Examining the impact of an innovative online qualitative study (netnography) in developing a clinical pharmacist-led review for persistent pain patients in primary care (PROMPPT study)

Problem

Qualitative methods are central to adopting a person-centred approach to intervention development in order to maximise intervention effectiveness. Face-to-face interviews and focus groups are often used, but risk omitting views of those unable or unwilling to participate in person, a barrier more likely to affect those living with a chronic illness or stigmatized condition. Online methods have the potential to extend participant inclusivity and contribute towards a comprehensive assessment of an intervention’s acceptability and inform its development. To further understand the value of online methods, we compared findings from face-to-face interviews with those from an online discussion forum used in the iterative development of a clinical pharmacist-led primary care review for patients prescribed opioid medicines for persistent pain.

Approach

An online discussion forum was available for 11 weeks, with a new discussion topic posted approximately weekly. In this time 69 participants joined the forum, with 31 of these posting 160 comments ranging in length from 19 to 2,143 words. The discussion topics (n=10) and semi-structured interviews (n=15) were informed by behaviour change theories, and explored patient experiences of living with persistent non-cancer pain, pain management and taking opioid medicines, to identify facilitators of and barriers to delivering a pain review in primary care. All interviews were carried out by one researcher, whilst the forum was moderated by a team of six researchers specialising in behaviour change, psychology, applied health research and clinical pain management. A framework approach to data analysis was used, and findings between the two methodological approaches were compared in terms of thematic codes.

Findings

Preliminary findings indicate thematic overlap between interview and forum data including provision of multidisciplinary care, importance of clinical pharmacist consultation skills, and development of individualised plans for patients’ pain self-care. The discussion forum attracted participants who had experience of reducing off opioids and led to additional themes concerning patient support when reducing opioid medicines, and alternative ways to help manage pain and self-care strategies. Findings fed into refining the content of the PROMPPT intervention and training programme ahead of a formal feasibility study.

Consequences

The present study highlights the contribution of online qualitative methods in maximising intervention development. Inclusion of a discussion forum allowed participants with different experiences of using and changing pain medicines, from a wider geographical region to engage in research at a personally convenient time and location. Initial findings suggest research targeting patient populations involving chronic and/or stigmatized conditions could benefit from including online methods as an accessible alternative to face-to-face approaches when evaluating facilitators of and barriers to intervention implementation and delivery.