Gathering user requirements and assessing usability of a digital pain self-reporting tool among people living with chronic musculoskeletal pain in Pakistan: A qualitative study (Preprint)

BACKGROUND Chronic musculoskeletal pain is a global problem, management of which is sub-optimal in Pakistan. The traditional pain assessment tools often lack cultural relevance for culturally and linguistically diverse communities. Manikin-based digital pain self-reporting tools may support pain management but require cultural adaptation to ensure their accessibility and inclusivity. OBJECTIVE This study aimed to gather user requirements and preferences for digital pain self-reports and assessing usability of a digital pain self-reporting tool, which would support digitally enabled pain assessment and management in future. METHODS A qualitative study was conducted at Shalamar Hospital, Lahore, involving four gender-segregated group discussions with adults living with chronic pain and individual interviews with rheumatologists. User requirements of digital pain self-reporting tools were gathered using the table of specification approach. The clickable prototype of the digital pain self-reporting tool was presented, and its usability was assessed with the help of testing scenarios through the think-aloud technique and researchers’ observations. To improve the tool’s usability, the content was culturally adapted through pictograms and translating it into Urdu by employing an adapted FACIT methodology. Pictograms were designed to enhance communication of pain qualities and tested their relevance with participants. Focus groups and interviews were transcribed verbatim and analyzed descriptively. RESULTS Twenty people living with chronic pain participated in focus groups and four rheumatologists participated in interviews. Majority of people living with chronic pain were middle-aged (35-54 years; 55%), employed (n=14; 70%), and diagnosed with rheumatoid arthritis (n=9; 45%). We found similarities between user requirements captured in the UK for digital pain self-reporting tools and for those collected in Pakistan. However, female participants did not prefer gender personalization of the manikin due to socio-cultural factors. Four different usability testing scenarios revealed that the digital pain reporting tool was easy to use. Participants confirmed Urdu translated tool’s content and pictograms improved the tools’ usability through iterative improvements. Rheumatologists found the tool to be capturing all important pain aspects and recognized its potential to improve patient-provider communication, particularly for patients with low literacy. CONCLUSIONS The study demonstrated that manikin-based digital pain self-reporting tool is easy to use among Pakistanis living with chronic musculoskeletal pain. Preferences for manikin personalisation based on gender highlight the significance of cultural adaptations which are responsive to socio-cultural contexts. Accessible digital pain self-reporting tools have potential to improve pain outcomes through inclusive and digitally enabled pain assessment and management.