Magee Michael R, Gholamrezaei Ali, McNeilage Amy G, Sim Alison, Dwyer Leah, Ferreira Manuela L, Darnall Beth D, Glare Paul, Ashton-James Claire E
Pain Management Research Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Consumer Advisory Group, Pain Australia, Deakin, Australia.
JMIR Form Res. 2022 Nov 10;6(11):e40507. doi: 10.2196/40507.
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.
We aimed to evaluate and improve the content of an mHealth intervention before pilot-testing, based on consumer and clinician feedback.
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.
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.
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.
患有慢性疼痛的人群表示，逐渐减少处方阿片类药物的用量具有挑战性，需要更多支持。在我们的前期研究中，消费者指出移动健康（mHealth）技术可能是一种可接受的阿片类药物减量支持形式，并且可能提高减量自我效能感。
我们旨在根据消费者和临床医生的反馈，在进行试点测试之前评估并改进一项移动健康干预措施的内容。
参与者包括12名消费者和12名临床医生，他们对一个视频脚本初稿和90条短信进行了评估。消费者和临床医生使用5点李克特量表（1=完全不同意；5=完全同意）对视频脚本以及随机抽取的15条短信的适宜性和可能的有用性（消费者）或可能的有效性（临床医生）进行评分。每条短信初稿由2名消费者和2名临床医生进行评审。只有当参与者对短信适宜性和有用性或有效性的评分总和≥8分时，这些短信才被认为可纳入试点干预。参与者还被邀请就脚本初稿和短信提供开放式反馈。
消费者普遍认为视频脚本初稿和文本内容可能是适宜的（视频：均值4.4，标准差0.52；文本：均值4.3，标准差0.79）且有用（视频：均值4.3，标准差0.65；文本：均值4.2，标准差0.84）。同样，临床医生普遍认为视频脚本初稿和文本内容可能是适宜的（视频：均值4.5，标准差0.67；文本：均值4.4，标准差0.81）且有效（视频：均值4.0，标准差0.43；文本：均值4.3，标准差0.76）。总体而言，77%（69/90）的短信初稿达到了可被纳入移动健康干预试点测试的可接受性阈值评分，82%（74/90）达到了临床医生的可接受性阈值。消费者和临床医生的评分被用于对短信进行排序。选取了前56条短信初稿（均达到可接受性阈值水平）纳入试点干预。当提供了消费者或临床医生的反馈后，符合纳入试点标准的短信会进一步修订和完善。关于视频脚本的反馈也被用于在对干预措施进行试点测试之前进一步提高视频脚本的可接受性。
本研究描述了一项为期28天的移动健康干预措施在进行试点测试之前的评估和改进过程，该干预措施旨在支持慢性疼痛患者逐渐减少阿片类药物用量。该移动健康干预措施包括一个关于疼痛和阿片类药物减量的10分钟心理教育视频以及56条提供信息和安慰的独特短信（短信每天发送两次，共28天）。由于已确定移动健康干预措施的内容为消费者和临床医生群体所接受，该移动健康干预措施将在未来研究中进行试点。
