Stefan Elbers

215 General discussion The AGRIPPA Application In Chapter 7, we discussed the main deliverable of the second aim of this project: a first version of the AGRIPPA mHealth application. Although this application is currently only accessible for treatment facilities that are participating in the trial where its additional value is being assessed, it is possible to distribute the application further across multiple facilities. New partners can be provided with access to a personal back-end environment where they have the ability to set up their own education module for their patients, with texts, video clips or links to websites. Importantly, the developers have taken the possibility of including additional languages, facilitating potential future endeavours in other countries and increasing the accessibility of the app to non-native Dutch speakers in the Netherlands. Specific valorization and dissemination strategies are currently being discussed in the AGRIPPA consortium. Other potential development ideas include the incorporation of EMA, which is increasingly provided through smartphones (Doherty et al., 2020; Shiffman et al., 2008). For patients with chronic pain, this could help in obtaining a complete and accurate insight into the impact of pain in their personal lives (May et al., 2018). Furthermore, the inclusion of options for communicating with the treatment team to facilitate a form of blended care could enhance the application. This facilitates the possibility of tailoring IMPT treatments in more flexible and efficient ways as regards the needs of patients in terms of time and place. Integration of all these services into one platform would help to bring all information sources together, which is likely to improve usability. Another possible direction is to explore the potential of the application in other domains. The value-based goals module and the insight cards are not specific to pain rehabilitation and could be adapted to support self-regulation for a range of chronic conditions. Value-based goal-setting has even been successfully tested in high schools (Chase et al., 2013), indicating the wide potential of these instruments. Towards an Integrative Model of Clinical Reasoning and Behaviour Change During the development of our intervention, we used the persuasive-by-design model to explore barriers and facilitators for maintenance of treatment gains. This model was originally created to help design professionals with no expertise in behaviour change to design evidence-based health interventions (Hermsen et al., 2014). The model includes five different perspectives or ‘behavioural lenses’ that each highlight a different aspect of behaviour regulation (e.g., habits and impulses). Any target behaviour can be evaluated through each ‘lens’ to identify potential barriers or facilitators for effective regulation. Although we used this model to develop generic interventions that could benefit all patients, we believe that it has the potential to assist health care professionals in developing maintenance strategies for individual patients. This corresponds to the recommendations