749: Multiphase study protocol for a digital tool supporting pain communication with deaf patients

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Other chronic pain category, Psychology

Background and Aims: Pain is a leading reason for seeking medical care worldwide1, yet access to adequate assessment and management remains uneven, particularly for deaf patients2. Evidence shows that deaf individuals face increased risks of misdiagnosis, inadequate treatment, and poorer health outcomes3,4 — disparities further exacerbated in chronic pain, a complex condition affecting over 30% of people worldwide5. Pain communication remains a central challenge for both deaf patients and clinicians, directly shaping assessment, clinical decision-making, and care quality6. In this context, digital health technologies offer significant—yet underexplored—potential to support pain communication by enabling more accessible, multimodal, and patient-centred interactions that better capture lived experience. However, there is limited systematic knowledge on the barriers and facilitators of pain communication in this population, and existing digital solutions neither address these factors nor adopt user-centred approaches. This study addresses this gap by co-developing an evidence-based digital intervention – SIGNPAIN - designed to enhance pain communication.

Methods: The development of SIGNPAIN follows a user centred approach, and iterative co design process, using the Intervention Mapping Protocol7 for systematic, theory driven planning. First, we will identify personal, interpersonal, and environmental factors that hinder or facilitate pain communication, and explore user needs and preferences regarding a digital tool through qualitative user research (needs assessment). These insights will inform the logic model of change, specifying behavioural outcomes, performance objectives, and determinants relevant to pain communication, followed by the selection of theory based behaviour change methods. The collaborative and participatory design process will underpin the development of SIGNPAIN, ensuring that its features are shaped by interdisciplinary expertise and grounded in users’ lived experiences. A pilot study will subsequently assess feasibility, acceptability, usability and the potential of SIGNPAIN to support pain communication during clinical encounters. An evaluation plan will assess implementation outcomes and inform future refinement and scalability.

Results: The SIGNPAIN project is expected to improve pain communication between patients and healthcare professionals by addressing key personal, interpersonal, and environmental barriers/facilitators. Anticipated outcomes include increased patient ability to express pain clearly and confidently, and enhanced clinician understanding of patients’ pain experiences during clinical encounters. The intervention is also expected to support more structured and efficient communication, contributing to improved shared understanding and decision-making. At the implementation level, SIGNPAIN is expected to demonstrate feasibility, acceptability, and usability among target users, alongside strong engagement with its core features. The project will also generate insights into factors influencing adoption and integration within clinical workflows. In the longer term, SIGNPAIN has the potential to contribute to improved quality of care, patient satisfaction, and more person-centred care, while providing a scalable, theory-informed digital solution adaptable to healthcare settings.

Conclusions: This project aims to advance the development of inclusive digital health solutions to enhance pain communication between deaf adults with chronic pain and hearing clinicians. Communication about pain during clinical encounters is often challenging for both parties, shaped by multiple interacting factors that contribute to disparities in assessment and treatment. SIGNPAIN, a digital intervention specifically designed to support this interaction, has the potential to promote more accurate, accessible, and equitable pain care.

References: 1. Goldberg DS, McGee SJ. (2011). Pain as a global public health priority. BMC Public Health. 6;11:770. https://doi.org/10.1186/1471-2458-11-770.
2. Sheppard, K. (2014). Deaf adults and health care: Giving voice to their stories. Journal of the American Association of Nurse Practitioners, 26, 504–510. https://doi.org/10.1002/2327-6924.12087
3. Emond, A., Allsop, L., Alexander, A. & Kyle, J. (2015). Access to primary care affects the health of Deaf people. British Journal of General Practice. 65(631):95-6. https://doi.org/ 10.3399/bjgp15X683629
4. Mansutti, I., Tomé Pires, C., Chiappinotto, S. & Palese, A. (2023). Facilitating pain assessment and communication in people with deafness: a systematic review. BMC Public Health 23, 1594. https://doi.org/10.1186/s12889-023-16535-5
5. Cohen SP, Vase L, Hooten WM. (2021). Chronic pain: an update on burden, best practices, and new advances. Lancet, 29;397(10289):2082-2097. https://doi.org/10.1016/S0140-6736(21)00393-7.
6. Craig KD. (2015). Social communication model of pain. Pain, 156(7):1198-1199. https://doi.org/10.1097/j.pain.0000000000000185.
7. Bartholomew Eldrigde, L. K., Markham, C. M., Ruiter, R. A. C., Fernandez, M. E., Kok, G., & Parcel, G. S. (2016). Planning health promotion programs: An Intervention Mapping approach (4th ed.). Hoboken, NJ: Wiley

Presenting Author: Catarina Tomé-Pires
Submitting Author: Catarina Tomé Pires

Senior Author: Catarina Tomé-Pires

IASP 2026 Global Year theme of Neuropathic Pain: No

• Catarina Tomé-Pires - Department of Psychology, University Research Center in Psychology (CUIP), Universidade Autónoma de Lisboa, Lisboa, Portugal
• Hugo Nicolau - Interactive Technologies Institute (ITI/LARSyS), Técnico Lisboa (Universidade de Lisboa, Lisbon, Portugal)
• Ana Cristina Pires - Iscte-University Institute of Lisbon; Interactive Technologies Institute (ITI-LARSyS), Técnico de Lisboa (Universidade de Lisboa, Lisbon, Portugal)
• Jordi Miró - Unit for the Study and Treatment of Pain—ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Tarragona, Spain
• Sónia F. Bernardes - Centre for Social Research and Intervention (Cis-iscte), Iscte-University Institute of Lisbon, Lisbon, Portugal
• Alvisa Palese - Department of Medicine, University of Udine, Italy
• Luísa Ribeiro - Department of Psychology, University Research Center in Psychology (CUIP), Universidade Autónoma de Lisboa, Lisboa, Portugal
• Elvia Vasconcelos - Department of Psychology, University Research Center in Psychology (CUIP), Universidade Autónoma de Lisboa, Lisboa, Portugal
• Rocío de la Vega - Department of Personality, Assessment, and Psychological Treatment, University of Málaga, Málaga, Spain