Exploring Stakeholders' Perceptions of Using Digital Health Technologies to Improve the Conservative Treatment of Adolescent Idiopathic Scoliosis: Qualitative Study

Abstract

Background: Adolescent idiopathic scoliosis (AIS) affects 2%-3% of adolescents, with conservative treatments like bracing and physiotherapeutic scoliosis-specific exercises (PSSEs) recommended for mild to moderate cases. However, patient compliance with these treatments is often low. Digital tools, including smartphone apps and web applications, offer capabilities such as spinal curvature monitoring, remote consultation, and reduction of health care professionals' workload. These tools may also enhance adherence by increasing motivation and providing real-time feedback, which can be particularly beneficial for patients struggling with brace discomfort or self-esteem concerns. Despite these potential benefits, research remains limited on how digital health technologies can specifically enhance conservative AIS treatment and improve patient outcomes.

Objective: This study aimed to explore the perspectives of multiple stakeholders, including patients, caregivers, and health care providers, on using digital health technologies to improve AIS treatment adherence and outcomes.

Methods: This qualitative research study was conducted in Norway and included 17 participants (1 medical doctor, 2 physiotherapists, 8 patients, 4 family caregivers, and 2 IT specialists). The study adhered to Norwegian regulations. After approval from authorities and approval of the study protocol, patients were recruited through the Norwegian Spine and Back Pain Organization. A portion of the sample was recruited through direct communication from one of the researchers. After obtaining written informed consent from all participants, 5 focus group interviews were conducted between April and June 2023. Data were transcribed, translated, and analyzed using a content analysis approach, with findings reviewed by 2 independent researchers for validation.

Results: The content analysis revealed four key themes: (1) AIS-specific education and information, (2) psychosocial support for patients with AIS and community connection, (3) health care communication and access, and (4) treatment adherence to AIS and gamification. Participants highlighted the need for accessible, adolescent-friendly, and multilingual education on AIS; digital platforms for peer support; improved remote communication with health care providers; and gamification elements tailored to AIS challenges (eg, brace compliance tracking, avatar customization for self-expression, and real-time exercise feedback).

Conclusions: Key findings highlighted the need for accessible information, peer support, and better communication with health care providers, with gamification enhancing treatment adherence. The findings of this study show the potential of digital health technologies in AIS management through fostering accessible information, peer support, and improved communication with health care providers. Customized gamification features may further enhance adherence, offering actionable insights for clinical practice and future research.

Keywords: adherence; braces; digital health; focus groups; mobile app; mobile health; monitoring; peer support; scoliosis; telemedicine.

Figure 1

Themes and subthemes that emerged from data analysis, with short descriptions capturing the main concern of each topic. AI: artificial intelligence; AIS: adolescent idiopathic scoliosis; DIPS: Distributed Information and Patient Data System in Hospitals (Distribuert Informasjons- og Pasientdatasystem i Sykehus).