Coping experiences in child and adolescent rehabilitation through a novel device: A multi-method feasibility study

Abstract

Purpose

This study aimed to explore the feasibility and user experience of Grasp, a novel digital tool designed to register coping experiences during paediatric rehabilitation, and to examine perceived impact on reflection and sense of mastery.

Methods

Children and adolescents aged 8–16 years, their parents, and healthcare professionals in paediatric rehabilitation participated. Those participating were instructed to squeeze Grasp when experiencing mastery or coping during activities. Data were visualised and discussed during the end-of-stay summary meeting. A multi-method design was applied, integrating data logs, questionnaires, and semi-structured interviews to capture measurable indicators and in-depth perspectives.

Results

Twenty-three children and adolescents with parents and healthcare professionals were included. Recruitment rate was 100% and retention 96%. All participants used the device and software (median registrations 19, range 4–80). The majority found Grasp easy to use (71%), enjoyable (61%), and motivating (89%). Healthcare professionals reported that data provided valuable insights into children's coping experiences. Interviews identified two main themes: (a) coping registration with Grasp was feasible, and (b) Grasp seemed to facilitate self-efficacy and reflection.

Conclusion

Registering coping experiences through Grasp was feasible and well-received in paediatric rehabilitation. For some, it appeared to strengthen reflection and sense of mastery, potentially enhancing self-efficacy.

Keywords

coping digital innovations motivation in child and adolescent rehabilitation patient reported outcome measures self-efficacy tangible interaction

Introduction

Advances in medical treatment have markedly improved survival rates among children and adolescents with life-threatening or chronic conditions.^1,2 Nevertheless, survivorship during these developmental stages remain associated with elevated risks of premature mortality, long-term morbidity, and diminished health-related quality of life.^3–8 Patients across various disease categories perceive their capability differently compared to healthy peers and exhibit reduced motivation to engage in physical and social challenges.^9–11 Previous or chronic illness can shape body mindset and confidence in one's own capability.^12–16 Holding a more adversary body mindset or having low confidence in personal abilities have been associated with poorer outcomes and reduced physical activity in this group of patients.^13,17–19 As a result, there is widespread consensus that fostering effective coping strategies in these children and adolescents is important for encouraging physical activity and improving long-term life quality.^18,20,21

The degree of confidence in one's own ability to master challenges is described as self-efficacy in Albert Bandura's Social Cognitive Theory – a seminal and extensively replicated framework used for understanding behaviour change within health and social sciences.^22,23 Over the past decades, this theory has informed a large body of research demonstrating that self-efficacy is a key determinant of behaviours, including in paediatric and rehabilitation contexts. High self-efficacy has been shown to be strongly predictive of future performance and accomplishment, also within health promotion.^17,23–25 Four important determinants of self-efficacy have been identified; previous performance experience in similar situations, observation of peers in similar situations, verbal persuasion from others, and the emotional arousal experienced in similar situations (e.g., enthusiasm or anxiety).²² Among children and adolescents, higher self-efficacy has been associated with physical activity and a healthier lifestyle. Interventions to encourage self-efficacy have been shown to increase participation in physical activity.^17,24,25

Novel technological advancements have allowed for development of new systems for symptom tracking and patient feedback. Within paediatric rehabilitation, most existing digital tools and interventions primarily focus on symptom monitoring, physical activity tracking, or delivery of exercise content and adherence support through apps or wearables.^26–28 In contrast, a recently developed device called Grasp offered an opportunity to design an innovative patient-driven feedback system to capture positive experiences and sense of mastery rather than mere symptom tracking.

The Grasp device is a bean-shaped soft silicone unit with an inner sensor that connects to software when squeezed. The design enables users to respond to positive coping experiences by physically squeezing the device. In the current study, the Grasp intervention was implemented in the context of the ‘Life Coping Programme’ (LCP), a comprehensive rehabilitation framework for children and adolescents with a variety of chronic diseases or survivorship.²⁹ Hence, the Grasp intervention was an adjunct to the LCP. No prior paediatric rehabilitation studies enabling children to capture positive coping experiences using a handheld device without requiring screen interaction during use were found. The primary aim of this study was to explore the feasibility and user experience of the Grasp system for registration of coping experiences. A secondary aim was to investigate whether the use of Grasp had a perceived impact on participants’ reflections, motivation, and sense of mastery.

