Table 4.

Themes, sub-themes, and exemplary quotes

Sub-theme	Exemplary quote
Theme 1: Easy to understand and following
Clearly explained	Bob “it made sense, you know I must say the whole program was very good in explaining the whys and [what] fors…I think the whole program is very well set up and it certainly does, I mean it teaches you the skills and then through the follow ups and the program right through to the end, just keeps reinforcing what you need to do to improve it. I thought it was very good.” John “The introductory section about, you know, pain and how its transmitted to the brain…It sort of did it in a very basic way. It wasn’t really complicated in terms of the, the human anatomy but and how that works but I thought that was really useful” Sandra “It was very well explained and put together and I found it easy…you understood exactly what was meant with the exercises”
Presented well	Alice “I found that I really liked the way the lady talked. I really, really did. I liked her accent and I liked the way she explained things…I just liked the way that she worded it. It wasn’t over long that what she was trying to tell you. She was very clear about what she was saying.” Olivia “I think [the presenter] was excellent she was very good, she was very straight forward with what she said. Everything was very easy to follow.” Jane “listening to the presenter, she’s really good the way they put that presenter on and her voice and everything is all very calming and enlightening. I find that very helpful” Adam “the dialogue … Just the ease of kind of it didn’t actually sound very clinical at all. It sounded very basic, very generic, very user adaptable and easy to understand and quite relevant”
Theme 2: Better able to cope with pain
Controlling pain	Sandra “I have I think learnt from [the online PCST program] that you can actually ride the pain out as it where, you can actually deal with it, whereas, before that it was always you were scared of pain because you thought you couldn’t deal with it but now I know you can actually deal with it in some way, you have some control. I mean you can’t get rid of it but you can deal with it” Caroline “I learnt so much…the pain - I can control it. I know I can control it. It’s also taught me to control my mental side of the pain, which has been huge…It put me in control. It put me in the driver’s seat” Olivia “I can control the pain a bit more… A few minutes to sit down and stop and do one of the practices for the [online PCST program] just changes things for you… they’re very positive thing to get me through the days”
Helping relax	Jane “[progressive relaxation] is particularly helpful and I was able even to drop off sometimes during it, it was really calming and soothing and it really helps you relax. I found it very, very good.” Andrew “I used to like doing pleasant imagery distractions where you can go and relax and just go and pretend you’re somewhere else…you could sit back and just with the progressive relaxation you just sit back and listen to your body and really focus in on to the part that was on your knee that was annoying you” John “the relaxation techniques were really good, not just for pain, but it’s just to - to get you back down into a calm state. I really enjoyed that. I really, I really thought that was really good”
Pacing self	Adam “the other things that I kind of fully got out of the [online PCST program] was also spacing out jobs and actually taking a break every so often…[normally] I’ll just keep on going until I collapse…[now] I’ll spend an hour doing work or whatever and then I will actually have a, you know, a ten minute cut off break or whatever.” Sandra “I think the one about pacing yourself was really good. I thought that stood out for me in my daily life because I wasn’t doing that before…saying “I can do that later, my knee is now bad I’m going to sit down and do that later” or give myself a break for 10 minutes and then keep going” Caroline “my biggest thing is that the work-rest cycle – I can plan, and I now know that if I need to do something, I can do it, but I just break it down into smaller amounts…I will rest it, and then I’ll go back and I’ll go back to where I need to be and do things in smaller amounts.”
Incorporating skills into exercise program	Bob “if you’re doing the exercises, you start to get pain or whatever, you can stop and take a few deep breaths and sort of re-focus before you get back to it…taking a break, a rest cycle, doing some of the other stuff, the pleasant imagery or whatever to help them get through the exercise program.” Jane “it was helpful when you’re doing the exercises because you might, when you’re feeling in pain you can go to your [online PCST program] and learn how to cope with that and do your relaxation techniques as well to help you if you’re feeling any pain from your exercises or from what you’re doing around the house. So it is helpful to have them in conjunction”
Theme 3: Anonymity and flexibility
No judgement by a clinician	Alice “if I didn’t understand something I could just replay it without feeling like I was a ditz…You haven’t got anybody judging you. I like that. I like the fact that you know sometimes I didn’t do a really good job that week for one reason or another but I was never judged. So you don’t have that person looking at you. I loved it.” Jane “I liked the presenter even though she wasn’t there with me…sometimes [a clinician] might be a bit smart, they’re very knowledgeable and they are making out they are so you might be thinking well they’re a bit smart sort of thing so you don’t feel as comfortable with them. So it was good on the computer the way that woman presented herself.”
Work at own pace	Sandra “It’s just something you can go back anytime you want to, you can think “oh, what did they mean with that” and you go back and you just see it again. If you’re talking to someone in an office you can’t go back and say “what did you mean by that?”, you know what I mean? It was for me it was perfect” Jane “on the computer being able to go in there and be able to replay if you wanted to listen to the segment over and over again. I thought that was very helpful as a lot of us tend to forget very easily and I find it’s better, myself, to see it on the computer like that, interact with it”
Accessibility	Andrew “you could do it at your time when you had the time…if you didn’t feel like doing it today you do it tomorrow or something. If you only want to do half of it you could do half of it and go back another day” Sandra “I liked the fact that I could do it in my own time when I was ready to do it and when I really needed it. I didn’t have to worry about going somewhere having appointments.” Adam “The fact that you can just access it at any point in time. It was online like, you know, there were a few times when I did it while my son was doing soccer training in the evenings and there were a view times like on a Sunday morning when I just sort of log in quietly while I was chilling up in bed and I’d watch it.”
