Mobile App-Supported Self-Management for Chronic Low Back Pain: Realist Evaluation

Area of Science:

• Digital health interventions
• Chronic pain management
• Health services research

Background:

• Chronic low back pain (CLBP) prevalence is rising globally, increasing healthcare burdens.
• Mobile health (mHealth) apps offer scalable self-management solutions for CLBP.
• Limited understanding exists on how mHealth apps function in real-world CLBP self-management.

Purpose of the Study:

• To test and refine program theories on mobile app effectiveness for CLBP self-management.
• To identify contextual factors and mechanisms influencing digital intervention success or failure.
• To understand how, why, and for whom mHealth tools work in chronic pain.

Main Methods:

• Realist evaluation employing one-on-one telephone interviews with 9 participants using the Curable app.
• Teacher-learner cycle in interviews to explore, test, and refine program theories.
• Abductive and retroductive analysis to develop context-mechanism-outcome configurations (CMOCs).

Main Results:

• 20 CMOCs refined theories on empowerment, self-management burden, and timing.
• App empowerment linked to credible knowledge; engagement varied by user beliefs.
• App utility depended on proactive delivery and low-demand interfaces; timing and trust influenced engagement.

Conclusions:

• Mobile apps like Curable can enhance CLBP self-management and continuity of care.
• Success factors include personalization, timing, and relational dynamics.
• mHealth tools should supplement, not replace, ongoing clinical support to avoid patient abandonment.