth technologies. 2011. Publisher Full Text

[12] 12. Verhoeven F: When staff handle staph: user-driven versus expert-driven communication of infection control guidelines. 2009. Publisher Full Text

[13] 13. Verhoeven F, Tanja-Dijkstra K, Nijland N, et al.: Asynchronous and synchronous teleconsultation for diabetes care: a systematic literature review. J Diabetes Sci Technol. 2010; 4(3): 666–84. PubMed Abstract | Publisher Full Text | Free Full Text

[14] 14. van Gemert-Pijnen JE, Nijland N, van Limburg M, et al.: A holistic framework to improve the uptake and impact of eHealth technologies. J Med Internet Res. 2011; 13(4): e111. PubMed Abstract | Publisher Full Text | Free Full Text

[15] 15. Kelly M, Fullen B, Martin D, et al.: eHealth Interventions to Support Self-Management in People With Musculoskeletal Disorders, "eHealth: It's TIME"-A Scoping Review. Phys Ther. 2022; 102(4): pzab307. PubMed Abstract | Publisher Full Text | Free Full Text

[16] 16. Kress HG, Aldington D, Alon E, et al.: A holistic approach to chronic pain management that involves all stakeholders: change is needed. Curr Med Res Opin. 2015; 31(9): 1743–54. PubMed Abstract | Publisher Full Text

[17] 17. Keogh E, Rosser BA, Eccleston C: e-Health and chronic pain management: current status and developments. Pain. 2010; 151(1): 18–21. PubMed Abstract | Publisher Full Text

[18] 18. Keogh E: Developments in the use of e-health for chronic pain management. Pain Manag. 2013; 3(1): 27–33. PubMed Abstract | Publisher Full Text

[19] 19. Bazzano AN, Martin J, Hicks E, et al.: Human-centred design in global health: a scoping review of applications and contexts. PLoS One. 2017; 12(11): e0186744. PubMed Abstract | Publisher Full Text | Free Full Text

[20] 20. Altman M, Huang TT, Breland JY: Design thinking in health care. Prev Chronic Dis. 2018; 15: E117. PubMed Abstract | Publisher Full Text | Free Full Text

[21] 21. Yardley L, Ainsworth B, Arden-Close E, et al.: The person-based approach to enhancing the acceptability and feasibility of interventions. Pilot Feasibility Stud. 2015; 1(1): 37. PubMed Abstract | Publisher Full Text | Free Full Text

[22] 22. Varsi C, Ekstedt M, Gammon D, et al.: Using the consolidated framework for implementation research to identify barriers and facilitators for the implementation of an internet-based patient-provider communication service in five settings: a qualitative study. J Med Internet Res. 2015; 17(11): e262. PubMed Abstract | Publisher Full Text | Free Full Text

[23] 23. Varsi C, Nes LS, Kristjansdottir OB, et al.: Implementation strategies to enhance the implementation of eHealth programs for patients with chronic illnesses: realist systematic review. J Med Internet Res. 2019; 21(9): e14255. PubMed Abstract | Publisher Full Text | Free Full Text

[24] 24. Kelly M, Fullen BM, Martin D, et al.: eHealth Interventions to Support Self-Management: Perceptions and experiences of People with Musculoskeletal Disorders and Physiotherapists - 'eHealth: It's TIME': A Qualitative Study. Physiother Theory Pract. 2022; 1–11. PubMed Abstract | Publisher Full Text

[25] 25. Granja C, Janssen W, Johansen MA: Factors determining the success and failure of eHealth interventions: systematic review of the literature. J Med Internet Res. 2018; 20(5): e10235. PubMed Abstract | Publisher Full Text | Free Full Text

[26] 26. Craig P, Dieppe P, Macintyre S, et al.: Developing and evaluating complex interventions: the new Medical Research Council guidance. Int J Nurs Stud. 2013; 50: 587–92. PubMed Abstract | Publisher Full Text

[27] 27. Kip H, van Gemert-Pijnen LJ: Holistic development of eHealth technology.eHealth Research, Theory and Development: A Multi-Disciplinary Approach Abingdon-on-Thames, UK: Routledge. 2018; 151–86. Publisher Full Text

[28] 28. Kushniruk AW, Patel VL: Cognitive and usability engineering methods for the evaluation of clinical information systems. J Biomed Inform. 2004; 37(1): 56–76. PubMed Abstract | Publisher Full Text

[29] 29. Donald M, Beanlands H, Straus SE, et al.: A web-based self-management support prototype for adults with chronic kidney disease (my kidneys my health): co-design and usability testing. JMIR Form Res. 2021; 5(2): e22220. PubMed Abstract | Publisher Full Text | Free Full Text

[30] 30. French SD, Green SE, O’Connor DA, et al.: Developing theory-informed behaviour change interventions to implement evidence into practice: a systematic approach using the Theoretical Domains Framework. Implement Sci. 2012; 7(1): 38. PubMed Abstract | Publisher Full Text | Free Full Text

[31] 31. Wentzel J, van Velsen L, van Limburg M, et al.: Participatory eHealth development to support nurses in antimicrobial stewardship. BMC Med Inform Decis Mak. 2014; 14(1): 45. PubMed Abstract | Publisher Full Text | Free Full Text

