Exploring Motivational Strategies for Scoliosis Orthosis Wear Using Health Design Thinking: A Co-design Study in Norway

Introduction

Adherence to brace treatment is challenging for many adolescents with idiopathic scoliosis, even though wearing the brace as prescribed can reduce curve progression. Improving adherence requires addressing motivational, educational, and psychosocial needs alongside clinical care. Previous research has highlighted the importance of brace comfort, peer support, and avoiding surgery as key motivators. Digital and sensor-based technologies may offer new opportunities to support motivation and long-term adherence, but little is known about young users' preferences. Therefore, this study aimed to identify motivational strategies that could inform the design of future digital support solutions.

Methods

An exploratory study was conducted using the Health Design Thinking (HDT) framework (observe–imagine–make). Literature, previous co-design findings, and early concept ideas informed the design process. During the observe phase, personas and empathy maps were used to explore user needs and contextual challenges. In the imagine phase, three preliminary design concepts were developed and evaluated through group discussion and voting. During the make phase, children (n=10; 10–13 years, 7 girls and 3 boys) participated in group discussions, observations, and role-play using low-fidelity brace and mobile app prototypes to explore age-appropriate motivational and interaction patterns. The resulting insights informed the refinement of the concepts and the development of a digital prototype in Figma.

Results

Three motivational design concepts were developed: pain distraction, motivational coaching (the preferred concept), and working toward freedom, based on their perceived potential to support engagement and sustained motivation. Qualitative co-design analysis identified six themes related to motivation, including emotional expression, character preferences, communication style, challenge types, reward mechanisms, and personalized feedback. Participants also highlighted supportive communication, relatable avatars, and brief, achievable challenges as important features of a future digital solution.

Conclusion

This study identified motivational strategies to inform the development and future evaluation of digital solutions to support brace adherence among young people with scoliosis.