Brief Report: Web-based Management of Adolescent Chronic Pain: Development and Usability Testing of an Online Family Cognitive Behavioral Therapy Program

There is strong empirical support for the use of cognitive behavioral therapy (CBT) in the treatment of pediatric chronic pain (Eccleston, Morley, Williams, Yorke, & Mastroyannopoulou, 2002). Despite support for CBT interventions, many youth do not have access to outpatient psychological services for chronic pain due to a number of barriers, including lack of trained clinicians, expense, competing school and work schedules, and travel distances. To date, the largest treatment advances in making CBT more accessible have been minimal therapist contact and self-administered treatment delivery strategies. These treatments use written materials as a supplement to or substitute for outpatient appointments with a therapist. Self-administered treatments for headache management have produced results that are equal or better than the equivalent therapist-led treatments (Larsson, Daleflod, Hakansson, & Melin, 1987; Richardson & McGrath, 1989). Recently, two randomized controlled trials have tested computer-based technologies to deliver minimal therapist contact CBT to children with headache and abdominal pain. Headstrong, a CD-ROM intervention for 7–12-year-old children with recurrent headache successfully reduced headache frequency, severity, and duration (Connelly, Rapoff, Thompson, & Connelly, 2006). In the second study, an online treatment program was developed for 9–16 year olds with headache and/or recurrent abdominal pain, demonstrating clinically significant pain reduction (Hicks, von Baeyer, & McGrath, 2006). This 7-week program included online content, written materials for children and parents, and therapist telephone and email contact. These studies provide support for the feasibility of delivering CBT for chronic pain via computer-based technology. While the existing computer-based interventions for pediatric recurrent pain are quite promising, they do not utilize the interactivity, multimedia formats, personalization, and communication possible with the Internet. These features may increase engagement and positively impact treatment outcomes (Wade, 2004). Initial research on Internet interventions for delivering behavioral treatments has demonstrated feasibility for a variety of pediatric conditions (Ritterband et al., 2003; Wade, 2004). Web-based interventions also provide researchers with unobtrusive measurement of Web site usage and access patterns, which can be used to assess compliance and engagement (Danaher, Boles, Akers, Gordon, & Severson, 2006). Evaluating the feasibility and usability of Web-based interventions early in Web site development is important, as these factors may impact frequency of use, understanding, and the likelihood that a user will implement recommendations (Ritterband et al., 2003). Evaluation of usability can also help determine the appropriateness of Web site interface and content for a target population (Gustafson & Wyatt, 2004). Lack of compliance with accessing Web-based information is a significant barrier to this type of intervention, and improvement of Web content and usability has been suggested as one means of improving compliance (Ritterband et al., 2005). The purpose of this report is to describe usability testing of an online family CBT program for adolescents with chronic pain (Web-based Management of Adolescent Pain; Web-MAP). This formative evaluation model may be applied in the development of other online treatments. We hypothesized that acceptance of content and usability of Web-MAP would be high, and that participants would appropriately interact and engage with the Web site.