Abstract:

Low back pain (LBP) is now the leading cause of disability globally. In Denmark, 20% of sick leave is due to LBP and 10% of all general practitioners consultations are due to back pain problems. In Denmark, LBP is common, especially among ethnic minorities. Fifty percent of the Middle East ethnic minority groups suffer from three or more diseases, where LBP is the primary complaint. The incidence of Low Back Pain (LBP) is 40 % higher compared to the Danish majority population. Diagnosis and treatment of LBP requires close cooperation between the patient and the health practitioner thus communication and mutual perception of LBP are essential. Language barriers may therefore be a challenge for both. Health professionals call for new innovative health technology solutions to address this complex issue.
Health related applications for smart phones are developing fast. However, ethnic minority groups with complex bio-psycho-social issues have not been included in this development.
This study aims to fill that gap by describing a conceptual design of a mobile LBP application (app). This app is designed to target patients, who primarily speaks Arabic and who suffer from non-specific LBP. The app aims to encourage increased health literacy and self-management after the patients have been diagnosed with non-specific LBP by a health professional.

Design:
Participatory Design (PD) methods have been modified to use in an online Facebook-platform.

Population:
Primary: People who’s first language is Arabic and how suffer from LBP.
Secondary: Health care professionals specialized and experienced in diagnosis and treatment of LBP.

Method:
4 weeks process of co-design of Participatory Design (PD) methods have been modified to use in an online Facebook-platform. People form the Arabic Community in Denmark suffering LBP have been invited to participate in a 4 weeks process of co-design at SP يINE
Facebook-group developed for the purpose of the study.
Interviews with general-practitioner (GP), rheumatologist and physiotherapists specialized and experienced in diagnosis and treatment of LBP have been interviewed about the problem arena and based on own experience they have been giving their recommendations for content in a mobile back-app.

Discussion:
Between 7 -12 people have participated in each of the 4 weeks with participatory design-questions. They have participated by answering the questions and giving their feedback.
The participants have primarily been younger well-educated men living in the Middle East and in Denmark
An advantage of the PD process is the break down of the language barrier by translating Arabic into

Results:
The participants find it more helpful to use small videos and educational illustrations instead of a written test. The participants highlight the need for a specific biomechanical diagnosis confirmed by MRI or X-ray as a premise for feeling less anxious about their back pain. The health care professionals recommend patient information that focus on understanding the complexity of pain to increase the understanding of having LBP and how to self-manage by staying physically active.
The PD methods show that the participants in the SP يINE Facebook-group are at least as
interested in the appearance and usability of the back-app as in the content.
In relation to language barriers between Arabic and Danish it has been an advantage to use Facebook as a platform. Translating the written Arabic to Danish and responding back into Arabic is an asynchronous act that mimics normal asynchronous communication on Facebook.

Conclusion:
Further studies are needed to develop functioning methods for PD activities for ethnic minorities. This would add positively to the developing patient related m-Health technology.