Qualitative assessment of the use of a smart phone application to manage post-concussion symptoms in Veterans with traumatic brain injury

ABSTRACT

Purpose

As part of a larger study to test the efficacy of the Concussion Coach cell phone application for patients with post-concussion symptoms, qualitative data were gathered to assess barriers and facilitators for app use and differences in use of the app among those who declined or improved in symptom severity, or were low-use users.

Materials and Methods

Using a prospective descriptive study design, 35 semi-structured qualitative interviews were conducted between 2016–2018. Participants had a history of mild traumatic brain injury and were symptomatic. Interview data were analyzed using qualitative content analysis.

Results

Primary facilitators were the app’s ease of use, privacy, availability/portability, and increased self-efficacy of the user. Primary barriers were a lack of sufficient app training, stigma, overly “basic” content, and symptom severity. While there were not prominent differences among user groups, users whose symptom severity improved described using more modules of the app than users who declined. Low-users attributed not using the app to content that was too basic or to their forgetting.

Conclusion

Interview data suggest that Concussion Coach can benefit Veterans with post-concussive symptoms through increased agency, perceived benefits to emotional well-being, and the availability of non-stigmatized strategies for symptom management.

KEYWORDS:

• Traumatic brain injury
• concussion
• mental health
• service members
• Veterans
• mobile health
• smartphone apps

Acknowledgments

The authors give our thanks to the staff and investigators involved with this project, including Tracy Kretzmer, Julie Hoffman, Peter Toyinbo, Emily King, Zoe Proctor-Weber, Tanya Harris, Tamara McKenzie-Hartman, Nina Sayer, Kevin Kip, Nitin Patel, Susan Horrigan, Barbara McKenzie, Padmaja Ramaiah, Angel Klanchar, Lee Augello, Blake Barret and Jemy Delikat.

Declaration of interest

The authors declare no conflict of interest. This article is based on research supported by a study, Smart Phone Application for Postconcussion Symptom Reduction (IIR 13-196), U.S. Department of Veterans Affairs Health Services Research and Development Program. The research reported here was supported by the Department of Defense (DoD) and 9 Line LLC. Further support was provided by the Defense and Veterans Brain Injury Center (DVBIC), Grant number MDA 905-03-2-0003. The views expressed herein are those of the authors and do not necessarily reflect the views of the Department of Health Affairs, the U.S. Department of Veterans Affairs, U.S. Department of the Army, U.S. Department of Defense, or the United States Government.

Additional information

Funding

This work was supported by the Defense and Veterans Brain Injury Center [MDA 905-03-2-0003]; U.S. Department of Defense.