Engaging with EPIO, a digital pain self-management program: a qualitative study
Open accessAbstract
BACKGROUND: Chronic pain conditions entail significant personal and societal burdens and improved outreach of evidence-based pain self-management programs are needed. Digital cognitive-behavioral self-management interventions have shown promise. However, evidence is still scarce and several challenges with such interventions for chronic pain exist. Exploring patients' experiences and engagement with digital interventions may be an essential step towards developing meaningful digital self-management interventions for those living with chronic pain. OBJECTIVES: This study aimed to gain insight into the experiences of people with chronic pain when engaging with EPIO, an application (app)-based cognitive-behavioral pain self-management intervention program. METHODS: Participants (N = 50) living with chronic pain received access to the EPIO intervention in a feasibility pilot-study for 3 months. During this time, all participants received a follow-up phone call at 2-3 weeks, and a subsample (n = 15) also participated in individual semi-structured interviews after 3 months. A qualitative design was used and thematic analysis was employed aiming to capture participants' experiences when engaging with the EPIO intervention program. RESULTS: Findings identifying program-related experiences and engagement were organized into three main topics, each with three sub-themes: (1) Engaging with EPIO; motivation to learn, fostering joy and enthusiasm, and helpful reminders and personalization, (2) Coping with pain in everyday life; awareness, practice and using EPIO in everyday life, and (3) The value of engaging with the EPIO program; EPIO - a friend, making peace with the presence of pain, and fostering communication and social support. CONCLUSIONS: This qualitative study explored participants' experiences and engagement with EPIO, a digital self-management intervention program for people living with chronic pain. Findings identified valued aspects related to motivation for engagement, and showed how such a program may be incorporated into daily life, and encourage a sense of acceptance, social support and relatedness. The findings highlight vital components for facilitating digital program engagement and use in support of self-management for people living with chronic pain. TRIAL REGISTRATION: ClinicalTrials.gov NCT03705104 .
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In a feasibility pilot study, participants living with chronic pain rated EPIO as useful, with excellent system usability.
“In accordance with the Medical Research Council framework for complex intervention evaluation,16,57 the EPIO program was tested in a feasibility pilot study, with participants living with chronic pain rating the program as useful, with excellent system usability.10”
From Living well with chronic pain: a 12-month randomized controlled trial revealing impact from the digital pain self-management program EPIO (2024) · cites this paper as [10]
The Methods (Recruitment and participants; page unavailable) confirm that 50 people living with chronic pain took part in an EPIO feasibility pilot. The Results (The value of engaging with the EPIO program; page unavailable) report that most interviewed participants would recommend it. Our copy does not report a rating of excellent system usability; the Background (Objectives) says usability-related measures were examined in a separately cited pilot-study report. (LLM, conf=0.86)
Experimental — accuracy not yet measuredProgram optimization based on user feedback was conducted before efficacy testing in a randomized controlled trial.
“Program optimization based on user feedback [32,33] was conducted before embarking on efficacy testing in a randomized controlled trial (RCT).”
From Short-Term Findings From Testing EPIO, a Digital Self-Management Program for People Living With Chronic Pain: Randomized Controlled Trial (2023) · cites this paper as [33]
The Methods (Data collection; page unavailable) describe collecting participants’ comments and interviewing them about EPIO’s design and use. The Discussion (Future implications; page unavailable) says an RCT testing EPIO’s efficacy was underway. Our copy does not say the program was optimized based on that feedback before the RCT. (LLM, conf=0.84)
Experimental — accuracy not yet measuredA qualitative study examining participants' experiences with EPIO complemented the feasibility pilot findings, pointing to engagement factors such as motivation to learn, fostering joy and enthusiasm, personalization, coping with pain in everyday life, and the value of engaging with EPIO.
“a qualitative study examining participants’ experiences when engaging with EPIO complemented the feasibility pilot findings, pointing to engagement factors such as the motivation to learn, fostering joy and enthusiasm, and personalization, as well as factors related to coping with pain in everyday life (eg, awareness and need for practice) and the value of engaging with EPIO (eg, EPIO—a friend and”
From Short-Term Findings From Testing EPIO, a Digital Self-Management Program for People Living With Chronic Pain: Randomized Controlled Trial (2023) · cites this paper as [33]
Participants described the EPIO program as fostering communication and social support.
“This was also underlined when examining aspects of engagement with EPIO, with participants describing the EPIO program as fostering communication and social support [33].”