Theme 4: Not always relatable or engaging
Some techniques not useful	Melanie “if you were able to pull off and say look, I like the look of this technique and that one and so customise the delivery a bit. I think that probably would have been better for me…you get to a point and you go I can’t be bothered. I’m not finding the benefit that it’s asking me to do. Not the [techniques] I felt comfortable with, it asked me to do those other ones and I was thinking “I don’t want to do that”; sit there and think about being on a beach. I don’t want to think about that” Lauren “[the online PCST program] wasn’t my cup of tea, so to speak, that’s all, and sure, it might help for some people but, you know - like on some of the tapings on there, you know, I'm sure maybe it helped some people but I don't know, I didn’t find it all that beneficial” John “the pleasant activity scheduling and all that sort of stuff, you’ve really got to try and, you know, program something in your life, get some spare time in your life to do all of that. So that’s a little more difficult to do and as I said before I didn’t really think that that added much value to me personally”
Americanisation of the program	Andrew “the only thing I didn’t like the American accent…get rid of those American accents” Olivia “I don’t particularly like the Americanisation it was very American…it would be a problem for some people I think… it would be better with a program more based in Australia” Melanie “I think the American accents with the American examples, if there is any way you can get an Australian example or Australian presenters to do it, I think that would work.”
Character examples were annoying	Sandra “These people that come on and say what their experiences were like, I find them the least useful… it’s almost was to me as if I was doing the [online PCST training] and I was right into it and then these people come on and it’s like, “oh God, okay, I’ll listen to you because I have to but I don’t really want to”. I was on a roll as it were and I thought “oh, well, now here they go, yes, I know, I know”.” Caroline “[the character examples] felt like they were actors. They weren’t real people. So, I turned off pretty quick…if I could have skipped past that, possibly yeah, that would have been – maybe not more helpful, because everything that I was doing I was finding helpful – but for me, personally, I didn’t find that necessary” John “The ‘next’ button very important for people who don’t want to listen to that through the [character] examples in particular because I didn’t really think the examples were much good either way. They sounded fake to me, you know, they sounded like they were scripted”
Time consuming and slow paced	Lauren “I don't know, maybe it was a bit too time consuming for me…it took a heck of a lot of time, for me, and, like I said, some days I just couldn’t do it” Melanie “I thought “yes, yes, yes, I got what you’re trying to get me to do but do I have to listen to all of this?” You can’t skip ahead and move on. You’re forced to sit there and listen to it all as well” Sandra “I think it was a little bit longwinded…to me it was almost like, “oh, come on get on with it”. For me personally it was too slow, I know that some other people who are elderly and have these problems and whatever probably need the slowness of it, but to me it was almost a bit longwinded.” John “It was a bit drawn out with some of the examples. So, you know, you sort of like - it was a bit slow paced I guess, … “yeah I did this, yes keep going, hurry up”.”
Theme 5: Support from clinician desirable
Follow-up from a clinician would be beneficial	Bob “I guess maybe some follow up would be beneficial. There are times when you sort of, you experience kind of mini break throughs, where you thought this is terrific, I feel great and you want to share that in a way… as a telephone call or whatever, just to touch base and assess you know how the person’s going and how they’re coping” Caroline “maybe once a week if someone could just touch base and just say, are you okay? Because sometimes, if people aren’t coping well, it is difficult to take that step to pick up the phone to ring. But if someone rings you, it can make a big difference” Olivia “when I was seeing the physiotherapist every couple of weeks or whatever that was good because that gave added support to the [PCST program]… being able to speak to someone would be an advantage rather than just having something online even if you speak to someone about the pain that say it face to face even on Skype would be good rather than just an animated character”
Worked in tandem with physiotherapist-prescribed exercise	Sandra “it was like a whole package and I really thought that was really good. If I would have had the physio and then the [online PCST program] or the other way round I don’t think it would have worked so well….it’s like a tandem thing, like a thing that works together” Caroline “[the online PCST plus the physio consults] incorporated it into a whole program…doing physio with the rest of the [online PCST program], I think it’s needed as a whole package. One without the other wouldn’t have worked” John “the physio was all about building up your muscle strength around your knees and your back and the [online PCST program] was all about training your mind to manage the pain. So I think they were linked, I think it’s good that they were linked together. Doing it one, just doing one and not the other probably lessens the impact of the outcomes I guess. So, you know, the outcomes were, I think anyway, the outcome for me was more enhanced because I did both together” Melanie “I think having the physio well and truly aware of what stage a person should be at within the Pain Coach, it actually helps reinforce it rather than have it presented as two separate things.”
Desire referral to the program by trusted source	Sandra “I think it’s probably best if you get given [referral to the online PCST program] by a health professional because overall I think a lot of people don’t use computers very much in that sense, they don’t go and Google it… the doctor can say “look, there is this program” and I’m sure people would access it.” Olivia “if a health professional referred you there maybe you’re more inclined to take notice of it. Then an arthritis website you’re more inclined to take notice of it.” John “if a health professional told me to do something, I know that the health professional is saying you need to do this because its going be beneficial to you. So I think you get more impact from a health professional telling you to do that or suggesting that as part of your treatment”