Access to group-based multidisciplinary pain management programmes is limited in Aotearoa New Zealand. To address this, a 12-week online pain management programme - iSelf-help, was co-designed with people living with persistent pain including cultural considerations for Māori - the Indigenous population of Aotearoa New Zealand. A non-inferiority randomised controlled trial demonstrated clinical and cost-effectiveness of iSelf-help compared to the in-person programme. The Behaviour Change Technique (BCT) Taxonomy (v1) contains 93 distinct BCTs in 16 clusters and is one way of describing the active components of iSelf-help. Using mixed-methods, this study aimed to: (1) map content of 13 iSelf-help modules using the BCT Taxonomy, and (2) identify and code participant experiences, mapping these to the taxonomy. Three reviewers independently mapped 130 resources across the modules to distinct BCTs, calculating frequencies by consensus. Of the 36 participants randomised to the iSelf-help arm of the non-inferiority trial, 15 took part in process evaluation interviews. A qualitative deductive analysis identified participant quotes corresponding to the distinct BCTs. Findings from the content analysis and qualitative mapping were then integrated using a mixed methods approach. 46 BCTs were identified in iSelf-help content. From seven BCT clusters, (#5) Natural consequences and (#8) Repetition and substitution were most frequent. Alignment between content and qualitative mapping was found in (#1) Goals and planning, (#4) Shaping knowledge, (#8) Repetition and substitution, (#9) Comparison of outcomes, and (#13) Identity. As group-based pain management programmes improve long-term outcomes, the identified BCT clusters could be key targets for future online group-based pain management programmes. PERSPECTIVE: iSelf-help is a co-designed, online group pain management programme with cultural considerations for Māori - the Indigenous population of New Zealand. The mapping of iSelf-help contents and iSelf-help participants using Behaviour Change Technique (BCT) Taxonomy (v1) has identified key behaviour change techniques. The identified BCTs could be candidates to include in online group pain management programmes.

SYNOPSIS: In the fifth article of the Moving Forward Together series, we explore the role of allyship and advocacy in improving the musculoskeletal health of Indigenous Peoples. Aligned with the truth telling and healing required in response to the ongoing impacts of colonization, these are important concepts for physical therapists to understand and act upon to improve musculoskeletal health outcomes for Indigenous Peoples. Our group-comprising Indigenous clinicians and/or academics from Aotearoa/New Zealand, Australia, and Canada, alongside non-Indigenous colleagues-collaborated to conceptualize allyship and advocacy in the context of musculoskeletal physical therapy. Using a socioecological model, we propose actions and share resources to support physical therapists in allyship and advocacy, and to drive change in clinical, education, and research organizations and systems. J Orthop Sports Phys Ther 2026;56(6):324-330. Epub 2 April 2026. doi:10.2519/jospt.2026.13858.

Chronic or persistent pain disproportionately affects Māori and their whānau (family and significant others). Our previous engagement with Māori living with persistent pain has identified significant barriers for Māori to accessing primary, secondary, and tertiary services. This paper describes the insights obtained from Māori living with persistent pain by using a creative art-based data collection method as part of a co-design process to understand how they would like to be supported in their pain management journey. We used brainstorming discussion sessions and a creative art session to encourage divergent thinking and to stimulate innovative ideas for better pain management support for Māori. The creations showed a deep connection to taiao (nature) and the support of whānau as sources of strength. Connecting with other whānau living with pain in a safe space (i.e. community setting or a marae (community meeting place)) was an aspiration. Existing mainstream services were viewed as deficit-focused with an overwhelming support for Māori-led solutions delivered kanohi-ki-te-kanohi (face-to-face). Creative activities can be used as a culturally appropriate research method for both generating rich insights into the lived experiences of Māori living with persistent pain and how to deliver culturally responsive pain services.

