mHealth: providing a mindfulness app for women with chronic pelvic pain in gynaecology outpatient clinics: qualitative data analysis of user experience and lessons learnt

Abstract

ObjectivesTo determine whether a pre-existing smartphone app to teach mindfulness meditation is acceptable to women with chronic pelvic pain (CPP) and can be integrated into clinical practice within the National Health Service (NHS) CPP pathways, and to inform the design of a potential randomised clinical trial.DesignA prestudy patient and public involvement (PPI) group to collect feedback on the acceptability of the existing app and study design was followed by a three-arm randomised feasibility trial. In addition, we undertook interviews and focus groups with patients and staff to explore app usability and acceptability. We also obtained participant comments on the research process, such as acceptability of the study questionnaires.SettingTwo gynaecology clinics within Barts Health NHS, London, UK.ParticipantsPatients with CPP lasting ≥6 months with access to smartphone or personal computer and understanding of basic English.InterventionThe intervention was mindfulness meditation content plus additional pain module delivered by a smartphone app. Active controls received muscle relaxation content from the same app. Passive (waiting list) controls received usual care.Main outcome measuresThemes on user feedback, app usability and integration, and reasons for using/not using the app.ResultsThe use of the app was low in both active groups. Patients in the prestudy PPI group, all volunteers, were enthusiastic about the app (convenience, content, portability, flexibility, ease of use). Women contributing to the interview or focus group data (n=14), from a ‘real world’ clinic (some not regular app users), were less positive, citing as barriers lack of opportunities/motivation to use the app and lack of familiarity and capabilities with technology. Staff (n=7) were concerned about the potential need for extra support for them and for the patients, and considered the app needed organisational backing and peer acceptance.ConclusionThe opinions of prestudy PPI volunteers meeting in their private time may not represent those of patients recruited at a routine clinic appointment. It may be more successful to codesign/codevelop an app with typical users than to adapt existing apps for use in real-world clinical populations.Trial registration numberISRCTN10925965.

MEMPHIS: a smartphone app using psychological approaches for women with chronic pelvic pain presenting to gynaecology clinics: a randomised feasibility trial

“…Suggestions are given for improving the intervention such as co-development, an approach to intervention that involves the users in the design of the intervention. The findings are published in the companion paper describing the qualitative arm of this study 15. The length of the intervention in this study (60 days) may also have been a barrier to participation and future work may want to explore different treatment lengths for remote-based mindfulness interventions.…”

“…However, due to extremely low adherence, further randomised trials to evaluate the benefit of the Headspace mindfulness meditation app for women with chronic pelvic pain are not warranted, unless additional steps to improve engagement with the app are included in the intervention. Further discussion of reasons for low engagement and what could be done to improve engagement may be found in the qualitative part of this study 15…”

“…Pain acceptance was chosen by the study group with input from pain patients and clinicians because it has been shown to be a meaningful clinical outcome that was improved by mindfulness mediation in other pain conditions 8. This article reports quantitative findings; qualitative findings will be published separately 15…”

Guidance for gynecologists utilizing telemedicine during COVID‐19 pandemic based on expert consensus and rapid literature reviews

“… ●Telemedicine is well‐accepted among patients for treatment of CPP and has been shown to improve pain acceptance and overall function 39 ●Mobile health apps and online resources can be used as adjuncts to treatment of CPP 29,32–34,59 ●During the COVID‐19 pandemic, pelvic physical therapy clinics can offer telemedicine sessions for pelvic wellness (EC). ●CPP: In the absence of the ability to perform a pelvic exam, in‐person pelvic floor therapy, or surgery, providers could consider outpatient management strategies such as short‐term vaginal diazepam, transcutaneous electrical nerve stimulation (TENS) units, at home pelvic physical therapy, cognitive behavioral therapy, yoga, topical anesthetics, vaginal estrogen, tricyclic antidepressants, and anticonvulsants 60–62 .…”

“…39 • Mobile health apps and online resources can be used as adjuncts to treatment of CPP. 29,[32][33][34]59 • During the COVID-19 pandemic, pelvic physical therapy clinics can offer telemedicine sessions for pelvic wellness (EC). • There is no literature guiding the initiation or use of narcotics for CPP or other pelvic pain disorders via telemedicine, but we recommend against initiation of narcotics for CPP without guidance from a pain specialist (EC) due to the fact that narcotics are generally considered a controversial last resort therapy for this disorder.…”