JMIR Publications

ABSTRACT

Background:

On a population level, digital mental health interventions are accessible and effective. However, middle-aged and older adults with chronic pain are a large and growing population who have been neglected during the development process of these interventions. Although technology use is rapidly growing among this population, their engagement with digital health interventions is lagging because usability is often not optimized for their needs and preferences.

Objective:

This study aimed to identify design preferences and determinants of engagement with digital mental health interventions by middle-aged and older adults who have chronic pain and coexisting symptoms of depression or anxiety.

Methods:

In this qualitative study, participants completed a semi-structured interview regarding their experience with, and perceptions of, mobile devices, apps, and digital health interventions. Participants were at least 45 years old; scored ≥10 on the Patient Health Questionnaire (PHQ)-9, Generalized Anxiety Disorder (GAD)-7, or both; and endorsed pain on most days or every day in the past three months. The interview guide was informed by the Consolidated Framework for Implementation Research and the Behavioral Intervention Technology model. Codes were organized into themes. Recruitment continued until data saturation was achieved.

Results:

Forty-two participants were interviewed (mean (SD) age 57 (8) years, 32 (76%) women). Participants strongly preferred apps that are free, describe strong privacy policies, and add functional value to their lives. They were more motivated by “real-life” goal achievement and tangible health improvements than by gamification within an app, and many were wary of allowing apps to passively collect certain types of data, especially to make inferences about their mental health. Most participants were unaware of apps designed to address chronic pain, but they were interested in the concept, particularly to help track their mood and pain and then identify associations between their symptoms, app activity, and other life events. Despite their daily use of apps, many participants described frequent challenges related to app navigation. While on-demand access to app tools was preferred, most participants appreciated the potential value of occasional push notifications if their timing was thoughtful and customizable. Participants cautioned against an overly cheerful, “infantile,” or informal tone for an app that addresses serious issues such as mental health and chronic pain.

Conclusions:

Digital health interventions for middle-aged and older adults should highlight tangible health improvements that can be achieved from app engagement (more so than gamification), potentially using a multi-domain tracking feature, if appropriate. This population is available to receive just-in-time adaptive interventions, but JITAI frequency and timing should be thoughtful, customizable, and not wholly reliant on passively collected personal data. Digital health interventions designed to address conditions that are more common with increasing age should account for these preferences. Clinical Trial: N/A