Getting the Know-How: The Feasibility of Delivering a Digital Self-Management Programme for Axial Spondyloarthritis

Purpose

Despite recommendations by the National Institute for Health and Care Excellence in the management of Axial Spondyloarthritis (AS), adherence to exercise and self-management education is reported to be variable. The Axial Spondyloarthritis Know-How (ASK) self-management programme offers service-users a single attendance exercise and education workshop supported by a self-management digital toolkit. The digital toolkit consists of a short educational film and self-assessment tool prior to attendance and an interactive self-management handbook to support health behaviour change following attendance. The feasibility of delivering a digital self-management programme for adults with AS was explored prior to implementation.

30 patients (14 male; 16 female) attending the ASK group
workshop between February and April 2019 completed the ASK self-assessment tool prior to attendance.

86.7% (26/30) viewed the ASK film before attending,
with 86.9% (20/23) rating the film ≥ 7/10 for helpfulness in managing expectations of the ASK workshop.

53.3% (16/30) downloaded the interactive ASK
self-management handbook to a mobile device prior to attending.
81.3% (13/16) rated the helpfulness
of receiving the ASK self-management handbook prior to attendance at ≥ 7/10.

Approach

The development of the ASK digital toolkit involved multiple stakeholders. Service-users, the host NHS trust communications team and charity partners from the National Ankylosing Spondylitis Society (NASS) reviewed the ASK digital toolkit with user-testing and feedback contributing to the reiterative design of the digital resource. Service-users were also involved in the co-production of the ASK film. The feasibility of delivering the ASK digital toolkit via a web link in an automated pre-appointment text message and the acceptability, trustworthiness, safety and helpfulness of the digital toolkit was evaluated using a patient questionnaire between February and April 2019.

Outcomes

  • 23 patients (12 male; 11 female) completed the feasibility questionnaire. 
  • The acceptability of receiving the ASK digital toolkit via a web link in a text message was rated 9.6/10.
  • The trustworthiness and safety of data was rated 9.4/10 and 8.6/10 respectively.
  • The helpfulness of receiving the ASK self-management handbook prior to attending the ASK workshop was rated 8.2/10.
  • The overall helpfulness of the ASK digital tool in supporting self-management was rated 9.1/10.
  • The acceptability of receiving the self-assessment tool at 3, 6 and 12 month follow-ups to support adherence to self-management was rated 9.5/10.
  • 30 patients (14 male; 16 female) attending the ASK group workshop between February and April 2019 completed the ASK self-assessment tool prior to attendance.
  • 86.7% (26/30) viewed the ASK film before attending, with 86.9% (20/23) rating the film ≥ 7/10 for helpfulness in managing expectations of the ASK workshop.
  • 53.3% (16/30) downloaded the interactive ASK self-management handbook to a mobile device prior to attending.
  • 81.3% (13/16) rated the helpfulness of receiving the ASK self-management handbook prior to attendance at ≥ 7/10.

Qualitative feedback regarding the helpfulness of the digital toolkit in supporting self-management was also obtained.

Implications

A digital-first approach to the delivery of the ASK self-management programme is acceptable and rated highly for helpfulness in preparing patients for a journey of self-management. The award of the Department of Health Information Standard status, a high level of user-engagement and feedback have demonstrated the level of trust and helpfulness users experienced when engaging with the ASK digital toolkit. Delivery of the ASK toolkit appears to be feasible using digital technology and has the potential in supporting adherence to self-management for patients with AS.

In the digital era of the NHS, the development of a safe and acceptable self-management digital resource which could support adherence to health behaviour change has the potential for adoption across other long-term conditions.

Additional notes

This work was presented at Physiotherapy UK 2019