Background
Methods
Design
Participants
Recruitment
Integrated intervention outline
Data collection
Wireframe Slide | Intervention Component | Description |
---|---|---|
Slides 1 & 2 | Layout/home screen | Provided a brief description of the program’s purpose and instructions for accessing the menu. Menu content included “modules, tracker, progress, scheduler, strategies, and coaching” |
Slides 3 & 4 | Modules page | Provided an overview of the different topics for each week’s 10-min lesson and a sample of module 1 content: understanding how pain is related to alcohol use and medical conditions |
Slide 5 | Video skill demonstration | Featured an example of how pain management strategies would be introduced through video demonstrations, in this case, for progressive muscle relaxation |
Slide 6 | Tracker | Presented an overview of the tracker feature which would allow participants to track pain intensity, triggers, and coping mechanisms for a given day |
Slide 7 | Progress | Displayed how progress would be tracked and graphed weekly for both alcohol use and pain intensity |
Slide 8 | Feedback | Provided information and personalized feedback regarding participant alcohol use in comparison to national averages |
Slides 9 & 10 | Strategy scheduler | Provided an overview of how to use the program scheduler to track goals and set up specific times and reminders to practice strategies each week |
Slide 11 | Post-strategy ratings | Presented how to evaluate mood and track success after completing a strategy or activity |
Slide 12 | Strategies tab | Displayed where to quickly access the compiled list of strategies for a quick reminder |
Slides 13 & 14 | Coaching | Demonstrated how to schedule appointments and access the health coach via instant messaging for personalized participation |
Slides 15 & 16 | Reminders | Provided examples of four types of push notifications the participant would receive in the program: reminders to use the tracker, to practice sessions, to attend an appointment with the health coach, and to start newly added modules |
Slide 17 | Sample module | The last slide included a sample module video which gave an overview of the program as an example of the program’s weekly modules |
Analytic measures
Results
Sample Characteristics
Themes from qualitative analyses
Intervention themes | Subthemes | Quote |
---|---|---|
1. Experiences and expectations of treatment | Intractable pain | “Long. Years. Of misery. And still no results.” [Participant 12, Black male in his 50′s] |
Helpless re: pain | “But I mean, when it’s not the weather it’s still, you know it’s still there. The showers and the baths not gonna do anything.” [Participant 6, Black female in her 50′s] | |
Treatment history and temporary results | “I’m just tired of taking pills and it’s not working. You know what I’m saying? It’s like okay I sit here, I don’t do nothing. I take the pills and it you know, it sustains some and so it gives me a little bit of motivation but like still. It’s just constant pain. It’s just constant pain. It gets aggravating.” [Participant 12, Black male in his 50′s] | |
Barriers to care | “Well, I uh plan to go to acupuncture very soon. […] So I hope I’m one of the people they can actually get in because it’s on a first come first serve basis. Get there early and you know, get some acupuncture.” [Participant 5, Black female in her 50′s] | |
Treatment expectations | “A lot of people want the instant results. And if they don’t see the instant results, ‘pfft, what I’m I doing it for?’ […] The individual, the individual themselves has to realize it’s not a microwave. Everything can’t be done quick.” [Participant 3, Black male in his 30′s] | |
2. Reasons for drinking | Enjoyment/relaxation | “I feel comfortable with it [current amount of drinking]. Like it just gets me where I want to be. I mean I don’t want to get drunk drunk. I just want to be mellow and then after that go to bed.” [Participant 1, White Hispanic male in his 60′s] |
Social interaction | “it’s more of a social thing as opposed to an addiction or becoming a problem for me.” [Participant 10, Black female in her 40′s] | |
Routine | “I just go home, I drink, and then I go to bed.” [Participant 4, Black female in her 60′s] | |
Sleep | “And sometimes for sleep I know I would drink alcohol to help me sleep you know cause the pain pills is hard to get. Especially these days […] So right now my pain is probably worse when I’m trying to go to sleep so if I tend to drink alcohol, that’s probably why. Cause it helps me go to sleep.” [Participant 7, Black male in his 50′s] | |
Mood | “I was in a lot of pain, like as far as physically and emotionally, you know. Like I lost a sibling so it was you know, I would say maybe I was kind of self-medicating with like alcohol. Cause at that point I used to drink to the point where I would pass out. So that I wouldn’t have to feel anything.” [Participant 11, Black Hispanic female in her 30′s] | |
