This study used a mixed methods sequential explanatory design [26]. Integration of quantitative and qualitative data occurred at the level of sampling and analysis [27]. For sampling, we used a connecting approach in that participants who completed the quantitative surveys were invited to participate in the qualitative interviews. For the analysis, we used a merging approach, in that we compared responses from the surveys to comments from the interviews to identify any differences and gain a deeper understanding of the perceptions and acceptance of the MyGuide Concussion tool. Qualitative interview questions were developed based on responses provided in the quantitative surveys. The Design and Evaluation of Digital Health Interventions (DEDHI) framework was used to develop survey and interview questions in order to understand the perceptions and acceptance of using MyGuide. The DEDHI framework is a consolidation of various health promotion evaluation frameworks and life cycle models specific to digital health programs and can be used in all aspects of the technological life cycle, from early conceptual models to large-scale implementation in the health care sector [28].

Recruitment occurred from December 11, 2020, to May 31, 2021, using convenience sampling. Recruitment for the survey was done through a pop-up window that appeared on the MyGuide Concussion tool. Individuals with concussion were included in the survey if they were 19 years or older, experienced a concussion within the last 2 years, and used the MyGuide tool. Individuals with any neurological health condition (eg, stroke, multiple sclerosis, Parkinson, and spinal cord injury) that may require services and resources beyond the scope of the tool were excluded from the study.

A total of 8 participants with concussions completed a 10- to 15-minute survey conducted online or by telephone from January 24, 2021, to May 30, 2021. The survey included questions about general demographic information and an outcome measure of technology usability (Health Information Technology Usability Evaluation Scale (Health-ITUES)). This measure consists of 20 items with 4 subscales of impact, perceived usefulness, perceived ease of use, and user control, which have been used to assess the usability of web-based programs for adults living with a chronic health condition [29]. The measure has demonstrated high internal consistency reliability (Cronbach α=0.85-0.92).

The data are reported using the Good Reporting of a Mixed-Methods Study [30]. Quantitative data were analyzed using descriptive analysis to describe the demographics and Health-ITUES questionnaire.

Recruitment occurred from February 7, 2021, to September 9, 2021. Participants with concussions were invited to participate in the qualitative interviews once they had reached the end of the quantitative survey. Recruitment for clinicians occurred through the use of the researchers’ professional network. Clinicians were included if they were currently working in the concussion rehabilitation field for at least 2 years, had therapeutic roles (eg, occupational therapists, physiotherapists, doctors, and neurologists), were practicing in British Columbia, and were familiar with or used the content in the MyGuide tool.

Participants (both clinicians and people with concussions) engaged in online semistructured interviews through Zoom [Zoom Video Communications] from February 7, 2021, to September 9, 2021. The interview guides for participants with concussions are provided in Multimedia Appendix 1. The interview guides for clinician participants are provided in Multimedia Appendix 2. Interview questions for participants with concussions were adapted from a previous study that examined the user experiences of a self-management tool for individuals with spinal cord injury and their caregivers [31]. Qualitative analysis occurred alongside data collection to ensure data saturation was obtained.

The qualitative data were analyzed using conventional content analysis. This involves an inductive process of reviewing the data as a whole, then deriving codes from the individual responses themselves and categorizing these to identify connections and relatedness [32]. Conventional data analysis allows researchers to avoid imposing preconceived ideas or categories on participants and, instead, to focus on getting information directly from participants [32].

The qualitative data followed a 2-step analysis process. First, qualitative interview data were recorded and transcribed verbatim using a transcription program. Once transcribed, 2 researchers reviewed the transcripts and audio recordings for accuracy and removed any potential identifiers to protect participant identity. Each performed conventional qualitative content analysis separately and then compared to ensure accuracy and resolve any interpretive discrepancies. Both researchers performing the analysis were female undergraduate students, one with a background in behavioral neuroscience and the other in biology and psychology.

The research team used two main trustworthiness strategies. First, the authors were mindful of their positioning throughout data collection and analysis. A diverse range of perspectives was included to establish consensus in data analysis, including the remaining authors following the first round of coding. Complementary perspectives on the data were thus acknowledged, which allowed the authors to reflect on their biases [33]. Second, rich verbatim quotations from the interviews were included in the results to fully capture the voices of participants and increase the credibility of the findings [33,34].

Ethics approval was completed by the University of British Columbia’s Behavioural Research Ethics Board (H20-02982).

A total of 8 participants with concussions completed the surveys. Participants with concussion included 4 female and 4 male participants with an average age of 33.8 years (SD 12.3; Table 1). Health-ITUES scores are included in Table 2.