BACKGROUND:Chronic non-cancer pain is a major burden worldwide. Indigenous communities experience additional inequities in pain care and management influenced by long-standing impacts of colonization, including systemic racism, oppression, and marginalization. Traditional healing knowledges, practices and methods are valued by Indigenous people when managing their pain. However, mainstream health services often disregard this knowledge and fail to provide culturally safe management strategies. AIM:To understand how Indigenous peoples across the globe make sense of pain when experiencing chronic non-cancer pain. METHODOLOGY AND METHODS:This integrative literature review is reported according to the PRISMA checklist and CONSIDER statement. We focused on qualitative data reported by Indigenous adults with chronic non-cancer pain in empirical and theoretical studies. Electronic searches were performed in databases from health and humanities scopes, in addition to grey literature, from 1990 to August 2023. We drew from critical theory approaches to thematically analyze data from the included studies, privileging Indigenous perspectives through a Western intellectual framework (Two-Eyed Seeing epistemology). Data extraction and thematic analysis were managed using NVivo. Primary data were mapped according to geography and theoretical framework. RESULTS:After removal of duplicates, 1352 studies were screened using title and abstract, from which 99 full texts were assessed and 29 studies and 3 dissertations/theses were included. Included studies reported lived experiences of chronic pain among Indigenous peoples from Oceania, North America, and South America. Thematic analysis derived four main themes that indicated pain is entwined with nature, Indigenous identity, historical trauma, and the collective. Our findings suggest that pain is interconnected to a broader scenario of feelings, thoughts, peoples and places. CONCLUSION:Our findings highlight the layered and complex aspects of the lived experiences of chronic pain among Indigenous people. Indigenous-led alternatives focusing on culturally safe care can guide approaches to clinical pain practice and contribute to achieving health equity.

Disabled children have the legal right to play, yet often face discrimination, stigmatisation, and exclusion in public parks, impacting their wellbeing and that of their families. Using qualitative analysis and guided by a rights-based approach, we interviewed 17 children and their families in Aotearoa/New Zealand (NZ) about their park experiences. Three themes were developed illustrating how space, place and people matter when choosing whether to play: Spaces can enable interconnected Families, Place in Society and Environmental Safety and Accessibility. A NZ model of wellbeing (Te Pae Māhutonga model) was used to discuss the findings and highlight how access to play intersects with wellbeing elements of cultural identity, design, equity, and self-determination. Disabled children and their families continue to face significant physical and social barriers, often requiring extra effort to access parks. As microcosms of society, parks reflect broader issues of inclusion, ableism, and exclusion. Our research provides rich, transferable insights into the lived experiences of disabled children and families in NZ. Safe, inclusive play spaces are important for wellbeing, and policymakers must strengthen efforts to ensure accessibility for all.

BACKGROUND:Self-management is recommended for managing persistent musculoskeletal conditions. In self-management, standardized and validated measurements (e.g., questionnaires) should be used. However, there is no general questionnaire to evaluate the level of self-management in people with persistent musculoskeletal conditions. OBJECTIVES:To develop a generic questionnaire to evaluate the level of self-management and self-management skills in people with persistent musculoskeletal conditions. DESIGN:Measurement properties study focused on the development and content validity of the Musculoskeletal Self-Management Questionnaire (MSK-SMQ). METHODS:The MSK-SMQ was developed, consisting of 24 questions. To assess the content validity of the MSK-SMQ, three panels (patients, professionals, researchers/academics) were used. The relevance, clarity and essentiality of each question was evaluated. Moreover, specific feedback could be provided. The Content Validity Index (CVI) was used to test content validity (Item-CV [I-CVI]) and the Scale-level-CVI [S-CVI]). The CVI was calculated for both relevance and clarity. The essentiality of each item was measured with the content validity ratio (CVR). RESULTS/FINDINGS:91 people participated in this study. The overall content validity (relevance) was excellent, with an S-CVI of 0.96. Overall clarity was also excellent, with a score of 0.97. The range of the I-CVI for relevance was 0.91-1.00 and the range for clarity was 0.93-1.00. The mean CVR value was 0.51 and ranged from 0.14 to 0.87. CONCLUSIONS:The content validity of the questionnaire was found to be excellent. The study resulted in a revised version of the MSK-SMQ, which can be used in future research to determine further psychometric properties.

Sex and gender are important variables in research, but they are inconsistently explored. The international PAINDIFF Network makes 13 recommendations for studying sex and gender as variables in pain research, which are applicable across the spectrum of biopsychosocial research. Five universal recommendations apply to the majority of research studies: (1) include males and females as standard practice, (2) account for sex in randomization or counterbalancing and testing order, (3) power for sex differences when sex is a primary experimental variable, (4) include detailed reporting of experimental design, and (5) conduct sex-disaggregated analysis and reporting. Three additional recommendations specifically for preclinical studies and five additional recommendations for human and clinical studies are included. Recommendations for stakeholders, such as editors, reviewers, funding bodies and policymakers, have also been developed. Wide adoption and implementation of these recommendations will reduce variability, improve reproducibility and enhance the translatability of research findings within and beyond the field of pain.

