Development of iGET Living, a Digital Graded Exposure Intervention for Youth With Chronic Pain: Multiphase User-Centered Design and Pilot Study
Clinical Snapshot
PICO Framework
| P — Population | Youth with chronic pain recruited from tertiary pediatric pain clinic |
| I — Intervention | iGET Living - digital graded exposure intervention developed through user-centered design |
| C — Comparator | No comparator - single-arm development and pilot study |
| O — Outcomes | Feasibility, acceptability, treatment credibility and expectancy, user satisfaction, and user-perceived functional improvements |
Bottom Line
This multiphase development study successfully created iGET Living, a user-centered digital graded exposure intervention for youth with chronic pain. Using rigorous implementation science frameworks, researchers iteratively refined the intervention based on direct user feedback, resulting in high acceptability and treatment credibility scores. The study demonstrates the value of incorporating user-centered design and implementation frameworks early in digital health intervention development. While preliminary results are promising, the study's single-arm design and lack of clinical outcome measures limit conclusions about effectiveness. The intervention shows potential for addressing access barriers to evidence-based pain management, particularly relevant for geographically dispersed populations. Further evaluation through randomized controlled trials with clinical endpoints is needed before widespread implementation. The methodology provides a valuable template for developing other digital behavioral health interventions.
Key Findings
P Value: Not applicable - no statistical testing
Effect Size: Not applicable - descriptive feasibility study
Primary Outcome: Feasibility and acceptability of digital graded exposure intervention
Nnt Or Sensitivity: Treatment credibility: 19.71/30; Treatment expectancy: 17.96/30; Satisfaction: 46.12/60
Confidence Interval: Not reported
Clinical Application
High feasibility demonstrated with good completion rates and user engagement Highly relevant for Australian pediatric pain services given geographic barriers to specialist care; could complement existing telehealth initiatives and align with RACGP chronic pain management guidelines emphasizing multimodal approaches Youth aged 12-18 with chronic pain conditions seeking behavioral interventions
Abstract
BACKGROUND: Pediatric chronic pain affects up to one-third of youth and is associated with significant disruptions in social, emotional, and behavioral functioning. Although behavioral treatments are effective, access remains limited due to geographic, financial, and systemic barriers. Digital behavioral health interventions offer a promising solution, but many lack user-centered design, iterative refinement, and implementation-informed development strategies that support usability and scalability. OBJECTIVE: This study aimed to develop and iteratively refine iGET Living, a digital graded exposure intervention for youth with chronic pain, using a combined user-centered and implementation-informed framework, and to evaluate its preliminary acceptability, feasibility, and user-perceived success. METHODS: Guided by the Consolidated Framework for Implementation Research (CFIR) and the mHealth (mobile health) Agile Development and Lifecycle model, intervention development proceeded through 3 phases. Phase 0 translated an evidence-based in-person graded exposure treatment (GET Living) into an initial digital prototype. Phase 1 involved iterative user-centered refinement across 3 cycles of qualitative development sessions with youth with chronic pain (n=15), incorporating think-aloud usability testing, Likert-rated feedback, and rapid qualitative analysis mapped to CFIR constructs to guide real-time modifications to content, design, and functionality. Phase 2 piloted the refined intervention with a new sample of youth (n=38, n=30 completers) recruited from a tertiary pediatric pain clinic to evaluate feasibility, acceptability, treatment credibility and expectancy, and user-perceived functional improvements. Quantitative outcomes were summarized descriptively, and qualitative exit interview data were analyzed using rapid qualitative analysis. RESULTS: Across development cycles, youth feedback informed substantive refinements to the intervention, including reducing text density, incorporating animated educational videos, enhancing interactive features, and improving navigation and layout. These changes resulted in progressive improvements in clarity, satisfaction, and acceptability across prototypes. In the Phase 2 pilot study, participants reported moderate-to-high treatment credibility (mean of 19.71 out of 30) and expectancy (mean of 17.96 out of 30), as well as high satisfaction (mean of 46.12 out of 60). Acceptability ratings across domains of the Theoretical Framework of Acceptability were favorable. Qualitative exit interviews highlighted the interventions' perceived role in helping youth re-engage in valued activities. CONCLUSIONS: Using a combined CFIR and agile development approach, iGET Living emerged as a feasible, acceptable, engaging digital graded exposure intervention for youth with chronic pain. These findings highlight the value of integrating implementation frameworks and participatory design early in digital intervention development and support further evaluation in a preliminary efficacy trial.
References
- 1.Harrison, L. E., Webster, S. N., Choate, E. S., Mayanja, D., Jehl, N., Darnall, B. D., Stinson, J. N., Bonnert, M., Lalouni, M., Wicksell, R. K., & Simons, L. E. (2026). Development of iGET Living, a Digital Graded Exposure Intervention for Youth With Chronic Pain: Multiphase User-Centered Design and Pilot Study. JMIR Formative Research. https://doi.org/10.2196/89206
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