Methods

To explore whether the Grasp system could be employed for registration of coping experiences and the user experience, a single-arm, non-controlled feasibility intervention study was conducted using a multi-method design. The rationale for combining methods was to obtain a more comprehensive understanding of feasibility and user experience than either method alone could provide.

Participants

Children and adolescents aged 8–16 who were scheduled to attend the LCP at Haukeland University Hospital, Bergen, Norway, between May and October 2023, were eligible for inclusion. The LCP was delivered to four patient groups over the course of the study period. Parents of participating children and adolescents and the healthcare professionals involved in the LCP summary meetings were also included to provide perspectives on feasibility and utility.

The LCP

The LCP is a rehabilitation programme for children and adolescents with chronic disease or survivorship, including congenital heart disease, chronic pain, oral cleft, childhood cancer survivorship, prematurity (born before 32 weeks of gestation), or severe burn injuries. The overarching aim is to improve long term health outcomes through empowerment and increased participation of physical activity (ClinicalTrials.gov NCT06709248).²⁹ The LCP is offered as part of standard care to children and adolescents who are considered by their treating physician or multidisciplinary team to benefit from a structured rehabilitation course. Families cannot self-refer. The LCP contains three phases: (1) Introduction (3–5 weeks): Information and screening for activity indicators, individual resources, social relationships, quality of life, and ability of life mastery. The families set desired goals for achievements in the LCP and appoint designated supportive people in the child's environment. (2) Life Coping Course (LCC): A 5-day rehabilitation stay at the hospital's rehabilitation unit and the hospital school. Patients with similar medical backgrounds come in groups of 5–8. They participate in tailored physical activities, schoolwork, social activities, excursions to surrounding nature, group sessions with and without parents, and more. This phase ends with a summary meeting with their physician, physiotherapist, teacher, general practitioner, psychologist, parents, or other appointed resource people. The goal is to evaluate achievement of personal goals and outline strategies for implementation of physical and social activities at home. (3) Implementation: Follow-up consultation after 2–3 weeks on status and identification of needs to commence forward.

The Grasp intervention

The Grasp device and software are manufactured by the Grasp AS company, Norway. Grasp is a soft bean-shaped device containing a force-sensing resistor and a soft silicone inner core and outer layer (Figures 1 and 2 ). When Grasp is squeezed, an output is reported to software via Bluetooth. Eight similar Grasp devices (version Hw1.2,60ShA,00-30,no-fluor) were used during this study.

Figure 1.

The Grasp device with a centimetre ruler.

Figure 2.

The Grasp device in the hand of a 10-year-old male (left) and a 13-year-old female (right).

Figure 3.

Visualisation of the registered coping experiences in the Grasp mobile application. The software visualised a timeline of when and how many squeezes the participating children and adolescents had made during the intervention period. Every squeeze was depicted as a smiley emoji. For the first two Life Coping Courses, the results were additionally illustrated as a cup of soda that gradually was filled during the week; for the last two Life Coping Courses, the illustration was a path up a mountain.

The Grasp device was implemented as an embedded tool within the broader framework of the LCP. On the first day, participating children and adolescents were instructed to use the Grasp device during the 5-day LCC-phase of the rehabilitation programme. The participants got standardised age-appropriate written and oral introduction to the concept: They were encouraged to identify their personal experiences of coping – small or big – and convey them through squeezing the device either concurrently with the feeling or in retrospect (e.g., after activities not allowing for immediate use, such as swimming). To allow for individual variability, the definition of coping and mastery was broad and exemplified as overcoming different barriers, e.g., beginning climbing up a climbing wall, climbing to the top of the wall, or daring to talk to a stranger. Participants had opportunity to ask for clarification if the information given was unclear to them.

The participating children and adolescents were given a personal Grasp device along with a sleeve to carry it hanging around the neck and a belt pouch to have it on the hip. They practised the squeezing procedure, and study personnel verified that the technique was performed adequately.