A group-based, online-delivered version (iSelf-help) of an existing group-based in-person pain management programme was developed. Development included Māori (New Zealand's Indigenous population) cultural considerations of content. This study determined whether offering iSelf-help was non-inferior to the in-person pain management programme in reducing pain-related disability at six months. The study used a non-inferiority randomised, two-arm, parallel, open-label trial with blinding of assessors, including health economic and process evaluations. Participants were adults (age≥18 years) with persistent non-cancer pain referred to a hospital-based regional pain service who were deemed eligible for a pain management programme. iSelf-help groups participated in two 60-minute video-conferencing sessions (first, peer support facilitated; second, clinician facilitated) weekly for 12 weeks with access to resources via smartphone app and website. In-person groups received 12-week in-person pain management programme. The primary outcome was the Modified Roland Morris Disability Questionnaire. Secondary outcomes included anxiety, depression, stress, pain severity and interference, health related quality of life, self-efficacy, acceptance, and satisfaction. Recruited were 113 participants (56 iSelf-help, 57 in-person), mean(SD) age 38.2(13.7) years, 75% female, 16% Māori. Using modified intention-to-treat analysis on the primary outcome at six months (n=73), iSelf-help was non-inferior to in-person pain management programme with a point estimate (95% one-sided CI) of -0.4 (∞, 1.5). It was also non-inferior for secondary outcomes of anxiety, depression, stress, activity interference, health related quality of life, and self-efficacy. iSelf-help was cheaper, had similar overall satisfaction, but higher accessibility, scores. iSelf-help showed non-inferior clinical outcomes for improving pain-related disability in people with persistent non-cancer pain. PERSPECTIVE: This article evaluates a novel online-delivered pain management programme (iSelf-help) co-created with people with persistent pain, with committed and ongoing collaboration with Māori whānau (Indigenous population of New Zealand). iSelf-help may improve access to the regional pain service used in this study for more people living with persistent pain.

Objective:Opioid tapering is a complex process for both clinicians and patients with chronic pain. This qualitative study explored the experiences of Aotearoa New Zealand clinicians in managing opioids for patients with chronic non-cancer pain. Methods:Purposive and snowball sampling were used to interview nineteen health professionals including general practitioners (n=5), pain medicine specialists (n=5), addiction medicine specialists (n=4), pain fellows (n=3), addiction medicine registrar (n=1) and a pain nurse practitioner (n=1). Data were collected using a face-to-face focus group and fourteen individual interviews conducted via Zoom. The data were analysed using a Reflexive Thematic Analysis approach. Independent parallel coding was done by members of our research team, and the final themes were iteratively developed by mutual consensus. Results:This qualitative study suggests that meaningful opioid tapering requires a patient-centred approach that considers the individual's unique sociopsychobiomedical context. Clinicians emphasised the importance of building trust, addressing fears, and tailoring tapering regimens to patients' needs and motivations. While opioid tapering is a complex process for all patients, participants acknowledged unique considerations for supporting people living in rural areas - Māori and Pasifika and their whānau (families and significant others) addressing social determinants of health. There were overwhelming accounts of clinician distress from all participants especially for rural general practitioners due to the lack of support, conflicting practices, limited resourcing, and time constraints. Conclusion:These findings call for a co-ordinated, multidisciplinary approach to opioid tapering that addresses systemic inequities and prioritises patient and clinician well-being.

Chronic pain disproportionately affects autistic children and young people, yet they are underrepresented in pain research. Research on psychological, physical, and pharmacological therapies for other conditions suggests modifications are required to ensure treatment accessibility and efficacy for autistic individuals. However, no such evidence base has been synthesized in pediatric pain. The aim of this review was to (1) review existing "gold-standard" treatment literature for pediatric chronic pain to determine the representation of autistic participants, and (2) review literature on treatment of chronic pain specifically in autistic children and young people to describe the current evidence landscape and identify next directions for research. 16.7% (12/72) of randomized controlled trials included in Cochrane reviews of interventions for pediatric chronic pain explicitly excluded youth with a developmental delay/disability, of which only 8.3% specifically named autism. However, 52.8% of Cochrane-included trials had criteria or protocols which may have disproportionately impacted autistic participants, such as excluding intellectual disability, psychiatric conditions, medical conditions, and/or requiring participants to communicate verbally. Twenty-nine studies of treating chronic pain in autistic children and young people were identified, of which the majority were case reports (k = 27, 93%) with large variation in pain condition, intervention applied, and outcomes measured. Given the high prevalence of chronic pain in autistic children and young people, there is an ethical imperative to ensure their representation in intervention trials, co-develop interventions that address the specific needs of autistic individuals who live with pediatric chronic pain, and to increase accessibility in chronic pain research more broadly. REGISTRATION: PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=491423 registered March 19 2024. Open Science Framework: https://osf.io/8na64/ registered December 18, 2023 PERSPECTIVE: Autistic children and young people (CYP) are not represented in reviews of chronic pain treatments, and the literature on treating chronic pain specifically in this population is so variable no clear conclusions can be drawn. Efforts to increase accessibility of chronic pain interventions and research for autistic CYP is needed.

