Designing a Self-Guided Digital Intervention for Self-Management of Shoulder Pain in People Living With Spinal Cord Injury: A Tutorial on Using a Person-based Approach

Abstract

Shoulder pain is prevalent in people living with spinal cord injury. Technology and digital rehabilitation tools are increasingly available, but this has not yet included the provision of a self-guided exercise intervention focused on managing shoulder pain for people living with spinal cord injury. We drew on the person-based approach (PBA) to intervention development to design a Shoulder Pain Intervention delivered over the interNet (SPIN) to address this gap. However, in preparation for the design process, we found very few published examples of how the PBA had been operationalized. The aim of this paper is to provide a detailed explanation of our approach and how we operationalized the PBA in the design of SPIN to maximize relevance and engagement. Our design process followed the key PBA steps, combining additional evidence and theoretical components. Each step ensured that guiding principles were formulated and followed to maximize the probability that SPIN would be fit for purpose. We followed 3 steps: (1) we drew on themes from preparatory research (existing and primary) to identify the key behavioral issues, needs and challenges, and existing features to form the basis of SPIN design; (2) we formatted guiding principles that included articulating specific design objectives to provide a framework to identify system requirements; and (3) we selected and refined intervention features using existing literature, behavioral theory, and tools such as the “Behaviour Change Wheel.” We have designed SPIN by incorporating a deep understanding of the users’ needs and best available evidence to maximize engagement and positive outcomes. In this paper, we have made clear how we operationalized the PBA phases, including how existing evidence, theory, tools, and methods were leveraged to support the PBA process. In explicating our process, we have provided a blueprint to guide future researchers using this approach.