title: It's About Me: Patients' Experiences of Patient Participation in the Web Behavior Change Program for Activity in Combination With Multimodal Pain Rehabilitation.
abstract: Patients' participation in their health care is recognized as a key component in high-quality health care. Persons with persistent pain are recommended treatments with a cognitive approach from a biopsychosocial explanation of pain, in which a patient's active participation in their rehabilitation is in focus. Web-based interventions for pain management have the potential to increase patient participation by enabling persons to play a more active role in rehabilitation. However, little is known about patients' experiences of patient participation in Web-based interventions in clinical practice.
  
  
  
  The objective of our study was to explore patients' experiences of patient participation in a Web Behavior Change Program for Activity (Web-BCPA) in combination with multimodal rehabilitation (MMR) among patients with persistent pain in primary health care.
  
  
  
  Qualitative interviews were conducted with 15 women and 4 men, with a mean age of 45 years. Data were analyzed with qualitative content analysis.
  
  
  
  One theme, "It's about me," and 4 categories, "Take part in a flexible framework of own priority," "Acquire knowledge and insights," "Ways toward change," and "Personal and environmental conditions influencing participation," were developed. Patient participation was depicted as being confirmed in an individualized and structured rehabilitation framework of one's own choice. Being confirmed was fundamental to patient participation in the interaction with the Web-BCPA and with the health care professionals in MMR. To acquire knowledge and insights about pain and their life situation, through self-reflection in the solitary work in the Web-BCPA and through feedback from the health care professionals in MMR, was experienced as patient participation by the participants. Patient participation was described as structured ways to reach their goals of behavior change, which included analyzing resources and restrictions, problem solving, and evaluation. The individual's emotional and cognitive resources and restrictions, as well as health care professionals and significant others' attitudes and behavior influenced patient participation in the rehabilitation. To some extent there were experiences of restrained patient participation through the great content of the Web-BCPA.
  
  
  
  Patient participation was satisfactory in the Web-BCPA in combination with MMR. The combined treatment was experienced to increase patient participation in the rehabilitation. Being confirmed through self-identification and finding the content of the Web-BCPA trustworthy was emphasized. Patient participation was experienced as a learning process leading to new knowledge and insights. Higher user control regarding the timing of the Web-BCPA and therapist guidance of the content may further increase patient participation in the combined treatment.
authors.affiliation: Department of Primary Health Care, Region Norrbotten, Piteå, Sweden.|Department of Health Science, Division of Health and Rehabilitation, Luleå University of Technology, Luleå, Sweden.
authors.forename: Catharina
authors.identifier: 0000-0001-6032-665X
authors.initials: C
authors.lastname: Nordin
authors.affiliation: Department of Health Science, Division of Health and Rehabilitation, Luleå University of Technology, Luleå, Sweden.
authors.forename: Peter
authors.identifier: 0000-0003-0112-4657
authors.initials: P
authors.lastname: Michaelson
authors.affiliation: Department of Health Science, Division of Health and Rehabilitation, Luleå University of Technology, Luleå, Sweden.|Department of Public Health, Region Norrbotten, Luleå, Sweden.
authors.forename: Margareta K
authors.identifier: 0000-0001-8963-2247
authors.initials: MK
authors.lastname: Eriksson
authors.affiliation: Department of Health Science, Division of Health and Rehabilitation, Luleå University of Technology, Luleå, Sweden.
authors.forename: Gunvor
authors.identifier: 0000-0001-6975-8344
authors.initials: G
authors.lastname: Gard
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000523:psychology / Q000534:rehabilitation*; D059408:Pain Management / Q000379:methods*; D010358:Patient Participation / Q000379:methods*; D017216:Telemedicine / Q000379:methods
keywords: Web-based intervention; interview; pain; patient participation; qualitative research