ObjectivesTo address chronic musculoskeletal (MSK) pain effectively, a multidimensional model of care such as the biopsychosocial (BPS) model may be required. However, to date, the incorporation of the BPS model into osteopathic practice by New Zealand (NZ) osteopaths is unknown. Hence, the aims of this study were to: 1) investigate the incorporation of the BPS model into osteopathic practice by NZ osteopaths; (2) explore the attitudes and perceptions about the BPS model among NZ osteopaths; and (3) investigate the barriers to implementing the BPS model in NZ osteopathic practice.DesignIn-depth interviews; data analysed using thematic analysis.Settingonline.ParticipantsA total of 14 NZ registered osteopaths (mean age =49; 57% males).ResultsThematic analysis revealed three major categories: BPS resistant, BPS open and BPS embracing. A ‘cactus fractal model’ was proposed in which knowledge about the BPS model informs the professional identity of osteopaths and therefore their interaction with the health system. This can take the form of a positive or a negative fractal model. Hence, education about the BPS model during undergraduate training or as CPD courses may be imperative.ConclusionsParticipants in this study held a range of views about the usage of the BPS model in their clinical practice. Although, there is still resistance in using the BPS model, emerging evidence indicate that NZ osteopaths are open and/or to embrace the BPS model.

INTRODUCTION:Uncertainty about safe engagement in activity during early recovery after cardiac events is common. Websites are a potential source of health information, especially for those unable to access follow-up support from health professionals. The variability in online health information quality is concerning as poor web-based information can negatively impact patient health outcomes and the ability to self-manage. OBJECTIVE:To evaluate the quality and self-management-related content of websites providing information about physical activity following an MI or cardiac surgery. METHODS:Patient-facing websites were searched using three search engines (Google, Bing, and Yahoo). Information about activities of daily living (ADLs), exercise (aerobic and resistance), and safety considerations were explored. Self-management strategies for physical activity were evaluated using a customized 9-item checklist. Website quality was assessed using the 4-item JAMA framework criteria. RESULTS:31 websites were included. Aerobic exercise, ADLs, and safety considerations were the most comprehensively covered topics. Resistance exercise was less frequently and comprehensively covered. The median self-management checklist score was 3/9 (with nine being the highest possible score). Partnering with healthcare professionals, decision-making, action planning, and verbal persuasion were the most common self-management skills addressed by the websites. In contrast, ten or fewer websites modelled mastery experiences, vicarious experiences, reflection, problem-solving, and resource utilization. The median JAMA score for website quality was 2/4 (with four being the highest possible score). CONCLUSIONS:The findings highlight quality improvement opportunities for web providers and provide insight for patients and clinicians regarding the highest quality websites that best meet the information and self-management needs following an MI or cardiac surgery.

Chronic or persistent non-cancer pain disproportionately affects Māori - the Indigenous population of Aotearoa New Zealand (NZ) and their whānau (family and significant others). In a previous study with a Māori community service provider - Tū Kotahi Māori Asthma and Research Trust - Tū Kotahi, identified a need for a Kaupapa Māori (by Māori, for Māori) pain management programme (PMP) with embedded principles of Whānau Ora (care focusing on the wellbeing of the individual and their significant others as a collective). Using a qualitative case-study design, the main aims were to describe (1) the implementation of a community-based, whānau-focused PMP; (2) the participant experiences of the programme. This is community-based participatory action research guided by a Māori-centred research approach. Based on our previous co-design study with Tū Kotahi, a 6-week PMP (July - August 2021) was implemented at Kokiri Marae (community meeting place). Eight whānau living with persistent pain participated in the 6 sessions led by our Māori community partner and a pain management physiotherapist including a dedicated session on Rongoā Māori (Māori traditional treatment). Supporting resources were co-developed with our community partner, pain service clinicians, a Māori Health literacy expert, and a Māori illustrator. On completion, whānau reported enhanced confidence towards managing pain with "more tools to manage". The role of meaningful relationships, co-design, use of metaphors, and inclusion of traditional treatments - Rongoā were key aspects for the successful implementation. This initiative provides an exemplar for community and mainstream pain service partnership to address inequities in accessing pain management services for Māori. PERSPECTIVE: This study explains the key cultural processes of implementing a community-based pain management programme for Māori with persistent pain in Aotearoa New Zealand. The principles from our engagement could be applicable globally to engage with Indigenous and culturally and linguistically diverse communities with persistent pain to address longstanding health inequities.

