title: Developing a Web-Based Version of An Exercise-Based Rehabilitation Program for People With Chronic Knee and Hip Pain: A Mixed Methods Study.
abstract: BACKGROUND
  Osteoarthritis is highly prevalent and has enormous personal and socioeconomic impact. Enabling Self-management and Coping with Arthritic Pain through Exercise (ESCAPE-pain) is an integrated rehabilitation program that helps people understand how exercise can improve physical and psychosocial well-being. Unfortunately, its availability is limited. A Web-based version of the program could increase access for more people. Many Web-based resources are developed without end-user input and result in over-complex, unwanted, ineffective products with limited uptake.
  
  
  OBJECTIVE
  The objective of this study was to codesign a Web-based version of ESCAPE-pain that people with chronic joint pain find engaging, informative, and useful.
  
  
  METHODS
  To establish older persons' Internet use we conducted a postal survey of 200 people. To establish their opinions, likes or dislikes, and requirements for a Web-based version of the ESCAPE-pain program, we conducted two focus groups with 11 people who had participated in a program based on ESCAPE-pain and two with 13 people who had not. Information from the postal survey and focus groups was used to develop an online prototype website. People's opinions of the prototype website were gauged from thematic analysis of eight semistructured "think aloud" interviews.
  
  
  RESULTS
  The survey response rate was 42% (83/200), of whom 67% (56/83) were female and mean age was 67 years. Eighty-three percent of the people had used the Internet, 69% described themselves as either very confident or confident Internet users, and 77% had looked online for health information. With regard to participating online, 34% had read a commentary or watched a video of someone else's experience of a health problem and 23% had tracked a health issue. Key qualitative themes emerged that included engagement, acceptability and usability, and structure and content of the program.
  
  
  CONCLUSIONS
  Older people use the Internet as a source of health information but have concerns about safe use and quality of information. Users require a credible website that provides personalized information, support, monitoring, and feedback.
authors.affiliation: School of Rehabilitation Sciences, Faculty of Health, Social Care and Education, St Georges University of London and Kingston University, London, United Kingdom.
authors.forename: Jennifer
authors.identifier: http://orcid.org/0000-0002-5754-2762
authors.initials: J
authors.lastname: Pearson
authors.forename: Nicola
authors.identifier: http://orcid.org/0000-0002-0499-4829
authors.initials: N
authors.lastname: Walsh
authors.forename: Desmond
authors.identifier: http://orcid.org/0000-0003-2848-9015
authors.initials: D
authors.lastname: Carter
authors.forename: Sian
authors.identifier: http://orcid.org/0000-0003-4379-8190
authors.initials: S
authors.lastname: Koskela
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0001-6106-2895
authors.initials: M
authors.lastname: Hurley
keywords: behavioral change; exercise; osteoarthritis; qualitative research; quantitative research; self-care; web-based program