[32] 32. Kelders SM, Pots WT, Oskam MJ, et al.: Development of a web-based intervention for the indicated prevention of depression. BMC Med Inform Decis Mak. 2013; 13(1): 26. PubMed Abstract | Publisher Full Text | Free Full Text

[33] 33. Beerlage-de Jong N, van Gemert-Pijnen L, Wentzel J, et al.: Technology to support integrated antimicrobial stewardship programs: a user centered and stakeholder driven development approach. Infect Dis Rep. 2017; 9(1): 6829. PubMed Abstract | Publisher Full Text | Free Full Text

[34] 34. Moore G, Wilding H, Gray K, et al.: Participatory methods to engage health service users in the development of electronic health resources: systematic review. J Particip Med. 2019; 11(1): e11474. PubMed Abstract | Publisher Full Text | Free Full Text

[35] 35. Monkman H, Kushniruk AW, Barnett J, et al.: Are health literacy and eHealth literacy the same or different? Stud Health Technol Inform. 2017; 245: 178–82. PubMed Abstract | Publisher Full Text

[36] 36. Krueger RA: Focus groups: A practical guide for applied research. Sage publications; 2014. Reference Source

[37] 37. Caldwell B, Cooper M, Reid LG, et al.: Web content accessibility guidelines (WCAG) 2.0. WWW Consortium (W3C). 2008; 290: 1–34. Reference Source

[38] 38. Richardson S, Lawrence K, Schoenthaler AM, et al.: A framework for digital health equity. NPJ Digit Med. 2022; 5(1): 119. PubMed Abstract | Publisher Full Text | Free Full Text

[39] 39. Badarudeen S, Sabharwal S: Assessing readability of patient education materials: current role in orthopaedics. Clin Orthop Relat Res. 2010; 468(10): 2572–80. PubMed Abstract | Publisher Full Text | Free Full Text

[40] 40. NVivo: NVivo qualitative data analysis software. QSR International Pty Ltd Melbourne, Australia; 2015.

[41] 41. 10 Usability Heuristics for User Interface Design. Nielsen Norman Group. [accessed 10 Jul 22]. Reference Source

[42] 42. Nielsen J: Estimating the number of subjects needed for a thinking aloud test. Int J Hum Comput Stud. 1994; 41(3): 385–97. Publisher Full Text

[43] 43. Bangor A, Kortum PT, Miller JT: An empirical evaluation of the system usability scale. Int J Hum Comput Int. 2008; 24(6): 574–94. Publisher Full Text

[44] 44. Maramba I, Chatterjee A, Newman C: Methods of usability testing in the development of eHealth applications: a scoping review. Int J Med Inform. 2019; 126: 95–104. PubMed Abstract | Publisher Full Text

[45] 45. Eccles DW, Arsal G: The think aloud method: what is it and how do I use it? Qual Res Sport Exerc Health. 2017; 9(4): 514–31. Publisher Full Text

[46] 46. Weir CR, Nebeker JJ, Hicken BL, et al.: A cognitive task analysis of information management strategies in a computerized provider order entry environment. J Am Med Inform Assoc. 2007; 14(1): 65–75. PubMed Abstract | Publisher Full Text | Free Full Text

[47] 47. Ledel Solem IK, Varsi C, Eide H, et al.: A user-centered approach to an evidence-based electronic health pain management intervention for people with chronic pain: design and development of EPIO. J Med Internet Res. 2020; 22(1): e15889. PubMed Abstract | Publisher Full Text | Free Full Text

[48] 48. Hsieh HF, Shannon SE: Three approaches to qualitative content analysis. Qual Health Res. 2005; 15(9): 1277–88. PubMed Abstract | Publisher Full Text

[49] 49. Zapata BC, Fernández-Alemán JL, Idri A, et al.: Empirical studies on usability of mHealth apps: a systematic literature review. J Med Syst. 2015; 39(2): 1–19. PubMed Abstract | Publisher Full Text

[50] 50. Andersen TO, Bansler JP, Kensing F, et al.: Aligning concerns in telecare: three concepts to guide the design of patient-centred E-health. Comput Supported Coop Work. 2019; 28(6): 1039–72. Publisher Full Text

[51] 51. Kelly M: Study protocol supplementary material.figshare. Media. 2022. http://www.doi.org/10.6084/m9.figshare.20713978.v1

Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders - ‘eHealth: It’s TIME’: a study protocol

Abstract

Keywords

Introduction

Methods

Study aims

Study design

Figure 1. Study overview.

Step 1: Creation of website features and content

Step 2: Heuristic testing

Step 3: Usability testing

Conclusions

Data availability

Underlying data

Extended data

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Are you a HRB-funded researcher?

Thank you!

Design and development of an eHealth intervention to support self-management in people with musculoskeletal disorders - ‘eHealth: It’s TIME’: a study protocol

Abstract

Keywords

Introduction

Methods

Study aims

Study design

Figure 1. Study overview.

Step 1: Creation of website features and content

Step 2: Heuristic testing

Step 3: Usability testing

Conclusions

Data availability

Underlying data

Extended data

References

Comments on this article Comments (0)

Open Peer Review

Comments on this article Comments (0)

Open Peer Review

Reviewer Status

Reviewer Reports

Comments on this article

Competing Interests Policy

Stay Updated

Are you a HRB-funded researcher?

Thank you!