The software visualised a timeline of when and how many squeezes were made. Every squeeze was depicted as a smiley emoji. For the first two LCCs, the results were additionally illustrated as a cup of soda that gradually filled during the week. For the last two LCCs, the illustration was a path up a mountain (Figure 3). The participating children and adolescents did not see their registrations in the software during the study period, except for at the LCC end-of-stay summary meeting. In this meeting, the experiences of coping obtained in the software were presented on a tablet (provided to the healthcare staff by study personnel) and used as conversation starter and summary of experiences.

Data collection

To evaluate the feasibility and user experience of the Grasp intervention, four domains were assessed: recruitment, retention, adherence, and acceptability (see definitions in data analyses section). Recruitment, retention, and adherence were documented using study and device logs. Acceptability was assessed through both quantitative and qualitative methods. Quantitative data included a purpose-made questionnaire completed by participating children and adolescents, focusing on perceived utility and user experience. In addition, healthcare professionals involved in the summary meeting were invited to complete a questionnaire about their experience of using the Grasp system in conversations with the child or adolescent.

To gain in-depth understanding of acceptability, including user experience and perceived intervention impact, semi-structured interviews were conducted with participating children and adolescents who had completed the intervention and attended the summary meeting. Parents of children younger than 16 years of age were invited to join the interviews. The aim was a total of between 12 and 16 interviews. Thus, all participating children and adolescents from three of the four LCPs in the study were invited. The sample was assessed during recruitment to ensure sufficient variation in sex, age, and diagnosis to provide a sound basis for information power and diversity of perspectives. The interviews were conducted by EØR and LSL. Recorded audios were transcribed verbatim.

Data analyses

Taking a pragmatic stance, a multi-method design was applied, combining quantitative (feasibility metrics and questionnaires) and qualitative (semi-structured interviews) approaches.³⁰ Data from both sources were integrated during interpretation to provide a comprehensive understanding of acceptability, user experience, and potential mechanisms of effect. Findings were compared and interpreted together to identify converging and complementary insights.

Quantitative analyses

Feasibility outcomes were analysed descriptively, as follows: Recruitment was calculated as the proportion of invited participants who consented and were enrolled. Retention was calculated as the proportion of enrolled participants who completed the Grasp intervention. Adherence was assessed by whether participants used the Grasp device during the study period and the visualisation in the software during the end-of-stay summary meeting. These outcomes were summarised as counts and percentages. The total number of coping experiences registered was calculated and reported as median, range, and interquartile range (IQR). Additionally, the mean number of days the device was used during the LCC period was calculated. Acceptability was partly assessed through questionnaires completed by participating children, adolescents, and healthcare professionals. Questionnaire responses were analysed descriptively and reported as the percentage of participants choosing each response option.

Qualitative analyses

Semi-structured interviews were conducted to explore acceptability in depth, including user experience and perceived intervention impact. Analyses of interviews were carried out in collaboration by EØR, ME, and NEH, using the Systematic Text Condensation method.³¹ This is a method for cross-case thematic analysis consisting of four steps: (1) reading the material to get an overall impression and produce preliminary themes; (2) developing code groups from the preliminary themes, and identifying units of meaning that describe the participating children and adolescents’ experience with using the Grasp system, and coding for these; (3) establishing subgroups that exemplify important aspects of each code group, condense the contents of each of them, and identify illustrating quotes; and lastly (4) synthesising the condensates from each code group, presenting a reconceptualised description of each category concerning perceived utility and impact of using the Grasp system. The intervention study was not originally developed with an explicit theoretical framework; however, Albert Bandura's Social Cognitive Theory and specifically his definition of self-efficacy was applied post hoc to support the analysis and interpretation.²² The authors entered this study with preconceptions shaped by professional experiences. Two of the authors are paediatricians working closely with children and adolescents, which gave them some expectations about whether the intervention could mediate a more positive mindset and self-efficacy. Hence, an external researcher, NEH, joined the project during the process of analysis to validate and balance findings.

