JMIR Publications

ABSTRACT

Background:

Buprenorphine is an effective and safe medication for opioid use disorder that can be delivered in office-based addiction treatment (OBAT). Yet, over half of people who initiate buprenorphine disengage and return to unhealthy opioid use. Accordingly, it is critical to improve OBAT retention. Mobile applications using embodied conversational agents (ECA) have improved care in other chronic diseases and may increase OBAT retention.

Objective:

To explore patient perspectives on how an ECA can support retention in OBAT programs.

Methods:

We conducted a series of 6 focus groups with a single cohort of 8 patients receiving treatment with buprenorphine within an OBAT program. Focus group topics included experiences with treatment initiation and retention, beliefs about barriers to retention, understanding participants’ perspectives for how an application with an ECA could support retention for new patients, and feedback on ECA prototypes. A socioecological model guided our deductive and inductive thematic analyses.

Results:

Participants had been engaged in care for 4-18 years. They identified how an ECA could address barriers to retention across four levels of the socioecological model. At the society level, the application could provide information about basic needs including housing and food access. At the community level, participants expressed unclarity about buprenorphine and wanted information about dose, side effects and discontinuation strategies that had been verified by their healthcare provider. At the interpersonal level, they endorsed the application’s ability to function as peer-support. They recommended that the agent embodied a peer in recovery and that storytelling related to lived experience would be a constructive tool.

Conclusions:

An ECA was perceived as a helpful tool to support retention in OBAT by addressing fundamental socioecological needs and by providing information and linkage to resources. Implementation of an ECA system based on these findings should be evaluated in a clinical trial to improve retention in OBAT programs.