Applying Service Design Methods to Enhance Implementation and Adoption of a Digital Graded Exposure Treatment for Youth with Chronic Musculoskeletal Pain in Clinical Settings

Stanford University, Stanford CA

Investigators

Abstract

Abstract Chronic musculoskeletal (MSK) pain affects the lives of over a quarter of youth and impacts multiple domains of functioning, including social, emotional, and behavioral functioning. Digital behavioral health interventions offer solutions to existing access to care barriers, with outcomes similar to in-vivo treatment. Despite this, only 28% of digital tools are disseminated adequately or timely. Most research on digital interventions has focused on evaluating efficacy and adoption in the context of clinical trials but have largely ignored service design, the process in which patients and clinicians engage with each other and with technologies when integrating an intervention into practice. Ignoring the users or contexts (e.g., clinics) in which interventions are implemented leads to suboptimal healthcare innovation and significant research waste. Given this, there is an imperative need to integrate service design methods as part of the development of digital behavioral interventions for youth with chronic MSK pain. With my K23 Mentored Patient-Oriented Research Career Development award, I am designing and evaluating feasibility and preliminary efficacy of iGET Living, a digital graded exposure treatment (GET) for youth with chronic MSK pain. My long-term goal for this program of research is to establish iGET Living as an evidence-based intervention that is scalable and sustainable and can be broadly implemented in clinical care. To achieve this goal, I need to design the intervention (K23), understand how to integrate it into clinical care (R03), and validate its effectiveness and implementation in a hybrid trial (R01). The overall objective of this R03 small grant program application is to apply service design methods to understand how to implement iGET Living in three clinical settings. I will partner with three clinics that are typical settings youth with chronic MSK present and are the planned sites of a subsequent R01: pain management, rheumatology, and orthopedics/sports medicine. Using the 4-Phase Double Diamond Model design process, I will apply service design methodologies and collaborate with the clinics to create two products that describe how iGET Living will be embedded in each setting: Service blueprints and implementation roadmaps. Service blueprints are diagrams of the touchpoints when person-to-person and person-to-technology transactions occur through the intervention delivery process. Implementation roadmaps specify the implementation strategies and adaptions to the intervention and settings that are needed to support implementing the service blueprints for iGET Living. Dedicated attention to service design in advance of an R01 investigation is ideal for: 1) strengthening partnerships with the clinics for longer-term collaboration; 2) accelerating the timeline to deliver the intervention to patients by completing the implementation-preparation activities; and 3) identifying ways to address potential challenges when conducting research in real-world settings so they can be later avoided. Designing for the delivery of iGET Living for pediatric MSK pain will accelerate my science from K23 to R01 effectiveness- implementation investigation and propel digital intervention research toward improved engagement and impact.