A Realist Study of Self-management Apps to help People living with Chronic Low Back Pain

Student thesis: Doctoral ThesisDoctor of Philosophy (awarded by UHI)


For the majority of people with chronic low back pain (CLBP), there is
no cure. Instead, clinical guidelines recommend supporting people to
self-manage CLBP. Mobile health applications could help with this.
However, studies to date do not explain why self-management apps
may work for some people with CLBP, and not for others. The aim of
this research was to understand what it is about a self-management
app for CLBP that works, who it works for, why and under what
This research was conducted within the paradigm of scientific realism
which uses a generative understanding of causation to explain
programme outcomes. These causal explanations are expressed as
programme theories. The research was designed in two parts, a realist
synthesis followed by a realist evaluation.
Realist Synthesis
Six databases and several non-academic sources were searched.
Sources were selected and appraised for relevancy, richness, and
rigour. Nineteen realist interviews were conducted with stakeholders
and also included in the review. Data was coded with analytical memos
making retroductive inferences. Causal explanations were presented in
context-mechanism-outcome configurations to form three programme
theories under the themes of empowerment, self-management burden
and timing. These were tested further in a realist evaluation.
Nine people living with CLBP were recruited and used a commercially
available self-management app for chronic pain (Curable) for twelve
weeks. Afterwards, realist telephone interviews were conducted to test
the CMOCs from the realist synthesis. Data was coded using abductive
and retroductive logic to create 20 CMOCs. These propositions
supported the initial three programme theories around empowerment,
self-management burden and timing.
Three programme theories were created that identify how, why and in
what circumstances a self-management app might support a person
living with CLBP. Programme theory one suggests that, if introduced
as adjunct to care, an app could be an empowering tool to self-manage
CLBP. Programme theory two proposes that a mobile app can help
reduce some of the self-management burden by providing people with
CLBP a means of recording data that, with healthcare professional’s
buy-in, could facilitate consultations. Finally, programme theory three
identifies that a person with CLBP must feel believed and have
accepted their condition before they are likely to use a self-management
Date of Award5 Oct 2023
Original languageEnglish
Awarding Institution
  • University of the Highlands and Islands
SupervisorTrish Gorely (Supervisor) & Michelle Beattie (Supervisor)

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