JMIR Publications

ABSTRACT

Background:

Relaxation-based mHealth interventions hold great potential for addressing perioperative anxiety and pain management in a scalable manner. Success requires sustained user engagement with the intervention to facilitate the desired. However, there is limited research on how user perceptions and performance of relaxation-based interventions relate to each other in reflecting user engagement.

Objective:

The goal of our study was to investigate how user performance and perceptions can be used to understand user engagement with a relaxation-based mHealth intervention. We also explored important themes that enhance our understanding of user engagement with mHealth interventions.

Methods:

We designed and implemented an mHealth intervention known as MiCarePath, a relaxation-based intervention used to decrease preoperative anxiety and postoperative pain. In addition to three educational videos about surgery, MiCarePath includes video-based activities such as guided imagery and breathing exercises. Nineteen participants were given access to MiCarePath at least 10 days prior to surgery, and through one month post surgery. Participants’ video engagement data, repeated measures of pain and anxiety levels, and participant perceptions of the relaxation videos were collected. We conducted semi-structured interviews at different time points during the study to probe user experience with the intervention and analyzed changes in user engagement over time. This paper focused on a mixed-method analysis of participant engagement with video-based relaxation exercises.

Results:

Eleven participants reported developing or improving relaxation-based coping strategies while 8 participants reported little benefit from the intervention. Those reporting improved coping skills had a significantly higher level of engagement with the videos overall compared to the other 8 participants. However, within each group, we observed a discrepancy between participant performance and their perceptions. That is, some participants from the high benefit group showed a decrease in video engagement after surgery but still reported feeling engaged with the intervention. Interview data revealed that intentional use behavior (i.e., proactive and conscious engagement with the intervention for desired health-related effects) may help distinguish participants who reported high benefit from those who did not. Our data suggested that participants who developed intentional use behavior may practice relaxation techniques without the aid of the app and could resume their engagement after experiencing contextual disruptions.

Conclusions:

This study explored user engagement with a relaxation-based mHealth intervention for perioperative anxiety and pain management. Results from this study showed that user perceived benefit might not always be reflected in user performance (e.g., video engagement). The intentional use of mHealth intervention content surfaces as an important indicator of perceived benefit and suggests that future research should explore strategies for incorporating intentional use into evaluating mHealth interventions and designing interventions to shape intentional use.