Table 2.

General patterns of mobile device and app use among nondigitally native adults who have chronic pain and coexisting symptoms of depression or anxiety.

Theme		Representative quote
Tools
	Life navigation: participants typically used apps “because they have to” for daily life (eg, for driving directions, banking, taxes, shopping, coupons, alarm clocks, current events, and having a contact method in case of emergencies).	“I pretty much use my phone for absolutely every aspect of my life...work, grocery list, like everything.” (48-year-old male)
	Leisure: participants also frequently used apps that facilitate social connection and entertainment (eg, social media, video chatting, taking pictures, shopping, and, less commonly, to play games).	“Keep in touch with other people, movies and TV, sometimes books, sometimes for my grandkids.” (60-year-old female)
User design
	Usability challenges with mobile devices: participants commonly experienced challenges using their mobile devices due to dexterity difficulty with their screen’s size and forgetting passwords.	“Remembering my password is definitely [a challenge]. Sometimes finding the right one, because if you put in an AT&T one, sometimes there’s three or four of them and it’s like, ‘Which one is the one that I should actually be downloading?’” (60-year-old female)
	Usability challenges with apps: participants also reported challenges navigating within some apps, understanding how to take advantage of all an app’s features, and reducing unwanted notifications for some apps.	“Some of the apps are confusing with how they want you to move around, and they don’t really explain it.” (60-year-old female) “Trying to figure out everything that the app does—to make sure I’m using the maximum of everything that it does.” (53-year-old female) “Some of my apps give me notifications that I don’t really want. Figuring out how to turn off unwanted notifications can be a challenge.” (64-year-old female)
	Troubleshooting: when participants have trouble navigating an app, they typically first “push around” on their own to troubleshoot. Next, they search the internet for assistance. Finally, they reach out to their social circle or a professional for navigation assistance if needed.	“Pretty much in this order—I will try it on my own. Then I will look up a video because it’s like, ‘I’m determined to do this.’ But then if it’s something too complicated, then usually I call one of my kids.” (53-year-old female)
Timing of interactions
	Availability for alerts: most participants kept their smartphones almost always within arm’s reach, except maybe silenced while sleeping or driving.	“I rarely turn it off.” (60-year-old female)
	Response time: participants typically responded to mobile device messages immediately or within the same day.	“[I respond] when I see them, if I need to.” (50-year-old female)
General app preferences
	Pros: participants preferred apps that are free, functionally meaningful, personally relevant, and ideally have good brand reputation.	“I don’t typically pay for a lot of the apps. There’s usually free versions of something out there that you can find...There is a medication that I use that they have you download the app for, and there’s no point to it. There’s no purpose to it, so it’s just taking up space on my phone.” (49-year-old female)
	Cons: participants were less likely to use apps that raise privacy concerns about how their data will be used or that frequently display advertisements. Some participants were also less likely to use apps that require high data usage or a stable internet connection.	“Making sure tracking and invasion of privacy is not an issue.” (72-year-old male)