Results

A total of 23 children and adolescents (11 females) were invited to the intervention study, and all consented to participate, resulting in a recruitment rate of 100%. Among the included children and adolescents, 11 suffered from chronic pain, six had undergone surgery for oral cleft, and six had congenital heart disease. The mean age was 12.1 years (range 9–16 years). Of included children and adolescents, 22 completed the intervention during the LCC, while one dropped out on the final day, yielding a retention rate of 96%. Adherence was high: all participants used the Grasp device during the stay, and all used the visualisation in the software during the end-of-stay evaluation, corresponding to an adherence rate of 100%. The number of coping experiences registered ranged from four to 80 with a median of 19 (IQR 13–27). Of all included children and adolescents, 59% (n = 13) used the device daily. Among the remaining nine participants, the device was used an average of three days during the study period.

Questionnaires

The 22 participating children and adolescents who completed the study intervention also completed the questionnaire regarding use of the Grasp system for registration of coping experiences. The majority of the participating children and adolescents found that the concept was easy to understand (71%), that the Grasp device was enjoyable to use (61%), and that they got some or great motivation from using the Grasp device (89%) (supplementary table 1).

Sixteen healthcare professionals involved in the summary meeting completed the questionnaire on utility of the Grasp system from their professional perspective: physiotherapists, nurses, and psychologists. When asking healthcare professionals about utility, 88% found it very or somewhat useful to be informed about coping experiences through the Grasp software, and 94% found it very or somewhat useful to discuss records with children and adolescents (supplementary table 2).

Analysis of interviews

Out of 16 invited, 15 participated in a semi-structured interview (six females). Of them, 12 were interviewed with one parent present, one with two parents, and two with no parents. The mean age of those interviewed was 12.0 years (range 9–16 years). Through qualitative analysis of the interviews, the following three themes were identified.

Experiencing and understanding the concept

All the participating children and adolescents understood the concept of coping registration with Grasp, and they largely used the device as instructed during activities in the 5-day rehabilitation stay. For example, they squeezed the Grasp device when taking a gondola to a mountain top, when making new friendships, when trying virtual reality headsets, after climbing to the top of a climbing wall despite fear of heights, and after diving to the bottom of the swimming pool. Many described using the Grasp device as a positive experience (e.g., fun, pleasant, and easy to use) and that it connected well to the feeling of mastery. Some reported the concept to be generally all right, although they sometimes were in doubt whether or not to squeeze.

“I actually thought it was really good because it was fun to squeeze it when you felt you mastered something.” (Female #1)

The parents generally supported the overall positive impression of the intervention. A positive synergy between the LCP and the Grasp concept was mentioned:

“The symbiosis or synergy in the setup is really, really nice.” (Parent of male #2)

It was reported as a favourable aspect that the Grasp concept made room for spontaneous reaction on events and feelings. One parent raised a concern about the concept being unrealistic to conduct on the initiative of the child alone, and that children may need support from parents.

Even though the device hung on a cord around the neck or in a belt pouch, many participating children and adolescents forgot to register some coping experiences, especially in the beginning of the LCC. Some squeezed the device in retrospect either during the day or at their room in the evening.

“You had it quite easily accessible, so it was simple to find it if needed.” (Female #3)

“I've forgotten to squeeze it a few times.” (Male #4)

The parents added that the device was difficult to carry during some specific activities, and that it sometimes was difficult to remember using it when stored, for example, in a bag. One parent observed the beneficial aspect that the Grasp device is a physical and visible object, with only one function: to focus on positive outcomes.

“That ball is present and visible, so it's more like a physical thing that doesn’t do anything else; it just registers only the positive."(Parent of male #2)

When asked about the experience of going through the report on a tablet during the summary meeting, many participating children, adolescents and parents thought it was interesting and an educative way to evaluate the LCC. Some children and adolescents described that they got a sense of pride and that the sense of mastery was repeated and confirmed when they saw the coping registration summary.

“Yes, it was really cool to see how many times I had squeezed it and when I had squeezed it. […] I just got this little sense of mastery there, because I had experienced so much accomplishment.” (Male #5)

“A very useful summary - it helped us remember the different parts.” (Parent of male #4)

Facilitating self-efficacy and reflection

The feelings experienced when participating children and adolescents used the device were explored. Many expressed that they did not get any particularly different feeling other than ‘normal’ feelings. Nevertheless, some expressed that the registration procedure with Grasp made them happy and proud, and one participating child experienced a suppression of pain sensation. Having a physical object as a reminder, and doing the physical action of squeezing, helped some participating children and adolescents to connect to their deeper feelings which facilitated knowledge about skills.

