A Digital Video and Text Messaging Intervention to Support People With Chronic Pain During Opioid Tapering: Content Development Using Co-design

Abstract

Background People living with chronic pain report that tapering prescribed opioids is challenging and more support is needed. In our formative research, consumers indicated that mobile health (mHealth) technology could be an acceptable form of support for opioid tapering and may improve tapering self-efficacy. Objective We aimed to evaluate and improve the content of an mHealth intervention before pilot-testing, based on consumer and clinician feedback. Methods Participants were 12 consumers and 12 clinicians who evaluated an initial draft of a video script and 90 SMS text messages. Consumers and clinicians rated the appropriateness and likely usefulness (consumers) or likely effectiveness (clinicians) of a video script and a random selection of 15 SMS text messages using a 5-point Likert-type scale (1=totally disagree; 5=totally agree). Each draft SMS text message was reviewed by 2 consumers and 2 clinicians. Texts were deemed acceptable for inclusion in the pilot intervention only if the summed participant ratings of text appropriateness and usefulness or effectiveness were ≥8. Participants were also invited to provide open-text feedback on the draft script and SMS text messages. Results Consumers generally agreed that the draft video script and text content were likely to be appropriate (video: mean 4.4, SD 0.52; text: mean 4.3, SD 0.79) and useful (video: mean 4.3, SD 0.65; text: mean 4.2, SD 0.84). Similarly, clinicians generally agreed that the draft video script and text content were likely to be appropriate (video: mean 4.5, SD 0.67; text: mean 4.4, SD 0.81) and effective (video: mean 4.0, SD 0.43; text: mean 4.3, SD 0.76). Overall, 77% (69/90) of the draft texts met the threshold rating for acceptability for inclusion in the pilot test of mHealth intervention by consumers, and 82% (74/90) met the threshold for acceptability by clinicians. Consumers' and clinicians’ ratings were used to rank order the texts. The top 56 draft texts (all meeting the threshold levels of acceptability) were selected for inclusion in the pilot intervention. When consumer or clinician feedback was provided, the texts meeting the criteria for inclusion in the pilot were further revised and improved. Feedback on the video script was also used to further improve the acceptability of the video script before pilot-testing the intervention. Conclusions This study describes the process by which a 28-day mHealth intervention to support patients with chronic pain to taper opioid medications was evaluated and improved before pilot-testing. The mHealth intervention consisted of a 10-minute psychoeducational video about pain and opioid tapering and 56 unique SMS text messages providing information and reassurance (texts delivered twice per day for 28 days). Having established that the content of the mHealth intervention is acceptable to both consumer and clinician groups, the mHealth intervention will be piloted in future research.

Text messaging intervention to support patients with chronic pain during prescription opioid tapering: protocol for a double-blind randomised controlled trial

“…The development of this mHealth intervention was in response to previous research conducted by our team, as well as others, on patients’ experiences and needs during tapering opioid medications,7 8 12 and their perspectives on receiving support via mHealth interventions 20. As described previously, the mHealth intervention prototype was developed in close collaboration with clinician-researchers and a consumer representative 24. It was revised in response to feedback from panels of consumers and clinical experts, and then was tested in a pilot study 25.…”

“…Participants in the intervention group will receive a welcoming message and a message with a link to a psychoeducational video to watch (day 1) followed by daily text messages on their mobile phones for 12 weeks. The video and library of the messages were developed based on a codesign study, driven by the social cognitive theory (with emphasis on the self-efficacy construct) and direct feedback from consumers and clinicians 24. The contents have been revised further based on feedback received during a pilot RCT 25.…”

“…Studies have also shown that educational videos may be an effective means of providing patients with information about chronic pain, pain self-management and opioid tapering,21–23 and can increase the opioid-tapering self-efficacy of people currently on LTOT for chronic pain 21. Based on this foundational research, we co-designed a digital intervention (video and mobile text messaging) for patients with CNCP who are tapering prescription opioids under clinical supervision 24. Patients and clinicians have rated this programme as appropriate, useful and likely to be effective in supporting patients during opioid tapering 24.…”

“…Based on this foundational research, we co-designed a digital intervention (video and mobile text messaging) for patients with CNCP who are tapering prescription opioids under clinical supervision 24. Patients and clinicians have rated this programme as appropriate, useful and likely to be effective in supporting patients during opioid tapering 24. A pilot randomised controlled trial (RCT) has been conducted, demonstrating the feasibility, acceptability and potential efficacy of this intervention in patients referring to public and private outpatient pain management clinics 25 26…”

Digital Therapeutics (DTx) Expand Multimodal Treatment Options for Chronic Low Back Pain: The Nexus of Precision Medicine, Patient Education, and Public Health

“…DTx can not only improve precision medicine for CLPB but can contribute to public health by: (1) decreasing the use of opioid-based analgesia and thus reducing opioid use disorders, (2) improving health literacy via patient education, and (3) improving therapy outcomes and preventing recurrence of CLBP, hence decreasing the burden of CLBP on healthcare and economy. Digital interventions to support opioid tapering are under development [169][170][171]. To improve the treatment of opioid use disorder, it is noteworthy that an adjunct prescription DTx, reSET-O (developed by Pear Therapeutics), delivers CBT for patients who also receive buprenorphine [172][173][174].…”