The Health-ITUES subscales Perceived Ease of Use and User Control were used as indicators of ease of navigation of the tool, with higher ratings indicating higher perceived ease of use and user control domains. Results showed relatively high scores by participants with concussion, with the perceived ease of use being 4.42 (SD 0.46) and user control being 3.93 (SD 0.45) on a 5-point scale. Most participants were using the MyGuide tool on the desktop platform.

Both quantitative and qualitative data were used to understand adherence to using the tool. Survey data suggested that most participants had 1 to 5 visits to the tool in total. Furthermore, the survey data indicated that almost half of users completed 5 or more of the 11 modules.

Based on the Health-ITUES measure, where a rating of 5 on a Likert scale indicates strongly agree, Perceived Usefulness was 4.10 (SD 0.57), Impact was 4.41 (SD 0.46), and Overall Usability was 4.27 (SD 0.35). These high scores indicate that the tool had a positive impact on self-management and quality of life. Participants with concussion reported that they were looking for strategies to manage their concussion symptoms (8/8, 100%), more information about concussion symptoms (7/8, 88%), specific strategies for returning to normal day-to-day activities (7/8, 88%), and information on how to navigate the health care system (5/8, 63%). Overall, survey data suggested that people with concussions were either satisfied (4/8, 50%) or very satisfied (3/8, 38%) with the tool and generally described that the tool had met their needs (6/8, 75%). Respondents indicated that the tool provided background information about concussion, provided ways to manage concussion symptoms, and motivated recovery. All survey respondents indicated they would recommend the tool to other people with concussions, as they noted it was informative and provided people with reassurance and normalization of symptoms being experienced.

A total of 8 participants with concussions and 8 clinicians were included in the study. Participants with concussion included 4 females and 4 males with an average age of 33.8 years (SD 12.3; Table 1). Clinician participants included 7 occupational therapists and 1 physiotherapist, averaging 13.1 (SD 10.8) years in clinical practice with 8.5 (SD 4.7) years in concussion rehabilitation specifically (more details in Table 3).

Based on the interview data, the primary reason people with concussions continued to actively engage in the tool was to seek out information to gain a better understanding of concussion recovery. Participants reported that they stopped using the tool when they acquired enough information or when they saw improvements in their recovery. One participant said of the tool, “It is sort of a learning tool, right?... But once I’ve learned how I can just focus on that myself, and I didn’t really return to it, but I was using what it had taught me.” Overall, the tool was often used over a short period of time and not used as a resource that participants with concussions were continuously referred to over a prolonged period.

Clinician participant perspectives gave further insight into other factors related to adherence. As most clinician participants noted they were actively referring their clients to the site, one factor that may have influenced their clients’ adherence was based on how they were directing clients to the site. Participants mentioned they were either referring clients to the tool by working through the tool with their clients in sessions or by sending the link to their clients to have them go through the tool independently at home. For some participants, going through the tool was a good starting point for their clients, particularly when doing virtual sessions. One clinician said, “It’s been really helpful for the clients when we do Zoom sessions... I can share my screen, and we can go through it together.”

Clinician participants mentioned that most clients with concussions were only engaging with the MyGuide Concussion tool a few times independently but mostly accessed the tool when facilitated by the clinician. One participant stated,

As such, participants noted that the MyGuide Concussion tool was useful in therapy sessions but may not be as relevant if self-directed by participants.

Qualitative and quantitative results were integrated at the level of analysis. However, the accessibility, suitability, and relevance of the tool were only assessed using qualitative data. Multimedia Appendix 3 displays the integration of results using joint display.

Our study indicated that the MyGuide concussion self-management tool has good acceptance and perception by all participants (people with concussions and clinicians) using the tool.

Specific recommendations were provided by both participants with concussions and clinician participants to improve the ease of use of the MyGuide tool. Many clinicians requested that a downloadable PDF form be made for each module, as it would be beneficial to increase the accessibility of the tool for those with reduced screen tolerance. This format could also address the minor navigation issues that a handful of participants with concussions experienced when using the tool.

Participants also provided suggestions for increasing personalization and adherence to the tool. Participants with concussions reported that the use of the tool stopped when they acquired enough information or when they saw improvements in their recovery. Based on this, it would be beneficial to add more detail to modules, especially around nutrition, which one participant noted to be sparser. Clinician participants found that certain topics, such as return to sports, were irrelevant to the client’s recovery, and some information was inaccessible to those with low or no screen tolerance or low computer proficiency. To address this, the tool should be recommended to clinicians as something that should be adopted into practice so they can support clients in refining the tool to be more relevant to their own recovery goals. Furthermore, adding audio or visual modes of delivery as opposed to text could increase accessibility for individuals with lower screen tolerance.

