Chronic pain affects over a quarter of the workforce with high economic burden for individuals, employers and healthcare services. Providing education and advice to people with chronic pain about self-management strategies is recommended within clinical guidelines for chronic pain management. The Pain-at-Work Toolkit (PAW) is a digital intervention developed to support people with chronic pain in the workplace. In a series of mixed-methods studies and public involvement activity, we established proof-of-concept for the PAW toolkit and the subsequent trial processes.

This was achieved in multiple stages over 4 years:
(a) ‘Intervention need’ was established through a systematic review (8 studies, 1522 participants) identifying that there were no existing digital interventions providing education or advice on work-related adjustments or support, and no existing trials including work-related outcomes, despite the known impact of pain on work and work on health;
(b) ‘Theory of change’ for the PAW toolkit was established through stakeholder consultation (n=27);
(c) ‘Content and technical co-creation’ for the PAW toolkit occurred through a stakeholder consultation workshop (n=27), employer survey (n=107), employee survey (n=274), and an expert peer review panel (n=40).
(d) ‘Prototype development’ led to a digital toolkit providing education, signposting and support, which is theoretically informed, drawing on pedagogic theory, persuasive systems design, and behaviour change theories;
(e) ‘Prototype evaluation’ involved completion of an online evaluation survey by employees with chronic pain (n=104) and expert reviewers (n=15) who had used the toolkit. Qualitative interviews were undertaken with a sub-sample of these toolkit users (n=15). Mapped to the Technology Acceptance Model, evaluation demonstrated new learning, content relevance, perceived usefulness, perceived ease of use, positive attitudes towards the toolkit, behavioural intention to use it, and actual usage in the workplace setting;
(f) ‘Toolkit review and update’ then occurred to make changes suggested during evaluation, to confirm relevance of the toolkit post-COVID-19 pandemic, and prepare the toolkit for feasibility testing. This involved a concept mapping exercise that took place within an educational event (Masterclass on ‘Work and Health’, n=20), and expert peer review of the final version (n=5);
(g) ‘Public contribution to trial design’ (n=20) engaged potential users and stakeholders in the design of a cluster randomised feasibility trial to explore feasibility and acceptability of the toolkit and research processes in workplaces of different types, sizes and sectors.
(h) ‘Proof of concept’ was established through high interest in the trial, in which we significantly exceeded recruitment targets, for participating organisations (n=18/12, 50% over target) and employees (n=380/120, 217% over target).

Keywords: Technology, Digital Health, Chronic Pain, Workforce, Toolkit, Development, Education, Support, Feasibility Trial, Public Involvement, Stakeholders, Proof-of-Concept.