The aim of this retrospective cross-sectional study was to (1) investigate the association between the presence of subacromial bursal pathology and response to subacromial anaesthetic injection; (2) identify variables that are predictive of a negative anaesthetic response; and (3) calculate diagnostic accuracy of these predictors. A total of 208 people with shoulder pain referred from primary care received an ultrasound guided local anaesthetic injection into the subacromial bursa following standardised clinical examination. Pain was recorded on a visual analogue scale immediately prior to and within 15 min post-anaesthetic injection. No difference in pain reduction post injection was found between those with and without bursal pathology (p < 0.05). Five potential predictors of a negative anaesthetic response were identified, but did not reach statistical significance. Clusters of three of the five predictors (high occupational shoulder demands; high or low sport/recreational shoulder demands; no current history of night pain; loss of passive external rotation range of motion of more than 30° and shoulder pain reproduced on cervical spine testing) may have clinical relevance despite not reaching statistical significance. Use of a cluster of any three predictors results in post-test probability of 93% (pre-test probability 69%). The identified predictors may inform clinical decisions regarding the use of injection therapy in those with bursal pathology observed with ultrasound and therefore potentially reduce unnecessary and costly healthcare utilisation.

Non-invasive ventilation (NIV) is a critical therapy for many patients with neuromuscular disorders (NMD), supporting those with respiratory failure to achieve adequate respiration and improve their quality of life. The aim of this study was to explore the experiences of access to, consent, uptake, maintenance and safe use of non-invasive ventilation by people with NMD. Semi-structured individual interviews were conducted with 11 people with NMD, each using NIV for more than 12 months. A critical realism ontological paradigm with contextualism epistemology guided the Reflexive Thematic Analysis. An Equity of Health Care Framework underpinned the analysis. Three themes were interpreted: Uptake and informed consent for NIV therapy; Practicalities of NIV; and Patient-clinician relationships. We identified issues at the system, organization and health professional levels. Conclusions: We recommend the development of national service specifications with clear standards and dedicated funding for patients with NMD and call on the New Zealand Ministry of Health to proactively investigate and monitor the variations in service delivery identified. The specific areas of concern for patients with NMD suggest the need for NMD-related NIV research and service provision responsive to the distinct needs of this population.

OBJECTIVES:To explore the experiences of Australian and New Zealand clinicians with respect to care pathways, their awareness and use of non-invasive ventilation guidelines, and their perspectives on delivering quality non-invasive ventilation services to people with neuromuscular disorders.DESIGN, SETTING, PARTICIPANTS:Qualitative study; semi-structured focus groups and individual interviews with Australian and New Zealand clinicians who provide non-invasive ventilation services to people with neuromuscular disorders, recruited from participants at a 2017 sleep medicine conference. Interviews were conducted during 1 October 2017 - 31 May 2018.MAIN OUTCOME MEASURES:Major themes identified by an iterative, semantic, and inductive analysis.RESULTS:A total of 28 participants attended the four focus group sessions and five individual interviews; fourteen each from New Zealand and Australia, seventeen women and eleven men, eighteen physicians and ten other clinicians. Two major themes were identified: decision making for current practice, and resource constraints. Participants noted variable use of clinical guidelines and limited training to meet the needs of people with neuromuscular disorders who require non-invasive ventilation. They described a lack of dedicated funding, unstructured care pathways, equipment supply levels that do not meet need, low staff-to-patient ratios and staff shortages, and the inability to deliver quality multidisciplinary care. The need for clinical guidelines and service specifications was highlighted as requisite for reducing variation in clinical care.CONCLUSIONS:Systemic factors influence the needs-based provision of non-invasive ventilation for people with neuromuscular disorders. Development of clinical guidelines for Australia and New Zealand, dedicated funding for respiratory services for people with neuromuscular disorders, and specialist clinician training are important for equitable and high quality non-invasive ventilation care.

