Military cultural tailoring in web- and app-based chronic pain self-management programs for Veterans: A scoping review

Introduction: Chronic pain is more prevalent among Veterans than in the civilian population. While web- or app-based chronic pain self-management programs are increasingly available and show positive outcomes, it remains unclear if and how they are adapted to meet Veterans’ unique needs. This scoping review aimed to document the presence and nature of military cultural adaptations in these programs and to assess how such adaptations influence key user outcomes. Methods: We included studies focused on Veterans and military members with chronic pain who participated in a web- or app-based self-management program. We aimed to examine how cultural adaptations were described and whether any influence on user experience, engagement, satisfaction, motivation, or cultural relevance perceptions was reported. To do so, we conducted a comprehensive search of major databases (MEDLINE, CINAHL, Embase, PsycINFO) and grey literature for English and French studies published since 2010. Results: Of the 248 sources screened, we included nine studies from the United States and two from Canada. Ten reported Veteran-intended interventions, but only one outlined the adaptation process. We identified various adaptation components (e.g., including Veteran narratives, shortening modules), although most were superficially described. No studies assessed the specific effects of adaptations, aside from participants’ perceptions of cultural relevance. Discussion: Detailed reporting on adaptation processes, resulting tailored components, and effects is lacking. The understanding of what constitutes military cultural tailoring in digital programs is still evolving. Future research could consider actively involving Veterans early in the process and systematically evaluating the added value of military cultural adaptations.