ObjectivesThe aim of our study was to determine and enhance physicians’ acceptance, performance expectancy and credibility of health apps for chronic pain patients. We further investigated predictors of acceptance.DesignRandomised experimental trial with a parallel-group repeated measures design.Setting and participants248 physicians working in various, mainly outpatient settings in Germany.Intervention and outcomePhysicians were randomly assigned to either an experimental group (short video about health apps) or a control group (short video about chronic pain). Primary outcome measure was acceptance. Performance expectancy and credibility of health apps were secondary outcomes. In addition, we assessed 101 medical students to evaluate the effectiveness of the video intervention in young professionals.ResultsIn general, physicians’ acceptance of health apps for chronic pain patients was moderate (M=9.51, SD=3.53, scale ranges from 3 to 15). All primary and secondary outcomes were enhanced by the video intervention: A repeated-measures analysis of variance yielded a significant interaction effect for acceptance (F(1, 246)=15.28, p=0.01), performance expectancy (F(1, 246)=6.10, p=0.01) and credibility (F(1, 246)=25.61, p<0.001). The same pattern of results was evident among medical students. Linear regression analysis revealed credibility (β=0.34, p<0.001) and performance expectancy (β=0.30, p<0.001) as the two strongest factors influencing acceptance, followed by scepticism (β=−0.18, p<0.001) and intuitive appeal (β=0.11, p=0.03).Conclusions and recommendationsPhysicians’ acceptance of health apps was moderate, and was strengthened by a 3 min video. Besides performance expectancy, credibility seems to be a promising factor associated with acceptance. Future research should focus on ways to implement acceptability-increasing interventions into routine care.
Despite effective treatment approaches within the cognitive behavioral framework general treatment effects for chronic pain are rather small to very small. Translation from efficacy trials to naturalistic settings is questionable. There is an urgent need to improve the effectiveness of well-established treatments, such as cognitive-behavior therapy (CBT) and the investigation of mechanisms of change is a promising opportunity. We performed secondary data analysis from routine data of 1,440 chronic pain patients. Patients received CBT in a multidisciplinary setting in two inpatient clinics. Effect sizes and reliable change indices were computed for pain-related disability and depression. The associations between changes in the use of different pain coping skills (cognitive restructuring, activity despite pain, relaxation techniques and mental distraction) and changes in clinical outcomes were analyzed in structural equation models. Pre–post effect sizes range from g = 0.47 (disability) to g = 0.89 (depression). Changes in the use of cognitive restructuring, relaxation and to a lesser degree mental distraction were associated with changes in disability and depression. Effects from randomized trials can be translated to naturalistic settings. The results complement experimental research on mechanisms of change in the treatment of chronic pain and indicate an important role of cognitive change and relaxation as mechanisms of change. Our findings cautiously suggest that clinicians should optimize these processes in chronic pain patients to reduce their physical and emotional disability.
BACKGROUND Chronic pain is one of the most costly and widespread medical conditions in the world. Despite effective forms of treatment, there is an urgent need to optimize therapies. Studies on the effectiveness of health apps for chronic pain patients are increasing and show promising results as a treatment adjunct or stand-alone treatment. Nevertheless, physicians’ acceptance of electronic health interventions has been somewhat reluctant, resulting in low prescription rates of health apps. OBJECTIVE The aim of our study was to determine and enhance physicians’ acceptance, performance expectancy and credibility of health apps for chronic pain patients. We further investigated predictors of acceptance. METHODS In a repeated measures design, 248 physicians were randomly assigned to either an experimental group (short educational video about health apps) or a control group (short video about chronic pain). Primary outcome measure was acceptance. Performance expectancy and the credibility of health apps were secondary outcomes. In addition, we assessed 101 medical students to evaluate the effectiveness of the video intervention in young professionals. RESULTS In general, physicians' acceptance of health apps for chronic pain patients was moderate (M=9.51, SD=3.53, scale ranges from 3-15). All primary and secondary outcomes were enhanced by the video intervention: A repeated-measures ANOVA yielded a significant interaction effect for acceptance (F(1, 246)=15.28, P=.01), performance expectancy (F(1, 246)=6.10, P=.01) and credibility (F(1, 246)=25.61, P<.001). The same pattern of results was evident among medical students. Linear regression analysis revealed credibility (β=.34, P<.001) and performance expectancy (β .30, P<.001) as the two strongest factors influencing acceptance, followed by skepticism (β=-.18, P<.001) and intuitive appeal (β=.11, P=.03). CONCLUSIONS Physicians’ acceptance of health apps was moderate, and was strengthened by a three minutes video. Besides performance expectancy, credibility seems to be a promising factor associated with acceptance. Future research should focus on ways to implement acceptability-increasing interventions into routine care. CLINICALTRIAL Open Science Framework: https://osf.io/x693r Registration DOI: 10.17605/OSF.IO/X693R
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