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Using Intervention Mapping to Develop a Novel Pain Self-Management Intervention for People with Cirrhosis

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Abstract

Background

Chronic pain is common among patients with cirrhosis and is challenging to treat. While promising, pain self-management (PSM) interventions have not been tailored to this population’s needs.

Aims

To design a PSM intervention for patients with cirrhosis.

Methods

Semi-structured interviews with 17 patients with cirrhosis, 12 hepatologists, and 6 administrators from two medical centers were conducted to inform a rigorous, structured intervention mapping (IM) process. Qualitative content analysis was guided by social cognitive theory (SCT) and the Consolidated Framework for Implementation Research (CFIR) and incorporated into intervention development. A planning group met regularly throughout the intervention, to reach consensus about how to use data and theory to develop the intervention through IM.

Results

Participants described barriers to PSM behaviors, including the absence of simple, evidence-based interventions for pain for patients with cirrhosis, inadequate provider knowledge, time, and training, and lack of champions, funding, and communication. Patients described high motivation to treat pain using behavioral methods including meditation, prayer, and exercise. The intervention was designed to address barriers to PSM behaviors for patients with cirrhosis, using behavior change methods that address knowledge, self-efficacy, and outcome expectations. The LEAP (Liver Education About Pain) intervention is a 12-week, modular intervention delivered by phone via individual and group sessions with a health coach.

Conclusions

People with cirrhosis, hepatologists, and administrators informed this theory-driven, tailored PSM intervention, which was designed to be implementable in the real world.

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Acknowledgments

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health, Department of Veterans Affairs, or the Government of the United States. We would like to thank the members of our planning group for their help and expertise.

Funding

This study was funded by AHRQ K12HS019461 and NIDA K23DA048182.

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Authors and Affiliations

  1. Department of Medicine, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Shari S. Rogal, Sandra Gibson, Stephanie Hoyt-Trapp, Naudia L. Jonassaint, Jane M. Liebschutz, Kevin L. Kraemer & Jessica Merlin

  2. Department of Surgery, University of Pittsburgh, Pittsburgh, PA, 15213, USA

    Shari S. Rogal & Naudia L. Jonassaint

  3. Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA, 15240, USA

    Shari S. Rogal, Matthew J. Chinman, Sandra Gibson & Gloria J. Klima

  4. RAND Corporation, Pittsburgh, PA, 15213, USA

    Matthew J. Chinman

  5. Virginia Mason Franciscan Health, Bonney Lake, WA, 98391, USA

    William DeMonte

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  1. Shari S. Rogal
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  2. Matthew J. Chinman
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  3. William DeMonte
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  4. Sandra Gibson
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  7. Naudia L. Jonassaint
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  8. Jane M. Liebschutz
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  10. Jessica Merlin
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Corresponding author

Correspondence to Shari S. Rogal.

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Rogal, S.S., Chinman, M.J., DeMonte, W. et al. Using Intervention Mapping to Develop a Novel Pain Self-Management Intervention for People with Cirrhosis. Dig Dis Sci 67, 5063–5078 (2022). https://doi.org/10.1007/s10620-022-07380-4

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  • DOI: https://doi.org/10.1007/s10620-022-07380-4

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