Barriers and Facilitators for Implementing Resilience Coaching for Youth With Chronic Musculoskeletal Pain: Pediatric Rheumatologists' Perspectives.

Abstract

Promoting Resilience in Stress Management (PRISM) is a resilience coaching program designed for adolescents with chronic illness. We aimed to examine the perceived feasibility, acceptability, and appropriateness of PRISM among pediatric rheumatologists treating adolescents with chronic musculoskeletal pain and obtain recommendations for improvement to inform future implementation efforts. We performed semistructured interviews with pediatric rheumatologists across several US institutions. Interviews were audio recorded and transcribed verbatim. Hybrid inductive-deductive coding was employed to capture emergent themes, guided by the Consolidated Framework for Implementation Research 2.0, and develop the codebook. We performed double coding for 20% (n = 2) of the transcriptions to develop the codebook and ensure interrater reliability. Ten pediatric rheumatologists were interviewed, and feedback on PRISM was uniformly positive in terms of perceived clinical value and favorability for local implementation. Perceived facilitators included PRISM's brevity, remote delivery, and the potential for a peer group session. Finding the funding and having enough staff for such a program as well as the concerns around competing demands and building PRISM into adolescents' busy schedules were the primary perceived barriers for implementation. Pediatric rheumatologists report that PRISM would be valuable and of interest to their patients with chronic musculoskeletal pain, and the resilience coaching program could be further augmented by the addition of a peer support component. Implementation strategies are needed to support program costs and staffing to effectively deliver and sustain the program.