Distraction | “I’m thinking about stopping the drinking, going through the program, stop the smoking you know? But I got to do- my limbs gotta be good so I could try and do other stuff to occupy that time. Cause all of that is part of that addictive behavior, you know what I’m saying? I got to substitute it with something, you know what I’m saying? I got to be able to walk in the park, do something just, you know what I’m saying? When you get that urge or that crave, you know what I’m saying? You can occupy the mind with something else, you know what I’m saying?” [Participant 12, Black male in his 50′s] | |
Numbing | “I was just drinking to block everything. It’s pretty much a self-medication. I get a numbness from it. Like you’re not there, the pain is not really there.” [Participant 4, Black female in her 60′s] | |
3. Motives to change drinking | Low readiness to change | “I haven’t quit where it was full me. Where I made the decision. It’s been either the decision was made for me, as in um, a ruined relationship where I felt like if I quit drinking because the relationship ended I could be better in the next relationship. And I quit for… I quit for my ex more than I quit for me.” [Participant 3, Black male in his 30′s] |
Reasons to change | “ And I’m trying not to drink that much cause you know, some people use alcohol to suppress their depression. So I don’t want to fall in that category. You know, bad enough I can barely walk and imagine barely walking and walking around drunk or… you’re an accident waiting to happen. I got to take care of myself at the end of the day. You know? Not too much else I can do.” [Participant 12, Black male in his 50′s] | |
Barriers to change | “Not really, I know the dangers of it and I know I probably shouldn’t but right now it’s what works for me.” [Participant 7, Black male in his 50′s] | |
4. Use and perceived value of technology | Limited computer access | “No, I have to go to somebody to get on one [a computer].” [Participant 2, Black male in his 60′s] |
Daily smartphone use | “I use at least 4 apps, at least 3 times a day.” [Participant 5, Black female in her 50′s] | |
Videochatting/messaging | “I do like it. Especially now that my grandson- I have two grandkids, so they Facetime me every day so, I love it.” [Participant 8, White Hispanic female in her 50′s] | |
5. Barriers to a smartphone-based intervention | ||
5a. Lack of familiarity with and fear of new technology are key barriers to smartphone intervention | Unfamiliar and disorienting | “No, my friends does that. I don’t- you gotta download a plan or something in your phone they told me. Why people gotta see you? While I’m talking to them?” [Participant 12, Black male in his 50′s] |
Openness to learning | “No, cause I don’t know how to do that yet [watch videos on phone]. And I wish I did.” [Participant 6, Black female in her 50′s] | |
5b. Critical need for privacy, trust, and some limited contact with a provider | Security, privacy, legitimacy | “I don’t think I trust it. I would like the human opinion. Not this kind- I don’t go for that. Just as a whole- I, I don’t trust that.” [Participant 1, White Hispanic male in his 60′s] |
Desire for in-person contact | “But like I said every now and then I want to sit down and just talk. Face-to-face.” [Participant 2, Black male in his 60′s] | |
6. Ways to increase engagement and adherence | ||
6a. Support, results, and positive reinforcement | From coach | “I think it would be very helpful. I mean, you know to help you reach your goal, and you know, like just knowing that someone was helping you to reach the goal. Whether it’s managing pain or not drinking, you know.” [Participant 5, Black female in her 50′s] |
From content of intervention | “I think having a set time, you know? And like a, a certain number of days that you actually do it could be helpful because sometimes I just don’t feel like doing things but if it’s something that I really should do, then I just push myself to do it.” [Participant 5, Black female in her 50′s] | |
From rewards | “If they offered something that’s real. Not just giving you a gold star, you know? I think that’ll make people do even more.” [Participant 1, White Hispanic male in his 60′s] | |
From incentives | “Incentives inspire, inspire everybody […] When you’re setting your goal, give yourself a goal but give yourself an incentive to get to that goal.” [Participant 3, Black male in his 30′s] | |
6b. Importance of autonomy and choice | Value of having choices | “I think all that you have to offer [in regards to health coach interaction options]. The texting, or even a phone call. Yeah. Cause some people might not want to just talk.” [Participant 10, Black female in her 40′s] |
Value of convenience | “Yeah, I said that because you can- you’re home, and you ain’t gonna go nowhere, and they showing a fist [progressive muscle relaxation tutorial]. That’s something you can do easily. Anywhere in any part of the house you can do that. You know? Just out on the porch you know, just by yourself.” [Participant 7, Black male in his 50′s] |
Experiences and expectations of treatment
“Yeah so I’m always, I’m always hurting. And I’ve hurted so long it almost became something that I’m just normally adapted to, I done become adapted to the pain.” [Participant 10]“Nothing [relieves the pain], I just live with it.” [Participant 8]
