Stefan Elbers

207 General discussion workbook in the context of IMPT programmes were interviewed to discuss its feasibility. The ‘insight cards’ intervention was found easy to learn and apply in a clinical context, and was expected to benefit all patients. The concept of value-based goals was more difficult for patients to understand and did not always fit into the treatment programme. Important lessons learned included patients’ preference for a digital version of the interventions, and the recommendation to improve alignment between the intervention content and existing treatment activities, for example, by rethinking the goal-setting procedure. A major caveat in this study was the limited sample size. We believe that this was due to the absence of clear instructions on when and how to use the workbook and the organizational changes of one of the participating treatment teams during the feasibility study. We therefore made several adjustments to the prototype in a subsequent field test that was performed in the context of a master’s thesis (Wittkämper, 2018). These adjustments included a modified value-based goal-setting procedure, a more extensive training session for health care providers, and a brief treatment manual for health care professionals on how and when to use the workbook. Although the results of this intermediate step are not included in any of the previous chapters, the modifications were incorporated in the prototype workbook and further refined in the design of the mHealth application and the RCT protocol. In the final phase of this project, we performed a new development iteration to transform the workbook into an mHealth application. We used think-aloud procedures, co-creation sessions and digital mock-ups to integrate stakeholder input. The intervention components from the paper prototype were enhanced with additional features, such as the possibility of adding photos to the insight cards and creating calendar reminders for activities within the value-based goal-setting procedure. We also added a new educational module to the application, providing the opportunity for each treatment teamto add educational materials or video clips. To evaluate the effectiveness, efficiency and usability of the intervention, we developed a trial protocol (outlined in Chapter 7 ) . IMPLICATIONS FOR CLINICAL PRACTICE IMPT Practice Taken together, these findings provide several directions for clinical practice. First, this project is an example of how behaviour change strategies can be combined with IMPT programmes. This development direction helps to broaden the scope of treatment beyond achieving optimal functioning, towards maintaining positive treatment gains over time, in line with the WHO concept of rehabilitation (OECD et al., 2017). Importantly, the health psychology models that we used during the intervention development for deriving behaviour change principles can also help to further support behaviour change in current