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.

Published on Mar 23, 2021in Addiction Science & Clinical Practice3.088
· DOI :10.1186/S13722-021-00230-0
Tibor P. Palfai38
Estimated H-index: 38
(BU: Boston University),
Maya P. L. Kratzer2
Estimated H-index: 2
(BU: Boston University)
+ 1 AuthorsJudith Bernstein28
Estimated H-index: 28
(BU: Boston University)
Source
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.
References35
Newest
#1Stacy Sterling (KP: Kaiser Permanente)H-Index: 20
#2Vanessa A Palzes (KP: Kaiser Permanente)H-Index: 2
Last. Felicia W. Chi (KP: Kaiser Permanente)H-Index: 19
view all 10 authors...
Importance Excessive alcohol consumption is associated with increased incidence of several medical conditions, but few nonveteran, population-based studies have assessed levels of alcohol use across medical conditions. Objective To examine associations between medical conditions and alcohol consumption levels in a population-based sample of primary care patients using electronic health record data. Design, Setting, and Participants This cross-sectional study used separate multinomial logistic re...
5 CitationsSource
#1VanAnh L Vo (Columbia University)H-Index: 1
#2Lola Auroy (CNRS: Centre national de la recherche scientifique)H-Index: 1
Last. Aline Sarradon-Eck (French Institute of Health and Medical Research)H-Index: 8
view all 3 authors...
BACKGROUND: Mobile phones and tablets are being increasingly integrated into the daily lives of many people worldwide. Mobile health (mHealth) apps have promising possibilities for optimizing health systems, improving care and health, and reducing health disparities. However, health care apps often seem to be underused after being downloaded. OBJECTIVE: The aim of this paper is to reach a better understanding of people's perceptions, beliefs, and experience of mHealth apps as well as to determin...
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#1Joseph W. Ditre (SU: Syracuse University)H-Index: 25
#2Emily L. Zale (Binghamton University)H-Index: 20
Last. Lisa R. LaRowe (SU: Syracuse University)H-Index: 8
view all 3 authors...
Pain and substance use are highly prevalent and co-occurring conditions that continue to garner increasing clinical and empirical interest. Although nicotine and tobacco, alcohol, and cannabis each...
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INTRODUCTION: Although behavioral health treatment can improve distress and pain functioning for patients with chronic pain, few who are referred by their primary care physician will see a behavioral health specialist. Given the benefits of integrating behavioral health into primary care, this may be an avenue for delivering a psychological intervention for chronic pain. The purpose of this study was to optimize a psychological intervention for patients with chronic pain to be delivered in prima...
2 CitationsSource
#1Alex T. Ramsey (WashU: Washington University in St. Louis)H-Index: 10
#2Jason M. Satterfield (UCSF: University of California, San Francisco)H-Index: 18
Last. Enola K. Proctor (WashU: Washington University in St. Louis)H-Index: 47
view all 4 authors...
BACKGROUND: Primary care settings are uniquely positioned to reach individuals at risk of alcohol use disorder through technology-delivered behavioral health interventions. Despite emerging effectiveness data, few efforts have been made to summarize the collective findings from these delivery approaches. OBJECTIVE: The aim of this study was to review recent literature on the use of technology to deliver, enhance, or support the implementation of alcohol-related interventions in primary care. We ...
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#1Natalia E. Morone (BU: Boston University)H-Index: 18
The current opioid crisis has spurred the need for nonpharmacological therapies for chronic low back pain. In a study published in JAMA Internal Medicine, we reported that in 282 older adults with chronic low back pain, an 8-week mind-body group program modeled on Mindfulness-Based Stress Reduction (MBSR) decreased long-term pain and increased short-term function. Barriers to uptake remain such as patient resistance to accepting the benefits of nonpharmacological treatments for chronic low back ...
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#1E. Jennifer Edelman (Yale University)H-Index: 22
#2Jeanette M. Tetrault (Yale University)H-Index: 23
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Objective: Systematic review to identify predictors for dropout during interdisciplinary pain management programmes. Data sources: PubMed, PsycINFO, CINAHL, Embase, and SPORTDiscus were searched from inception to 22 June 2017. Study selection: Screening, data-extraction and quality assessment was carried out independently by 2 researchers. Data synthesis: Eight studies with low methodological quality were included in this review. Out of 63 potential predictors identified in univariate analyses, ...
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: Chronic pain, one of the most common reasons adults seek medical care (1), has been linked to restrictions in mobility and daily activities (2,3), dependence on opioids (4), anxiety and depression (2), and poor perceived health or reduced quality of life (2,3). Population-based estimates of chronic pain among U.S. adults range from 11% to 40% (5), with considerable population subgroup variation. As a result, the 2016 National Pain Strategy called for more precise prevalence estimates of chroni...
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