“And I hate the fact that when I go to the hospital I basically gotta start from, I guess the ground level up. Always switching doctors- ‘You wanna go to therapy? You wanna do injections?’ I already had 15 of those.” [Participant 7]“I don’t want to double up on the medication. It only says take once so once that one dose wears off, I’m back at square one and that’s when I’m going to the cream, use the ice packs, and the back exercises that you know my doctors gave to me.” [Participant 10]“They helped for the moment. It’ll get me probably through say, 7 or 8 hours if you know, I go get the injection. It takes, it almost helps me to forget that hey, it’s no longer a condition anymore. But then once that pain- that medicine wears off, it’s back to where it started.” [Participant 11]
“Nah, I liked everything about it [detox program]. Just what I don’t like about it is just that I constantly go back.” [Participant 12]“If you try, and you see the results, but the treatment is ending and you don’t have the resources, then you fall back to what you know.” [Participant 1]
“Yes, uh physical therapy and um- but my schedule wouldn’t work because I get my schedule once a week so it’s very hard to, to have um appointments for physical therapy when I don’t know when I’m working the next week.” [Participant 4]“I can’t go in and say hey, give me some Oxycodones. They say no they’re addictive […] Uh well short of that it’s the surgery. But I don’t want that- I want the less invasive surgery with the needle, you know. And I have no control over that [no insurance coverage].” [Participant 7]
“So in general, I feel like it really depends on the person itself. If it’s somebody that’s been probably dealing with like pain long term- they’ve learned somewhat how to manage it. […] Now if it’s somebody that […] hasn’t been dealing with it for a long time, they’re gonna want a quick fix. They’re not going to be as patient. […] When you’re in pain, not a lot of people have patience. Unless you’ve been dealing with it for a while.” [Participant 11]
Reasons for drinking
Enjoyment/relaxation: “it puts me in a happy space. And um, sometimes it’s just you know, to unwind, I guess.” [Participant 5]Social: “I mean, it makes me happy. I don’t know […] I don’t know why I continue drinking it. But just to have a little good time with my friends.” [Participant 8]Routine: “I’ve been drinking for so long, what am I gonna do? Sit down and twiddle my- I mean, come on you know, I mean I could go out for a walk. Come back home. Once you’re used to sitting down with a beer it’s like hard to get- hard to say no to it, you know?” [Participant 1]
Sleep: “It makes me go to sleep but it don’t do nothing for the pain, maybe- it might dumb it or I might forget about it for a little while but when I wake up stiff, hurting, moving, it’s pain, pain right back. But it’s better than not taking nothing at all.” [Participant 7]Mood: “Especially when I get off work it’s very hard um, sometimes I’m limping and uh yeah. So it’s just pain. Constant. And that’s uh, a lot of that has to do with some of my drinking cause I will stop and get beer and just go home and drink it and relax.” [Participant 4]Distraction from pain: “Well to me, when I do drink it takes my mind off of it. You know what I’m saying? I don’t really think about it, ya know. It’s just, I’m here, having a couple of drinks, playing some dominos, playing some spades. My mind is off it until I start walking.” [Participant 12]Numbing the pain: “It numbs me up [laughs]. And it just, it just numbs me. For a while. Cause I know, after that it’s still gonna be the same way after I, you know, after you know it’s all said and done.” [Participant 6]
Motives to change drinking
Health: “I don’t do much when I drink so um but I have a goal just to stop completely […] because I’m getting older and I want to be healthy and um, I don’t know if it’s actually healthy to consume alcohol you know, as you begin to age.” [Participant 5]Work: “I’m not gonna get up at 7 o’clock in the morning and have to be out the door at 8 o’clock and if I’ve been out all night, forget it. That ain’t gonna happen.” [Participant 7]Relationships: “Cause I go a lot of times to my daughter’s school so I don’t- that why I don’t want people writing bad stuff about me or what not. So I make it a point not to [drink].” [Participant 7]
Use and perceived value of technology
“I haven’t used it in years. I got one of those old big dinosaurs left.” [Participant 12]“I don’t know how to use it that well yet. The only thing that I know how to get on is my Facebook. That’s terrible but that’s what I do know how to use.” [Participant 6]
“My whole life is on my phone.” [Participant 11]“I’m kinda new to this technology stuff. I just started getting into it maybe a year ago.” [Participant 7]
“I’m not really into texting. My children text me. I receive more than I send.” [Participant 4]“I’m constantly texting. That’s like my means of communication. I don’t really talk much on the phone, it’s mainly texting.” [Participant 11]
“And my mom she’s sick […] I’m able to Facetime her and see that she’s okay. So I see the benefits of having it now.” [Participant 7]“Very rarely do I do videocalls and I can- like honestly I’ve only done that a few times and the last few times I’ve done it is only because my granddaughter called me. If it wasn’t her, I wouldn’t answer it. Most of the time, I don’t answer it.” [Participant 3]