From Short-Term Findings From Testing EPIO, a Digital Self-Management Program for People Living With Chronic Pain: Randomized Controlled Trial (2023) · cites this paper as [33]
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Andersen, L. N., Kohberg, M., Juul‐Kristensen, B., Herborg, L. G., Søgaard, K., & Roessler, K. K. (2014) · Scandinavian Journal of Pain · doi:10.1016/j.sjpain.2014.01.001 · Cited by 51 · cited 1× · see citing works
“The findings also point to the difficult aspects experienced by many people living with chronic pain; the feeling of being alone and not experiencing being heard, seen or understood [70].”
BackgroundPilot testing an app-based stress management intervention for cancer survivors
Børøsund, E., Varsi, C., Clark, M. M., Ehlers, S. L., Andrykowski, M. A., Sleveland, H. R. S., Bergland, A., & Nes, L. S. (2020) · Translational Behavioral Medicine · doi:10.1093/tbm/ibz062 · Cited by 49 · see citing works
Self-citationEassey, D., Reddel, H. K., Ryan, K., & Smith, L. D. (2020) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2020.1794879 · Cited by 45 · cited 3× · see citing works
“When people are more motivated by their values, interests and enjoyment of behavior change, they tend to stay continually engaged in the self-management process and be more satisfied [42, 43].”
BackgroundResultBørøsund, E., Ehlers, S. L., Varsi, C., Clark, M. M., Andrykowski, M. A., Cvancarova, M., & Solberg Nes, L. (2020) · Cancer Medicine · doi:10.1002/cam4.3000 · Cited by 43 · see citing works
Digital Self-Management in Support of Patients Living With Chronic Pain: Feasibility Pilot Study
Bostrøm, K., Børøsund, E., Varsi, C., Eide, H., Flakk Nordang, E., Schreurs, K. M., Waxenberg, L. B., Weiss, K. E., Morrison, E. J., Cvancarova Småstuen, M., et al. (2020) · JMIR Formative Research · doi:10.2196/23893 · Cited by 34 · see citing works
Self-citationInforming the development of an Internet-based chronic pain self-management program
Gogovor, A., Visca, R., Auger, C., LeBlanc, L. B., Symeonidis, I., Poissant, L., Ware, M. A., Shir, Y., Viens, N., & Ahmed, S. (2016) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2016.10.005 · Cited by 32 · see citing works
Russell, L., Ugalde, A., Milne, D., Austin, D., & Livingston, P. M. (2018) · JMIR Mental Health · doi:10.2196/mental.9645 · Cited by 26 · see citing works
Ankawi, B., Kerns, R. D., & Edmond, S. N. (2019) · Current Pain and Headache Reports · doi:10.1007/s11916-019-0813-x · Cited by 26 · cited 1× · see citing works
“For example, self-efficacy, or one’s belief that one can utilize the self-management techniques, may play an important role in this type of engagement [43, 53] and as several participants in the current study described an improved sense of control and self-confidence from the use of EPIO, this may indicate a potential…”
BackgroundDevan, H., Godfrey, H., Perry, M., Hempel, D., Saipe, B., Hale, L., & Grainger, R. (2019) · Journal of Pain Research · doi:10.2147/jpr.s206539 · Cited by 26 · cited 1× · see citing works
“, patients, health care providers) involvement in the development process [18], issues with attrition/adherence [19, 20], limited evidence of efficacy [12, 16] and limited implementation and actual use post study [21, 22].”
BackgroundNes, L. S., Ehlers, S. L., Whipple, M. O., & Vincent, A. (2017) · Pain Practice · doi:10.1111/papr.12480 · Cited by 21 · cited 1× · see citing works
“Self-regulatory capacity may play an important role in terms of ability to engage and undertake the necessary day-to-day practice in a digital self-management setting, and continuing to find ways to help people with chronic pain build or strengthen their self-regulatory capacity and support motivation to engage in pai…”
BackgroundSelf-citationSelf Determination Theory (SDT): a review on SDT as a Complementary Theory of Motivation
Gunasekare, U. L. T. P. (2016) · Kelaniya Journal of Human Resource Management · doi:10.4038/kjhrm.v11i1.28 · Cited by 21 · see citing works
Barriers to Recruiting Men Into Chronic Disease Prevention and Management Programs in Rural Areas
Gavarkovs, A. G., Burke, S. M., Reilly, K. C., & Petrella, R. J. (2015) · American Journal of Men s Health · doi:10.1177/1557988315596226 · Cited by 20 · see citing works
Duggan, G. B. (2016) · Behaviour and Information Technology · doi:10.1080/0144929x.2016.1141320 · Cited by 16 · cited 1× · see citing works
“This suggests facilitation of a supportive interpersonal aspect, and is also consistent with engagement-related research indicating that users are often willing to engage more and create relations with intervention technology that share features similar to human relationships [59, 60], and such human-technology relati…”
Result
Flagged first, then by citations
Research works printed but not linked: 2
- [28]van Gemert-Pijnen L, Kelders SM, Kip H, Sanderman R: eHealth Research, Theory and Development, 1st ed. edn: Routledge; 2018.