“It's easy to be hard on yourself and not acknowledge when you've done something well or achieved something. […] to squeeze when you've done something well, might help to connect with your feelings. Mentally, it helps to be able to see and know that you've done something well. And maybe having something physical to use when you've done something well makes it easier for people to feel a sense of mastery.” (Male #6)

The participating children and adolescents acknowledged that the Grasp concept helped them to remember good experiences and facilitated positive reflections on coping. Some thought that such reflections emphasised the feeling of mastery through increased attention on achievements.

“That way, you might get a bit more of a sense of mastery.” (Male #4)

Many parents noted that Grasp helped their children turn their thoughts away from the negative and towards a more positive mindset, and that the reflections on coping could lead to an awareness that further enhances the feeling of mastery. For many, it led to fruitful conversations between the child and parent about the good experiences. One parent pointed out the intervention's benefit of giving the child a chance to express feelings without the parents asking, thus influencing their answers.

“If you do something that gives you a sense of mastery, and you have that ball, it gives you extra focus on what you’ve managed to achieve. How that could be anything but positive? You end up with a completely different focus on what you're doing.” (Parent of female #7)

It seemed that the Grasp intervention encouraged some participating children and adolescents to take on challenges. While the majority did the same activities as they probably would have done without the intervention, some described a wish for squeezing the device which helped them to seek challenging experiences. In situations when they usually feel uncomfortable, squeezing the device helped them to follow through with activities that felt physically or mentally demanding.

“I thought if I tried new things I would feel accomplishment. Then I could squeeze.” (Male #2)

Ideas for further development

Some participating children, adolescents and parents easily envisioned the Grasp concept being used at home or in school. Others thought it was most relevant in this particular setting of rehabilitation. Many were content with the looks and the features of the Grasp device, yet they had valuable inputs on improvements. Some of these suggestions were a personal mobile application to view trajectories, differentiation of coping experiences in levels, and personalisation of the device with preferred colours and shapes. Some found the device to be too big and difficult to carry along in all situations and suggested that it could be worn on the arm or wrist as a watch. Also, quite a few wished for a software possibility to correct misunderstandings and error squeezes.

Discussion

Registration of coping experiences with the Grasp intervention appeared as a feasible and easily understood concept for children and adolescents in rehabilitation. The Grasp concept facilitated reflections on mastery experiences and helped participating children and adolescents turn towards a more positive mindset. Also, some even became motivated to try new challenges. Especially, having a physical object as a reminder and doing the physical action of squeezing was described as a helpful mediator of positive mastery feelings. Healthcare professionals valued the way the intervention encouraged conversations about coping.

Using a multi-method design allowed combination of quantitative and qualitative findings, offering complementary perspectives on feasibility, acceptability, and potential mechanisms. Qualitative findings helped contextualise quantitative patterns. For instance, occasional forgetting and retrospective logging explained why adherence captured uptake rather than continuous and consistent use; high motivation scores were elaborated by narratives of deliberate challenge-seeking; usability ratings were nuanced by practical barriers and concrete design suggestions; and variation in the number of coping reports did not map directly onto perceived usefulness. For example, one participant who only logged four entries described the device as highly useful, particularly in supporting awareness and control, suggesting that even limited use may yield meaningful benefit.

Looking at the intervention in the perspective of Bandura's definition of self-efficacy,²² findings of this study suggest that registration of coping experiences through the Grasp device enhance awareness of an ability to accomplish challenges. It may also emphasise a positive emotional arousal towards experiences by focusing solely on positive – and not negative – emotions in response to challenges. Both these effects of the intervention can be anticipated to enhance self-efficacy. Bandura emphasises that “efficacy beliefs are the foundation of personal agency” and that this is especially fostered through reflective self-consciousness.^22,32 Hence, looking upon the Grasp intervention in the light of a self-efficacy perspective could give explanations to the effects described by participants in this study (Figure 4).

Figure 4.

Logic model illustrating the Grasp intervention embedded in the Life Coping Programme (LCP). The model outlines key components from inputs and activities to outputs, short-term outcomes, and anticipated possible long-term impact.

