Chronic pain affects 30% of children and adolescents, putting them at risk for physical and psychological impairments. Given poor access to pediatric pain care, psychological treatments such as cognitive behavioral therapy are more accessible through digital health interventions. One intervention our lab created is Web-based Management of Adolescent Pain (WebMAP). In this mobile app, youth with chronic pain develop pain management strategies by progressing through interactive modules. Although digital health interventions like WebMAP are transforming accessibility to chronic pain care, limited information is available to understand how best to enhance youth engagement in a mobile app or whether there are differences in engagement among youth with different background characteristics. Our project aimed to 1) identify barriers to engagement with WebMAP among subgroups defined by user demographics and 2) develop recommendations for enhancing engagement with WebMAP and extending its reach to target underserved populations. In a previous cluster randomized controlled trial, participants assigned to the WebMAP intervention were 73 youth aged 10 to 17 (84.3% female) with various chronic pain conditions. We analyzed the app metadata to assess module completion rates across various subgroups, including groups defined by age, race, sex, and annual household income. We also coded interview and questionnaire responses from users to identify app preferences and areas of improvement. Results indicated that although users liked WebMAP’s design and content, they suggested changes to its display and features. By viewing our findings on usage and perception through a health equity lens, we summarized the accessibility of WebMAP and outlined recommendations to enhance its cultural relevance to different groups. Ultimately, our research identified factors that impacted engagement with WebMAP and offered valuable insight into optimizing digital health psychological interventions for chronic pain management. Moving forward, we hope to apply these findings as we develop the next release of WebMAP.

Sickle cell disease (SCD), the most common genetic blood disease in North America, is characterized by recurrent episodes of acute severe pain due to blockages of red blood cells. In past studies, digital cognitive-behavioral interventions have been shown to be beneficial in other chronic pain conditions through teaching pain-management skills. Our research investigates the effectiveness of iCanCope SCD (iCC-SCD), a web and mobile-based pain-management program for SCD pain in youth ages 12-18 years. The final enrolled sample for the study was 137 participants, of which 26 participants were excluded because they did not complete pre-treatment assessments. Thus, the final sample consisted of 111 adolescents (107 caregivers), 54 randomized to Education control, and 57 randomized to iCC-SCD. The iCC-SCD program includes modules teaching coping strategies, symptom and goal-tracking, and peer-based social support, while the attentional-control contains static education about SCD. The efficacy of the program is determined through self-report scales at pre-treatment, post-treatment (2 months), and follow-up (6-months) periods, targeting the primary outcomes of adaptive coding, pain reduction, and pain-related disability. A statistically significant effect of treatment group (iCC-SCD vs. Education) on change over time in average pain intensity from baseline to 6-month follow-up was found. While most youth engaged with the program (40/57, 70%), the overall usage was highly variable. Therefore, I will explore the differences between participant website and app engagement from this study, feedback on why participants may or may not have been able to complete the iCanCope program and determine areas to enhance engagement. The information collected in this analysis can help to improve web- and mobile-based interventions for not only youth coping with SCD pain but also those with other pain-related conditions, given the flexibility and universality of cognitive-behavioral frameworks.