'Dealing with it in a way that works for you': Adolescent perspectives on defining coping in the context of pediatric...

Coping is essential in managing pediatric chronic pain, yet current conceptualizations overlook its complexity and lived experiences. We investigated: (1) adolescents' definitions of coping and (2) their perspectives on the integrative model, a previously proposed framework capturing motivational, transactional, and biopsychosocial influences on coping. Twenty-one adolescents ages 14-19 years old with chronic pain from Canada, the United States, and United Kingdom participated in semi-structured interviews concerning their understanding of coping (objective 1) and feedback on the integrative model (objective 2). Recruitment through online platforms, pain clinics, and organizations serving gender and ethnic diverse youth were used. Data were analyzed using reflexive thematic analysis (objective 1) and qualitative content analysis (objective 2). For objective 1, two themes were generated. Theme 1, "dealing with it in a way that works for you", described adolescents' view of coping as an active, personal process involving effort and trial-and-error, occurring with or without conscious awareness. Theme 2, "coping should help but doesn't always" captured how coping is often portrayed as inherently positive, but outcomes can be negative. For objective 2, adolescents identified strengths and improvements for the integrative model related to clarity/accessibility, alignment with lived experiences, and supporting coping plans. For example, while adolescents described the model helpful and easy to understand, they suggested ways to depict the model visually and with greater flexibility to fit different situations. Results led to a new definition of coping and revision of the integrative model to align with adolescent perspectives; advancements for clinical practice are discussed. PERSPECTIVE: This article demonstrates that adolescents perceive coping as a personal, active process that various in intentionality and effectiveness. The results provide support for the integrative model and informs a more applied conceptualization of coping to advance research and clinical practices in the context of pediatric chronic pain.