- [50]Aziz N Roseli N Mat Salleh S Aziz N Persuasive technology in intervention programs for health issues: a comparative review J Appl Environ Biol Sci 2017 7 56 61
Cited by
Sorted by citations
Svendsen, M. J., Nicholl, B. I., Mair, F. S., Wood, K., Rasmussen, C. D. N., & Stochkendahl, M. J. (2022) · Chiropractic & Manual Therapies · doi:10.1186/s12998-022-00452-2 · Cited by 34 · see citing works
“The need for professional psychosocial support is key to building self-confidence and becoming empowered [14, 23, 41, 42, 46], and could explain why some of the selfBACK participants wanted more follow-up from their HCP. Typically, these participants did not experience an effect on pain and did not…”
Main, A., McCartney, H., Ibrar, M., Muirhead, F., Mavroeidi, A., Kaur, H., & Maguire, R. (2025) · Journal of Medical Internet Research · doi:10.2196/69100 · Cited by 20 · see citing works
“%) studies did not differentiate between chronic pain diagnoses [38,40,42,44,47,55], while the remaining 31 (84”
InfluentialBostrøm, K., Børøsund, E., Eide, H., Varsi, C., Kristjansdottir, Ó. B., Schreurs, K. M. G., Waxenberg, L. B., Weiss, K. E., Morrison, E. J., Stavenes Støle, H., et al. (2023) · Journal of Medical Internet Research · doi:10.2196/47284 · Cited by 12 · see citing works
“Qualitative explorations may also, in line with recommendations from the MRC [34,35], contribute to a better understanding of the impact and nuances of using pain self-management interventions [33,35].”
InfluentialStrain, J. D. R., Welch, L., & Sadler, E. (2024) · PLoS ONE · doi:10.1371/journal.pone.0306455 · Cited by 8 · see citing works
Solberg Nes, L., Børøsund, E., Varsi, C., Eide, H., Waxenberg, L. B., Weiss, K. E., Morrison, E. J., Støle, H. S., Kristjansdottir, Ó. B., Bostrøm, K., et al. (2024) · Pain Reports · doi:10.1097/pr9.0000000000001174 · Cited by 7 · see citing works
“10,11 Digital wearables could also complement self-report measures, for example to gauge factors such as physical activity and sleep.”
BackgroundMethodBlake, H., Chaplin, W. J., Wainwright, E. M., Taylor, G. T., McNamee, P., McWilliams, D. F., Abbott-Fleming, V., Holmes, J. A., Fecowycz, A., Walsh, D. A., et al. (2023) · JMIR Research Protocols · doi:10.2196/51474 · Cited by 6 · see citing works
Ali, S. M., Gambin, A., Chadwick, H., Dixon, W. G., Crawford, A. S., & van der Veer, S. N. (2024) · International Journal for Equity in Health · doi:10.1186/s12939-024-02299-w · Cited by 3 · see citing works
“…in our study suggested that digital pain self-reporting may have a positive impact on people’s pain awareness and self-efficacy, which aligns with findings reported by a study exploring people’s experiences of using an app-based cognitive-behavioural pain self-management intervention [13].”
BackgroundResultStrand, E. B., Varsi, C., Børøsund, E., Eide, H., Schreurs, K. M. G., Waxenberg, L. B., Weiss, K. E., Morrison, E. J. P., Støle, H. S., Kristjánsdóttir, Ó. B., et al. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1540852 · Cited by 2 · see citing works
“This is also in line with input received through the follow-up phone calls in the RCT and the feasibility pilot (Bostrøm et al., 2022; Solberg Nes et al., 2024).”
Influentialvan de Graaf, D. L., van der Lee, M. L., Smeets, T., Trompetter, H. R., & Mols, F. (2025) · JMIR Cancer · doi:10.2196/64983 · Cited by 2 · see citing works
“This approach neglects the qualitative dimensions of use that are critical for achieving individual health goals and therapeutic benefit [8-11].”
