Table 3.

Summary of perceived barriers to and facilitators of patients’ engagement with implications for mobile health design, functionality, and content.

Theme			Implication		Recommendation
Barriers to engagement
	Internet access	Functionality		SMS text messaging–based intervention may be more feasible than app-based intervention for this population
	Access to smartphone technology	Functionality		SMS text messaging–based intervention may be more feasible than app-based intervention for this population
	Digital literacy or confidence in using SMS text messaging versus apps	Design and functionality		SMS text messaging–based intervention may be more feasible than app-based intervention for this population
	Vision impairment	Design		SMS text messaging–based intervention may be more feasible than app-based intervention for this population
	Reservation about app use	Design		SMS text messaging–based intervention may be more feasible than app-based intervention for this population
Facilitator of engagement
	Maintaining contact with health care provider	Functionality		Communicate to users that the purpose of the intervention is to provide support in addition to that delivered by the health care provider
	Fluctuating dose (support) needs	Design		User controls frequency of messaging after an initial standardized dose
	Fluctuating content needs	Functionality		User can request support with specific issues by texting keywords to the server (eg, “crave,” “anxious,” or “pain”)
	Familiarity with pain management strategies	Design		Standardized pre-education may be needed to ensure that patients have a basic understanding of pain management and reasons for opioid tapering before they receive supportive messages
	Desire for individualized care	Functionality and content		Personalization of SMS text messaging content. Use of name and message tailored to demographic details of user
	Predictability	Functionality		Variability in the time of day the messages are sent can increase attention and engagement
	Socioemotional reassurance	Content		Validating message content that aims to normalize concerns that participants may have in their tapering (eg, “It’s natural to worry about pain increasing”)
	Informational reassurance	Content		Informational message content to educate on nonopioid pain management (eg, “opioids are proven to relieve acute pain but not chronic pain”)