Help Overcoming Pain Early (HOPE) - a person-centred intervention for adolescents with chronic pain in a school setting

Abstract

The overall aim of the thesis was to develop and evaluate a school health-based intervention, Help Overcoming Pain Early (HOPE) for promotion of adolescents’ ability to manage their problems with chronic pain. Study I. A qualitative study on the development and feasibility of the complex intervention HOPE, based on interviews with adolescents with chronic pain and school nurses. Results illustrated that HOPE, through its participative design, corresponded to the wishes expressed by school nurses prior to the intervention. The intervention was based on a person-centred approach, including an education program for school nurses and four sessions for adolescents with school nurses. Study II. A randomized controlled trial evaluating the effect of HOPE for adolescents with chronic pain in comparison with a wait-list control group. Results did not show any effect on self-efficacy in daily activities, pain intensity, or pain impact. Sub-group analyses illustrated a significant effect on self-efficacy in daily activities among adolescents in secondary school. Study III. A non-randomized study including participants from both the intervention and the wait-list control group in Study II after receiving the intervention. Results showed improvements in symptoms of insomnia at the six-month follow-up as well as perceived health at post-assessment and at the six-month follow-up. Study IV. A qualitative interview study with adolescents in the intervention group at secondary school. Results revealed the main theme: A trust-building process towards a strengthened identity, including two sub-themes: Trust in the school nurse and the intervention and Confidence in oneself as a person. Conclusively, HOPE can potentially be used as a brief intervention for adolescents with chronic pain and associated problems such as symptoms of insomnia and perceived health. HOPE did not influence self-efficacy in daily activities, pain intensity, and pain impact, except for adolescents in secondary school. Adolescents perceived HOPE as a trust-building process in relation to school nurses, the intervention and confidence in themselves.