Integrating patient perspectives in the development of a mobile health intervention to address chronic pain and heavy drinking in primary care: a qualitative study of patients in an urban, safety-net hospital setting

Abstract

Background Chronic pain and heavy drinking are conditions that commonly co-occur among primary care patients. Despite the availability of behavioral interventions that target these conditions individually, engagement and adherence to treatment remain a challenge, and there have been no interventions designed to address both of these conditions together for patients presenting to primary care. This study seeks to incorporate the perspectives of patients regarding symptoms, treatment experiences, views on behavior change, and technology use to develop a tailored, integrated mobile health intervention that addresses both pain and heavy drinking among patients in primary care. Methods Twelve participants with moderate or greater chronic pain intensity and heavy drinking were recruited from primary care clinics in a large urban safety-net hospital. One-on-one interviews were recorded and transcribed. Codes were developed from interview transcripts, followed by thematic analysis in which specific meanings were assigned to codes. Participants also completed a series of Likert-based rating scales to evaluate components of the proposed intervention to supplement qualitative interviews. Results A number of themes were identified that had implications for intervention tailoring including: ambivalence about changing drinking, low expectations about pain treatment success, desire for contact with a designated provider, common use of smartphones but lack of familiarity with functions as a potential barrier to use, and strategies to maintain engagement and adherence. Evaluative ratings indicated that the proposed intervention content was perceived as helpful and the proposed structure, layout and design of the mobile intervention was acceptable to patients. Conclusions Results supported the view that a mobile health intervention delivered via smartphone with electronic coaching is an acceptable method of addressing chronic pain and heavy drinking among patients in primary care. The interviews highlight the need to utilize an intervention approach that addresses motivation to change drinking, sets realistic expectations for change, provides careful attention to training/education of the use of technology components, and fosters engagement through the use of reminders, feedback, and personalized activities.

Barriers and Facilitators to Changing Drinking and Receiving Alcohol-Related Care: Interviews with Veterans Health Administration Primary Care Patients who Indicated Interest but Did Not Enroll in An Alcohol Care Management Intervention Trial

“…Many barriers and facilitators identified in this study align with prior qualitative studies of primary care patients in non-VA settings 21 – 27 . Participants also discussed factors that may be unique to Veterans.…”

“…35 Many barriers and facilitators identified in this study align with prior qualitative studies of primary care patients in non-VA settings. [21][22][23][24][25][26][27] Participants also discussed factors that may be unique to Veterans. Participants' sense of their Veteran identity overlapped with alcohol-related stigma and desire to change drinking without help.…”

“…Qualitative studies with primary care patients have identified multiple barriers and facilitators to changing drinking and engaging in alcohol-related care. [21][22][23][24][25][26][27] VA patients may have unique perspectives given their military experience and enrollment in an integrated healthcare system, as well as their Veteran identity (i.e., sense of self related to their experiences as a Veteran) which prior research suggests influences healthcare utilization. 28,29 However, few studies have qualitatively examined the perspectives of VA primary care patients on alcohol-related care, and existing studies have focused on women or specific types of alcohol-related care.…”

“…Qualitative studies with primary care patients have identified multiple barriers and facilitators to changing drinking and engaging in alcohol-related care 21 – 27 . VA patients may have unique perspectives given their military experience and enrollment in an integrated healthcare system, as well as their Veteran identity (i.e., sense of self related to their experiences as a Veteran) which prior research suggests influences healthcare utilization 28 , 29 .…”