Using Intervention Mapping to Develop a Decision Support System–Based Smartphone App to Support Self-management of Non-specific Low Back Pain (SELFBACK)

Background:

International guidelines consistently endorse promotion of self-management for people with low back pain (LBP), however, implementation of these guidelines remains a challenge. Digital health interventions, such as those that can be provided by smartphone apps, have been proposed as a promising mode to support self-management in people with chronic conditions including LBP. However, the evidence base for digital health interventions to support self-management of LBP is weak and detailed description and documentation of the intervention is lacking. Structured Intervention Mapping (IM) constitutes a six-step process that can be used to guide the development of complex interventions.

Objective:

The aim of this paper is to describe the IM process for designing and creating an app-based intervention designed to support self-management of non-specific LBP to reduce pain-related disability.

Methods:

Five steps of the IM process were systematically applied: the core processes included literature reviews, brainstorming and group discussions, and inclusion of stakeholders and representatives of the target population. Throughout a period of more than two years, the intervention content and technical features of delivery were created, tested and revised through user tests, feasibility studies and a pilot study.

Results:

One behavioural outcome was identified as the proxy for reaching the overall programme goal; increased use of evidence-based self-management strategies. Physical exercises, education and physical activity were the main components of the self-management intervention, designed and produced to be delivered via a smartphone app. All intervention content was theoretically underpinned by behaviour change theory and Normalization Process Theory.

Conclusions:

We describe a detailed example of the application of the IM approach to the development of a theory-driven, complex, and digital intervention designed to support self-management of LBP. This description provides transparency of the developmental process of the intervention and a possible blue-print for designing and creating future digital health interventions for self-management.