Stefan Elbers

212 Chapter 8 solely on educational self-management interventions. To understand these differences and to provide more clarity on what constitutes self-management, a concept analysis was recently published (Van de Velde et al., 2019). These authors reviewed self-management studies, identifying 10 different attributes considered to be unequivocal features of self- management. The eligibility criteria for our systematic review correspond to some of these attributes, explicitly emphasizing active participation (Attribute 1) and personal skills training (Attribute 9). One difference of our study compared to the concept analysis of Van de Velde and colleagues was that we excluded studies focusing on training disease- specific skills, while they considered medical management (Attribute 10.1) to be a part of self-management. For both primary intervention studies and systematic reviews, these attributes will help clarify which specific types of interventions are included. Two systematic reviews investigated self-management using eHealth applications. Du and colleagues (2020) analysed the short-term effects on pain intensity and disability of eight RCTs that included eHealth self-management interventions for patients with low back pain. At short-term follow-up, they reported moderate quality evidence for a positive effect on pain intensity and low quality evidence for no effect on disability. Unfortunately, none of the included studies reported long-term outcomes. Devan and colleagues (2019) systematically assessed 19 e-health applications designed to facilitate self-management support for patients with chronic pain, mapping the included mechanisms and intervention content. Similar to the results of our review, the content of the interventions greatly varied, suggesting different theories of the concept of self-management. Their analysis also indicated that none of the self-management applications had been tested in patients with pain and only a few offered the possibility of individual goal-setting. Given the importance of goal-setting and self-regulation in the context of self-managing a chronic condition (de Ridder et al., 2008; Van De Velde et al., 2019), this suggests that the workbook and mHealth application that we developed in this project address an important gap. 3. Co-Design By adopting co-designmethods, we aimed to involve and empower patients and healthacare providers throughout all stages of the intervention development project. This ambition is in line with current trends of increased public involvement in scientific research, such as the opportunity for the public to shape the Dutch National Research Agenda (NWO, 2021) or guidelines for involving citizens in research projects (Hickey et al., 2018). Williams and colleagues (2020) outline two different types of rationales for public participation in health research. First, a democratic rationale relates to the idea that allocating scarce public resources to clinical research will always result in some form of prioritization. To determine these