Previous studies among children and adolescents have found associations between self-efficacy and higher levels of physical activity and healthier lifestyle.^17,24,25 Also, interventions to encourage self-efficacy have been shown to increase physical activity levels.^24,33 Taken together, these findings seem to support the relevance of interventions like the Grasp in paediatric rehabilitation, consistent with contemporary evidence on self-efficacy-enhancing interventions. On the other hand, previous studies have also found that children's self-efficacy can be increased by enrolling in physical activity programmes.³⁴ Both findings suggest a connection between two variables: self-efficacy and a health-promoting lifestyle, while also leaving a question about which is the more dependent variable. Various interventions, including rehabilitation programmes, have shown positive impacts on physical activity levels and psychosocial well-being.^21,35,36 It is important to note that the Grasp intervention was integrated into the LCP rather than tested as a stand-alone intervention. Therefore, observed effects likely reflect a synergistic influence of the LCP framework and the Grasp tool combined. Some study participants pointed to this synergistic effect by outlining that the intervention fitted well into the LCP, adding a sense of mastery that truly was the intention of the LCP as well as the Grasp intervention. Bandura points out the conjoint impact of factors on efficacy beliefs being greater than simply their additive effect.²² Hence, the LCP and the Grasp intervention may work in concert to enhance self-efficacy.

In recent years, diverse digital solutions for health monitoring and interventions have evolved.³⁷ The Grasp concept used and possible effect mechanisms found through this study were relatively simple and come down to this: Feel, reflect, squeeze, remember – and reflect again. The simplicity may be both a strength and a limitation; it may be easier to comply with than other smartphone or digital interventions, but it also introduces a risk of reducing complex feelings too much with little opportunity to correct misunderstandings or error squeezes. A recent meta-analysis on digital interventions found medium to large effect sizes on inducing positive coping and body mindsets among children and adolescents.³⁷ Also, health game and mobile health interventions may add positive effects on children's physical activity self-efficacy.^38,39 These findings seem to support the current study's results. However, no studies were found exploring a handheld device used to capture concurrent coping experiences neither in the setting of paediatric rehabilitation or other rehabilitation settings. The novelty of Grasp lies in its tangible design and its focus on positive coping experiences, contrasting with the predominantly app-based solutions that track symptoms or activity levels.^26–28

In this study, the intervention was used only in children and adolescents who were chronically ill or survivors of severe disease. However, many children in general do not meet recommendations for daily physical activity,^40,41 implying that concepts like this intervention may be beneficial for a larger population. Providing children and adolescents with a tool to register feelings and convey them directly to healthcare professionals without involving parents may be valuable for empowering children and acknowledge their voices. In many clinical settings involving children, assessments and decisions are made based upon parents’ and clinicians’ perceptions of the children. This intervention may facilitate a more direct conversation between children and clinicians, which can improve assessment and motivate children's involvement in conversations and thus enhance commitment to treatment plans.

The success of implementation of innovations into clinical practice is highly dependent on the engagement of healthcare professionals using them.⁴² In the questionnaire, the responses of healthcare professionals revealed a higher degree of enthusiasm than expected. The findings may be influenced by an overall positive attitude of healthcare professionals involved in the LCP, but still, these findings may point towards this innovation being feasible to implement. However, the healthcare professionals’ ability to use the system independently was not assessed. Study personnel handled setup and device distribution, and provided a tablet with the system ready for use. Although this may have simplified the process, the procedures are considered realistic and not particularly time-consuming in routine practice.

