eHealth interventions to support self-management: Perceptions and experiences of people with musculoskeletal disorders and physiotherapists - ‘eHealth: It’s TIME’: A qualitative study

Figures & data

Table 1. Participant demographics – MSK physiotherapists (n = 13).

Gender (male/female)	7 male/6 female
Age range (mean)	26–42 (35)
Years qualified range (mean)	4–19 (12)
Work grade	Senior (n = 7) Clinical Specialist (n = 4) Private practitioner (n = 2)
Workplace setting*	Public hospital (n = 10) Private practice (n = 3) Primary care (n = 1)
Geographical location	Urban (n = 11) Rural (n = 2)
Experience of using eHealth	Pre COVID-19 (n = 7) Since COVID-19 (n = 6)

*Multiple answers possible; MSK; musculoskeletal

Table 2. Participant demographics – people with MSD (n = 13.

Gender (Male/female)	4 male/9 female
Age range (mean)	24–77 (58)
Location of physio*	Private practice (n = 8) Public hospital (n = 4) Private hospital (n = 3) Primary care (n = 1)
Geographical location	Urban (n = 6) Rural (n = 7)
Higher degree/professional qualification	Yes (n = 11) No (n = 2)
Employment status	Retired (n = 5) Full time employment (n = 5) Unable to work due to sickness/disability (n = 2) Student (n = 1)
Site of musculoskeletal problem	Lower limb (n = 5) Multiple (n = 3) Other (n = 3) Upper limb (n = 2)
Duration of symptoms	< 1 month (n = 2) 1–3 months (n = 3) 4–6 months (n = 1) 1–2 years (n = 1) 3–4 years (n = 4) > 4 years (n = 2)
Experience of eHealth within Physiotherapy	Yes (n = 8) No (n = 5)

*Multiple answers possible; MSD; musculoskeletal disorder

Table 3. Strategies for enhancing trustworthiness (Lincoln and Guba, 1986).

Criteria	Strategy	Details
Credibility	Prolonged engagement	Lead researcher (MK) conducted all interviews MK repeatedly listened, read, and re-read each interview transcript several times
	Triangulation	Both people with MSDs and physiotherapists were interviewed, allowing for perspectives from two different groups (i.e., the intended end-users of the intervention to be developed) MK analyzed the data, while another researcher (JMcV) reviewed the data analysis process and results to confirm credibility
	“show rather than tell’ (Tracy, 2010)	The research team aimed to ‘show rather than tell” (Tracy, 2010) by including participants’ voices as much as possible.
Transferability	Thick description	The use of detailed demographic and context descriptions will enable readers to decide if results are applicable within their settings
Dependability and confirmability	Audit trail	A detailed description of the data collection and analysis process Confirmability was achieved through the discussion of the analysis process by MK and JMcV once initial codes and themes were named. Final themes were discussed and agreed upon by all members of the research team
Reflexivity	Diary	Reflexivity memos were completed by MK during the analysis process A reflexivity paragraph is included in the methods section of this paper, discussing possible biases as researchers
MSD; musculoskeletal disorder

Table 4. Themes and subthemes.

Flexibility within a blended care model	eHealth as a facilitator of self-management support	Technology: Getting it right
Therapeutic relationship		Infrastructure and resources
Expectations		User experience

Table

Topic Guide Key Questions and Prompts
The purpose of this interview is to gain a greater understanding of your experience and opinion on the use of technological platforms (e.g. mobile, computer, tablet) in physiotherapy. Do you ___________ consent to taking part in audio recorded telephone interviews about your thoughts and opinions on the use of technology within physiotherapy* Thank you very much for agreeing to take part in the study, I really appreciate you giving up your time to talk with me. If you would like to stop the interview at any time just let me know and it will be stopped.We can then start again when you are ready.
(a) Understanding of self-management support
What is self-management support in your opinion? Prompts: Are you familiar with this term? What is your experience of this in the clinic? What are the advantages of this approach? What are the disadavntages
(b) Experiences, expectations and needs regarding eHealth
Have you used any form of eHealth with patients? Prompts: How did you find this? Did it meet your expectations? If not, why? What factors would reduce/limit your use of eHealth Are you still using?
(c)Willingness to use eHealth for self-management purposes
Do you think you would be interested in using technology to help a patient manage their “musculoskeletal disorder”? Do you think you would be willing to use eHealth to help a patient to manage their condition? Prompts: Do you think it could be helpful?Why/ why not? What would make you more likely to use eHealth? What would make you less likely to use eHealth?
Is there anything else you would like to tell me about your experience with technological platforms (e.g. mobile, computer, tablet) in physiotherapy? Is there anything I left out?
*Please note consent will be re-confirmed by the researcher at the outset of the interview and consent obtained orally. This process will be digitally recorded by the researcher

Table

Topic Guide Key Questions and Prompts
The purpose of this interview is to gain a greater understanding of your experience and opinion on the use of technological platforms (e.g. mobile, computer, tablet) in physiotherapy. Do you ___________ consent to taking part in audio recorded telephone interviews about your thoughts and opinions on the use of technology within physiotherapy* Thank you very much for agreeing to take part in the study, I really appreciate you giving up your time to talk with me. If you would like to stop the interview at any time just let me know and it will be stopped.We can then start again when you are ready.
(a) Understanding of self-management support
What are your first thoughts and feelings about receiving care and encouragement from healthcare professionals to help you manage your “musculoskeletal disorder” and make decisions about it? Prompts: Have you previous experience of this? Have you any worries/concerns?
(b) Experiences, expectations and needs regarding eHealth How would you feel about using technology during your sessions with the physiotherapist? Prompts: How did you find this? Did it meet your expectations? If not, would you have been interested in using? What factors would reduce/limit your use of eHealth Would you recommend to family or friends? (c)Willingness to use eHealth for self-management purposes
Do you think you would be interested in using technology to help you manage your “musculoskeletal disorder”? Prompts: Do you think technology could be helpful?Why/ why not? What would make you more likely to use technology? What would make you less likely to use technology? Is there anything else you would like to tell me about your experience with technological platforms (e.g. mobile, computer, tablet) in physiotherapy? Is there anything I left out? Note: “musculoskeletal disorder” will be replaced with the presenting complaint of the patient
*Please note consent will be re-confirmed by the researcher at the outset of the interview and consent obtained orally. This process will be digitally recorded by the researcher.

Lincoln YS, Guba EG 1986 But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Directions for Program Evaluation 1986: 30 73–84.10.1002/ev.1427.

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Tracy SJ 2010 Qualitative quality: Eight “Big-Tent” criteria for excellent qualitative research. Qualitative Inquiry 16: 10 837–851.10.1177/1077800410383121.

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