Barriers to a smartphone-based intervention
Lack of familiarity with and fear of new technology are key barriers to smartphone intervention
“I got a call from my aunt, last year, and when I answered it her face popped up. And I almost flew off the chair… I said ‘what the hell.’ […] And she’s just talking to me and I said ‘listen, listen. Can you hear me?’ ‘Of course I can hear you, I can see you too!’ I said ‘Yes, that’s what I don’t like, get off the air. Call me normal. I don’t want to talk to you looking at you. Just call me the way, you know what I mean? Normal people.’ … It’s spooky. […] And uh, to me I mean… it’s like- the future just hit me in the face.” [Participant 1]
“I never really got into it [new phone] but now I see how important it is to actually get into it. Because it can do so much. […] Because I want to learn how, how to do all of that and you know get on the computer and do this and that. So they got a class coming up. So I can learn how to use it.” [Participant 2]“I’m kinda new to this technology stuff. I just started getting into it maybe a year ago. My daughter kept urging me to do it and I didn’t wanna do it. Just give me a flip phone and I’m good, you know. […] Now I’d really get upset if I lose my phone..” [Participant 7]
Critical need for privacy, trust, and some limited contact with a provider
“I like it but… is it like really private?” [Participant 4]“And I could look into your eyes right now and find out if you really care or don’t. I don’t know what you’re thinking about online or over the phone. Or, or who am I talking to? They could say I am this and this and that.” [Participant 1]
“How about I could do that [in reference to IM sessions] and maybe like once in a while, come in and talk to a live person? Like how I’m talking to you? […] Because then that makes them feel better when they’re talking to somebody live sometimes. And you know, some people can relate a lot better.” [Participant 2]
Ways to increase engagement and adherence
Support, results, and positive reinforcement
“And they could you know, pretty much give you a pep talk […] and that encouragement is probably gonna be the biggest thing. The encouragement and the- just knowing somebody has your back.” [Participant 3]
“The reward would be to get better and hope this program works that you have here. But for me- other people may need rewards or something but I’m pretty much self-motivated.” [Participant 7]
“You know, just a small reward […] if you’re not drinking, with the money saved treat yourself to a nice dinner… Yeah, personalized goal. Something that, something that’s for you. [Participant 3]“Just have something on your phone that- like on your set up there, that once they do it and they go through the practice, there will be some kind of cheery thing. “Yay! You did great!” You know, “Congratulations, keep up the good work!” [Participant 12]
Importance of autonomy and choice
“I wouldn’t try to take one away cause then, you know, you’re limiting their choices. You’re taking a whole choice away. I would go with all three […] I say all three until that person can say personalize it. […] But it’s gonna vary from person to person I believe” [Participant 7]
“The advantage of it is um, sometimes you don’t really know where to go, you have to call, you have to set up an appointment, you have to figure out how to get there. With this, it’s with you.” [Participant 4]
Intervention component ratings
Proposed content areas | Number of “helpful” or “very helpful” ratings |
---|---|
Learning how to drink alcohol in a way that is consistent with personal standards and life goals | 8/12 |
Receiving personalized information about current drinking patterns | 9/12 |
Learning ways to improve and maximize sleep | 9/12 |
Behavioral activation [pleasant activities] | 10/12 |
Learning alcohol-related harm reduction strategies | 10/12 |
Learning strategies to relax | 10/12 |
Learning about pain triggers and coping mechanisms | 10/12 |
Stress management | 10/12 |
Psychoeducation about pain, stress, and alcohol use | 11/12 |
Learning ways to plan and pace activities | 11/12 |
Learning ways to manage negative thoughts | 11/12 |
Learning ways to continue self-management after completion of treatment | 11/12 |
Wireframe evaluations
“I would definitely use more excitement. More… live. You want to keep the attention of your watchers.” [Participant 11]
“The narrator was good and it went straight to the point. […] And it delivered a lot of things that it has to offer. And solutions that are open to people that want it. So yeah, it was set up good.” [Participant 10]
“I mean, overall I feel like the concept of it is good. Um, just probably the little details that I like pointed out here and there. But I think overall that it’s a good idea. It’s just all of how they design it and it’s put out there. Because that’s really what’s going to determine if it’s gonna be successful or not.” [Participant 11]
“I think they’re actually very good and I think that it would be very helpful to people, you know. Keep them reaching their goals.” [Participant 5]