Limitations

The study had several limitations. Firstly, incorporating the intervention into a comprehensive rehabilitation programme may have had a synergistic effect on the participants’ views on the intervention and its effects. The absence of a control group in this initial study limits the ability to determine the added effect of the Grasp intervention. Consequently, findings should be interpreted as exploratory and potentially influenced by the broader LCP framework. Secondly, the intervention was tried in a particular setting and explored through qualitative methods and questionnaires among a limited number of participants. Confirmation of findings in different settings and larger populations, and through quantitative methods is needed. Thirdly, the questionnaires were purpose-made and not validated. In future studies, validated psychometric instruments (e.g., for measuring self-efficacy) should be employed. Fourthly, the range of ages demonstrated limitations with younger patients having less complex reflections when expressing thoughts on the use of the device. Also, the parents being present during interviews may have biased children's answers in a more positive direction than elsewise. Fifthly, some authors who contributed to the conceptual development of using Grasp for coping registration also conducted interviews and participated in the analyses, which may have introduced bias and affected internal validity. The introduction of an external researcher (NEH) may have mitigated this risk of biased preconceptions. None of the authors had any financial interest in the Grasp AS company. Never having tested the intervention previously, it is believed that study professionals did not have strong expectations on findings that significantly biased the interview techniques. Participants in the study - children, parents, and healthcare professionals - were only briefly introduced to the procedure and not informed of any expected effects. Despite these limitations, the findings provide direct insight from chronically ill children and adolescents into how they engage with a feedback system for coping experiences, and demonstrate its potential to foster reflection, enhance self-efficacy, and encourage attempts at new challenges.

Conclusions

Registration of coping experiences through the Grasp system seemed feasible for children and adolescents in rehabilitation for chronic or severe illness. For some of those participating, the Grasp concept appeared to facilitate reflection, strengthen self-efficacy, and encourage taking on new challenges. Healthcare professionals found the system of value to gain insight into the children and adolescents’ experiences and as a conversation facilitator. Future research should examine effectiveness in larger and more diverse populations, long-term impact on self-efficacy and health behaviours, and strategies for integration into routine practice and in-home or school settings.

Supplemental Material

sj-docx-1-prm-10.1177_18758894261424016 - Supplemental material for Coping experiences in child and adolescent rehabilitation through a novel device: A multi-method feasibility study

Supplemental material, sj-docx-1-prm-10.1177_18758894261424016 for Coping experiences in child and adolescent rehabilitation through a novel device: A multi-method feasibility study by Elisabeth Ørskov Rotevatn, Nina Elisabeth Hjorth, Emilie Stensaker Paz, Louise Sandal Løkeland, Frode Guribye, Lars Jørgen Rygh and Mette Engan in Journal of Pediatric Rehabilitation Medicine

Supplemental Material

sj-docx-2-prm-10.1177_18758894261424016 - Supplemental material for Coping experiences in child and adolescent rehabilitation through a novel device: A multi-method feasibility study

Supplemental material, sj-docx-2-prm-10.1177_18758894261424016 for Coping experiences in child and adolescent rehabilitation through a novel device: A multi-method feasibility study by Elisabeth Ørskov Rotevatn, Nina Elisabeth Hjorth, Emilie Stensaker Paz, Louise Sandal Løkeland, Frode Guribye, Lars Jørgen Rygh and Mette Engan in Journal of Pediatric Rehabilitation Medicine

Footnotes

Acknowledgements

We thank all participating children, adolescents, parents, and clinicians for enrolling in this intervention study. Also, we thank the leaders of Energisenteret for the opportunity to conduct this study and offering implementation of the Grasp system into the LCP.

ORCID iDs

Elisabeth Ørskov Rotevatn

Nina Elisabeth Hjorth

Louise Sandal Løkeland

Frode Guribye

Lars Jørgen Rygh

Mette Engan

Author contributions

Elisabeth Ørskov Rotevatn: Conceptualization; methodology; patient screening and enrolment; data collection; formal analysis; writing – original draft. Nina Elisabeth Hjorth: Methodology; formal analysis; supervision; writing - review and editing. Emilie Stensaker Paz: Patient screening and enrolment; data collection; writing – review and editing. Louise Sandal Løkeland: Data collection; formal analysis; writing – review and editing. Frode Guribye: Conceptualization; formal analysis; writing – review and editing. Lars Jørgen Rygh: Supervision; writing – review and editing. Mette Engan: Conceptualization; formal analysis; supervision; writing – review and editing.

Funding

The authors disclosed receipt of the following financial support for the research, authorship and/or publication of this article: The study was financed through a grant from the Norwegian Research Council that covered the research expenses and the Grasp AS company's expenses for supplying the Grasp units and software development for the study. Norges Forskningsråd, (grant number Pilot Helse).

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Supplemental material

Supplemental material for this article is available online.

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