Interview with SPIDeRR partner: Estíbaliz Loza

“The feasibility, usability, and acceptability of digital tools like Rheumatic? are currently being tested to support diagnosis, with promising results”

During the annual meeting in Stockholm, we interviewed Dr. Estíbaliz Loza, who is involved in work package 6, ‘Context and Implementation’. While having a background as a clinical rheumatologist, Loza eventually moved into research. Loza: “For a while, I balanced both — seeing patients and conducting research — but in time, I realized my passion was fully in research. So now, I work exclusively as a researcher, specifically as a methodologist. One of my main roles in this project is designing qualitative studies. In our work package, for example, we have conducted what we call a ‘patient journey’, and I am responsible for designing and leading this type of study”.

Laying the groundwork

Work package 6 is aimed at contributing to the design of three digital tools: Rheumatic?, the Digital Twin, and Modular-SPIDeRR, and its ultimate goal is to ensure adoption of these tools by engaging and convincing future users, including the public, patients with rheumatic diseases, general practitioners (GPs), and rheumatologists. 

To achieve this, the first phase, focused on contextual analysis, involves understanding the needs, behaviours, and workflows of these target groups by gathering extensive data through five studies, all centred around the patient journey. This approach follows individuals from the onset of symptoms like pain and swelling to their interactions with GPs, referrals to specialists, and ongoing care within the healthcare system. “By analysing this journey from multiple perspectives ― patients, GPs, rheumatologists, and the healthcare system — we aim to create an effective implementation plan that incorporates the key insights gathered, ultimately ensuring the successful adoption of the digital tools”, explains Loza.

A comprehensive, patient-centred approach
The research within work package 6 involves a comprehensive approach to understanding and improving the diagnostic and management journey of individuals with rheumatic diseases and musculoskeletal complaints, addressing barriers at the individual, healthcare professional, and system levels, explains Loza. This began with a literature review to identify gaps in current knowledge and practices, followed by a multi-country European survey involving patients, citizens, GPs, and rheumatologists across seven countries, with qualitative insights further enriching the findings. The team then developed a set of personas, each representing a group of individuals with distinct characteristics that reflect real-world patient experiences, informed by data collected throughout the patient journey. Loza: “The feasibility, usability, and acceptability of digital tools like Rheumatic? are currently being tested to support diagnosis, with promising results. However, challenges remain in explaining risk scores and adapting the tools to different cultural contexts and age groups”.

Key findings: addressing barriers
The key findings of work package 6 highlight both the successes and the challenges in implementing digital tools — particularly Rheumatic?. As Loza explains, the tool is performing well overall; however, various barriers have been identified at multiple levels, including among the general population, patients, healthcare professionals, and within healthcare systems. While some issues can be addressed immediately, others require a more strategic approach and long-term planning, Loza notes. “If not managed properly, these challenges could hinder the widespread adoption of the tool. We are actively working to resolve several of the problems, but others demand careful planning and sustained future efforts. Ultimately, our goal is to ensure broad and effective use of the tool, which requires ongoing refinement and adaptation.”

Fostering collaboration
Loza explains that the team behind work package 6 is working closely with the teams from work packages 2 and 3 to bring research on how healthcare tools are used into ongoing clinical studies on rheumatic diseases and musculoskeletal complaints. While work packages 2 and 3 focus on clinical outcomes such as age, sex, and treatment effectiveness, work package 6 will contribute by examining implementation-related aspects, including feasibility, usability, and acceptability. By embedding tools from work package 6 — such as questionnaires and interviews — into the existing study protocols, the teams aim to collect complementary data from the same patient cohorts. This integrated approach ensures methodological consistency and enables comparative analysis across clinics in Sweden, Spain, the Netherlands, and Germany, with the potential future inclusion of Greece and Hungary. Ethical approvals are already in place, and the teams will continue to coordinate in the coming weeks to harmonise data collection and align key variables across work packages.

Next steps
Loza explains that the next phase of work package 6 will focus on further developing the implementation plan to address ongoing challenges — such as explaining risk scores and adapting digital tools like Rheumatic? to different cultural contexts and age groups. This work is essential to support the broader adoption of these tools across various healthcare systems and populations. Loza notes: “We are transitioning from an extensive contextual analysis phase — during which significant data were gathered through rigorous research — towards the more complex and critical stage: the development of the implementation plan. This plan will address major challenges and barriers to ensure the successful adoption of digital tools across all work packages.” María Villalobos-Quesada, a postdoctoral researcher at the National eHealth Living Lab, will lead this task. The team of work package 6 will work closely with all teams to gather further insights and develop a coordinated, effective strategy, explains Loza. “The team aims to begin preparations as early as possible due to the importance of this phase. In parallel, we will continue conducting usability, acceptability, and feasibility studies — including additional patient interviews — to support our goals.”

Personal and professional growth
For Loza, one of the most rewarding aspects of working on this project has been the chance to grow both professionally and personally. “As a methodologist, I've discovered new ways of working by learning from colleagues across different countries — integrating approaches and tools I hadn’t used before, which has really strengthened my own practice. Equally rewarding is the human side of the experience: building genuine friendships with people from all over Europe and creating a kind of international family. And perhaps most meaningful of all is knowing that the work we’re doing — developing digital tools — can truly improve the lives of people living with rheumatic diseases, including those close to me.” Loza adds that this experience is a powerful reminder of the importance of putting faces to the data and keeping the human impact at the heart of what we do.

Collaborative leadership
While the SPIDeRR project team has encountered various challenges — both within and between work packages — these are natural aspects of working on such a complex, multinational initiative. Importantly, the team has shown a strong ability to collaboratively address and overcome these issues. Recognizing the complexity of the project has helped foster a problem-solving mindset across the team, says Loza. “In particular, Rachel Knevel, Loreto Carmona, and María Villalobos-Quesada have played crucial roles in facilitating communication, collaboration, and mutual understanding across work packages. Rachel is consistently attentive and solution-focused, Loreto brings deep insight and dedication, and María has been essential in supporting alignment and encouraging open dialogue. Their combined leadership has been key to maintaining a positive, resilient, and forward-moving working environment.”