Findings from our study indicated the benefits of the MyGuide Concussion tool; specifically, participants emphasized the importance of reassurance to people with concussions by normalizing their experiences. Previous research looking at brain injury found that reassurance was ranked as highly important when considering aspects of an intervention [35] and that normalization of emotions and behavior were important facilitators of self-acceptance and willingness to reach out for help when needed [36]. Furthermore, the MyGuide Concussion tool was seen as beneficial for identifying symptoms, which, in turn, helped with finding ways to manage triggers. A study exploring barriers and facilitators of reintegration after concussion found that lack of concussion education was a major barrier to returning to learning, suggesting that the information provided in the MyGuide tool may be a facilitator in returning to everyday life following concussion [37]. Furthermore, education on symptoms following a brain injury has been tied to higher self-awareness and positive experiences during interventions [36], as well as better outcomes [35].

Findings in our study indicated satisfaction and benefit with using a web-based tool for self-management of symptoms and overall recovery after concussion. Similar web-based interventions designed for facilitating recovery in adolescents with mild TBI have also found that web-based interventions were effective in improving executive functioning and functional disability, although this was identified by parents instead of the adolescents themselves [38]. Other studies on mTBI have identified the active coping style involved in self-management as being linked to improved recovery after concussion and improved pacing of return to activity [39]. Participants with concussion and clinicians in this study both agreed that the MyGuide tool was best for individuals in the early stages of recovery who require basic information about concussion and self-management. In particular, participants with concussions suggested that providing the tool within one month of injury would be most beneficial as this is when concussion education is essential to reduce stress related to understanding concussions and what they look like. In line with our findings, other web-based interventions for mild TBI have identified time as a key factor affecting the effectiveness of the intervention, as individuals do not have the same need for more information later in recovery [35,38,39]. One study described that receiving information during an optimal time of exposure was more crucial to maximizing symptom improvement as opposed to the frequency of use of the tool [38]. Several other studies have highlighted providing timely services after a concussion as being a key factor in the effectiveness of self-management websites [13,19].

The ease of use of the MyGuide tool was reported to be relatively high for participants, and aspects such as the linearity of the modules, simple layout, and easy-to-understand information were described as effective by participants. The use of desktop computers seemed to be the preferred medium for the use of the tool, and those using a mobile device voiced the need for improvement of the mobile platform. Usability studies on web-based tools for people with TBI have similarly found that simple interfaces are favored [40]. However, in contrast to our findings, several studies on digital health have found that participants prefer using mobile devices over desktop computers as more people have mobile devices, and most people keep their mobile phones with them at all times compared with their computers [40,41]. This contributes to quick access to the digital tool whenever they need it, rather than just at home. Although participants in the present study all resided in urban areas, the use of digital platforms for health-related self-management programs has been noted as beneficial for use by people remote from treatment centers [42] and especially in rural areas [43], suggesting that the MyGuide tool has the potential to have more far-reaching benefits than was discussed in this study.

There are 3 main limitations to this evaluation. First, this study had a small sample size, which may limit the ability to generalize the findings to the broader clinical population of those with concussion. However, data saturation was met during qualitative interviews, and the findings show preliminary support for the use of the MyGuide tool. Second, there may have been selection bias with participants with concussions as they required the ability to participate in an online survey and, as such, a higher capacity to engage with screens than other people with concussions. To mitigate this effect, participants had the option of completing the survey by telephone, but no participants requested a telephone survey option despite 75% (6/8) of participants indicating decreased screen tolerance in the questionnaires. This suggests further research may be required to understand whether decreased screen tolerance impacted module completion and to assess the interpretability of the results to the questionnaires that reported having enough information as a reason to stop completing the modules. Finally, occupational therapists were overrepresented as clinician participants, with no physicians involved in the study and the findings not necessarily representing all clinicians. However, these findings provide crucial information for later studies that aim to specifically understand other clinicians’ perspectives.

Future research should be done to assess whether the tool can be used in practice by clinicians other than occupational therapists and if the earlier introduction of the tool can provide increased benefits to people with TBI. The use of the MyGuide Concussion tool should also be examined in the senior population, considering the frequency of concussions due to falls in this age category and because this study may have limited generalizability as it focused exclusively on young and middle-aged adults. In addition, it would be beneficial to gauge to what degree screen tolerance impacts the completion of modules and the need for clinician involvement. Finally, as this study revealed a lower rating for User Control relative to other features, it would be beneficial to explore what contributes to this lower rating and what improvements can be made to mitigate any difficulties.

The MyGuide tool is a web-based customizable concussion self-management tool with good acceptability and perceptions by people with concussions and clinicians in concussion rehabilitation. MyGuide provides foundational information on concussion and self-management strategies, normalizes symptoms, and provides reassurance and support for occupational reengagement.