Purpose To explore the end users' experiences of foot drop electrical stimulator use for people with neurological conditions. Materials and methods Electronic databases MEDLINE, EMBASE, CINAHL, Scopus, and Google Scholar were searched in March 2022. Included articles were quality assessed using the Critical Appraisal Skills Programme (CASP) checklist. A thematic synthesis approach was used to synthesise the review findings and establish analytical themes. A Confidence in the Evidence from Reviews of Qualitative Research (CERQual) Approach was used to assess the level of confidence of analytical themes. Results Seven qualitative studies were included with 67 participants with stroke and multiple sclerosis. The outcomes to foot drop stimulator use were enhanced walking ability, independence, confidence, and social participation. Main barriers to use were device aesthetics, usability challenges, trustworthiness of device in complex environments, and cost of the device. A conceptual model was created illustrating the barriers and outcomes in managing foot drop. Conclusions We recommend that the outcomes to continued use of foot drop electrical stimulators are carefully considered against the barriers. Our conceptual model may be useful to guide clinical conversations around the possible use of FES for managing foot drop in people with multiple sclerosis and stroke.

ABSTRACT Telehealth is a promising approach to support self-management with the potential to overcome geographical barriers. Understanding patient perspectives will identify practical challenges to delivering self-management strategies by telehealth. The aim of this study was to synthesize the perceptions of people with chronic musculoskeletal pain for engaging in interventions delivered using telehealth. We searched MEDLINE, Embase, CINAHL, LILACS, and PsycINFO databases. We included qualitative studies that explored perceptions or experiences or attitudes of people with chronic musculoskeletal pain engaging with telehealth. We assessed the methodological quality using the Critical Appraisal Skills Programme checklist. Meta-synthesis was guided by a thematic synthesis approach. The level of confidence of review findings was assessed using the Confidence in the Evidence from Reviews of Qualitative Studies (GRADE-CERQual). Twenty-one studies were included (n = 429). Telehealth comprised web-based, videoconference-based, telephone-based, video-based, and smartphone app-based programs delivered solely or combined. Chronic musculoskeletal conditions included people with knee or hip osteoarthritis, chronic low back pain, persistent pain (chronic joint pain or nonspecific chronic musculoskeletal pain), rheumatoid arthritis, and functional fatigue syndrome. The enablers for engaging in telehealth interventions were as follows: (1) "at my own pace, space, and place" and (2) empowered patient. Barriers to engaging in telehealth interventions were as follows: (1) impersonal, (2) technological challenges, (3) irrelevant content, and (4) limited digital (health) literacy. Telehealth interventions with well-designed interactive platforms, flexibility to fit patients' routine, and the broad availability of material may favor better engagement. Encouragement of self-efficacy is linked to successful telehealth-delivered self-management programs.

Introduction Current best practice recommends group-based pain management programmes for long-term improvements in persistent pain-related disability. However, there are barriers for people to access in-person delivered pain management programmes in Aotearoa. Aims To develop a co-designed, culturally responsive, online group-based pain management programme (iSelf-help) for people with persistent pain. Methods A modified participatory action research (PAR) framework was used to co-design contents and cultural-appropriateness of iSelf-help. The PAR team included: (1) seven end-users living with persistent pain, who had previously attended an in-person delivered group pain management programme, (2) two pain management clinicians, (3) two health researchers, (4) two digital health experts, and (5) a health literacy expert. Five meetings were held with the PAR group and a Nominal Group Technique was used to rank order the preferred features of content delivery. In parallel, to ensure cultural appropriateness of iSelf-help, three focus groups (n = 15) were held with Māori (the Indigenous population of Aotearoa) living with persistent pain in collaboration with a Māori community health trust. All contents were reviewed by a Māori Health literacy expert and core contents were translated into Te Reo (Māori language). All contents were finalised by iterative discussion among the PAR team and consultation with Māori stakeholders. The preliminary version of iSelf-help was pilot tested with the PAR group participants and Māori community members living with persistent pain and their feedback was included. The iterative co-design process occurred over a period of nine months. Results The finalised version of iSelf-help included a total of 130 resources organised in to 12 content relevant online modules plus a dedicated welcoming page and an online community forum. Each module included: short videos, animations explaining main concepts, patient stories, written content to accompany visual content, podcasts of relaxation techniques, illustrated texts, and evidence-summaries. A dedicated module of videos demonstrating cardiovascular and strengthening exercises of varying intensity was also included. Conclusions This is the first co-created, culturally appropriate, on-line group pain management programme for people with persistent pain, developed in Aotearoa. The next step is to evaluate the clinical and cost-effectiveness of iSelf-help compared to in-person delivered pain management programme.