Cheng, A. L., Gou, C. Y., Martin, A., Hartz, S. M., & Abraham, J. (2026) · JMIR mhealth and uhealth · doi:10.2196/87358 · Cited by 1 · see citing works
“This phenomenon is supported by prior studies among different target user populations, which have simultaneously reported high popularity of pain tracking features and mixed feedback regarding the helpfulness of these features [69,70].”
Lærkner, E., Bendix, L., Jäger, M., Hansen, M.-B., & Vægter, H. B. (2023) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2023-0044 · Cited by 3 · see citing works
Tang, J., & Qiu, X. (2022) · Highlights in Science Engineering and Technology · doi:10.54097/hset.v21i.3172
“Pain can impact physical, emotional and social functioning for the individuals living with pain, often resulting in significant personal and societal burden [1,2].”
BackgroundGuebey, J., Gosetto, L., Rehberg, B., Lovis, C., Ehrler, F., & Molinard‐Chenu, A. (2025) · medRxiv · doi:10.1101/2025.10.28.25338623
“Based on the results of the present study, it seems relevant to add features aiming at improving engagement over time, such as a reward system and more personalization features 26 .”
InfluentialSvendsen, M. J., Nicholl, B. I., Mair, F. S., Wood, K., Rasmussen, C. D. N., & Stochkendahl, M. J. (2022) · Figshare · doi:10.6084/m9.figshare.21266874
Svendsen, M. J., Nicholl, B. I., Mair, F. S., Wood, K., Rasmussen, C. D. N., & Stochkendahl, M. J. (2022) · Figshare · doi:10.6084/m9.figshare.21266877
A Chronic Pain Self-Management Mobile App (Dolodoc): Cross-Sectional Acceptability Study
Guebey, J., Gosetto, L., Rehberg, B., Lovis, C., Ehrler, F., & Molinard‐Chenu, A. (2026) · JMIR Human Factors · doi:10.2196/77163
“…perceptions of acceptability and study their perceptions of the information contained in Dolodoc using 5 selected acceptability criteria based on previous literature: understandability [25], motivation [26], feasibility [26], relevance [27], and alignment with the related quality-of-life dimension.”
InfluentialEather, C.-E., Sullivan, C. M., Sterling, M. M., Armfield, N. R., Liimatainen, J., Chandra, S. S., & Elphinston, R. A. (2026) · Pain · doi:10.1097/j.pain.0000000000003959
Delivery Model Matters for Digital Interventions in Pain Self-Management: Mixed Methods Study
Nes, L. S., Børøsund, E., Nordang, E. F., Asbjørnsen, R. A., Eide, H., Varsi, C., Waxenberg, L. B., Weiss, K. E., Morrison, E. J. P., Støle, H. S., et al. (2026) · Journal of Medical Internet Research · doi:10.2196/89780
“Interviews conducted after the feasibility pilot study identified EPIO as raising awareness, fostering joy and enthusiasm, being a friend, and helping participants make peace with the pain [29].”
- Authors
- Bostrøm, K., Varsi, C., Eide, H., Børøsund, E., Kristjansdottir, Ó. B., Schreurs, K. M. G., Waxenberg, L. B., Weiss, K. E., Morrison, E. J., Nordang, E. F., Stubhaug, A., & Nes, L. S.
- Affiliations
- Oslo University Hospital (NO)
- University of Twente (NL)
- University of Florida Health (US)
- University of Washington (US)
- Mayo Clinic (US)
- Corresponding author
- Nes, Lise Solberg
- ORCID
- Venue
- BMC Health Services Research
- Published
- 2022-04-29
- Volume
- 22
- Issue
- 1
- Pages
- 577-577
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC9052507
- OpenAlex
- W4225249107
- Cited by
- 18
- References
- 79
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 3 · 2023: 3 · 2022: 4
- FWCI
- 3.08
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Twente Research Information (publishedVersion, cc-by)
- Opin vísindi (Opin vísindi) (submittedVersion, cc-by-nc-sa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Opin vísindi (Opin vísindi) (submittedVersion, other-oa)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- University of Twente Research Information (submittedVersion, cc-by)
- Funders
- Norges Forskningsråd (256574)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- chronic pain, pain self-management, digital interventions, mobile health apps, cognitive behavioral therapy, patient engagement, user experience, motivation, pain acceptance, social support, personalization, reminders
- MeSH terms
- Self-Management, Humans, Pilot Projects, Qualitative Research, Chronic Pain, Pain Management
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