Table 1.

Examples of participant responses coded under each categorized domain to evaluate feasibility of the vAPA.

Acceptability (satisfaction, what participants like about intervention, intent to continue)

(i) Noninvasive, I do not need to use medication.

(ii) It's a natural remedy, holistic, and this is helping to reduce the pain.

(iii) I like that it is non-pharmacologic, no side effects.

(iv) Like tiny meditation anytime the seeds are pressed, press during the higher levels of discomfort helps bring the intensity down because it gives something to focus on. I would continue because of the mediation effect, takes mind off of the pain; and will suggest to others.

(v) I would like to continue using APA for tingling in my feet.

(vi) I might try APA with my other pains (e.g., headache, etc.)

(vii) I referred to my brother-in-law. Since he started APA, he has not used any pain killers. My sister used it for sciatica pain and it worked immediately.

∗ Usability and Implementation (participant engagement, recommendations)

(i) Training videos were helpful especially first time, help as a guide to place the seeds.

(ii) Videos helpful, maybe add more information on videos for clarity on finding ear points.

(iii) I watched it a couple times to understand the process and how to locate the points.

(iv) Recommend to develop a website with these videos, tips, Q&As that anyone can access.

(v) Zoom sessions very helpful and informative in locating ear points, instructions were clear; had 2 zoom meetings, these were sufficient.

(vi) The Zoom session was very helpful, nice interaction, live responses.

(vii) Instructions and explain better in the beginning as to frequency/time for pressing, to press more frequently if needed for pain, and that this is not a cure but the best to have realistic expectations.

(viii) Pictures of ears really helped.

(ix) It might be helpful if there were more photo of the ear points.

(x) Would also be better if there is a bigger diagram of the ear, both ears.

(xi) I found that sending my ear photo and receiving feedback were helpful.

(xii) Nice to participate with social distancing.

(xiii) ∗Participant responses related to participant engagement as to self-management and motivation in pain are noted in Table 3.

Practicality (cost, ability to carry out intervention)

(i) I would recommend to others because you do not have to spend money, helps alleviate the pain wherever the pain is.

(ii) It [APA] is cost-effective.

(iii) I can find my own pressure points at any time in the comfort of my home instead of depending on having to go to the doctor.

(iv) It [APA] is easy, easy to apply treatment, seeds/tapes stayed on very well, easy to find ear points.

(v) Small seeds and tapes, not easily noticed by others. I do not have to go to therapist, the treatment is simple to use and I can use whenever I feel pain.

(vi) I did not have to go anywhere, can do it [APA] at home.

(vii) I do not have to go to doctor's office, able to do all online.

(viii) I did not have problems finding the ear points.

∗ Perceived Benefits

(i) Pain went from 7 to 4 = 30 to 40% improvement, very happy with this.

(ii) If push seeds, pain go down to 1, normally have pain at 5.

(iii) Pain is constant but able to get it down with pressing the seeds; there is a change and happy with change.

(iv) You can start feeling results almost immediately.

(v) Pain seems to recur a lot on days without seeds, pain is less frequent.

(vi) Back pain is better, numbness down the leg is still a challenge.

(vii) I experienced improvement on the numbness in my toe, can walk a little bit further, and increased physical activity.

(viii) Stopped tingling feeling in feet when seeds are pressed, reoccurrence of tingling is less by pressing the seeds.

(ix) I was not into alternative medicine initially but this helps control the anxiety of getting the intense pain.

(x) It [APA] relaxes, helps with pain and stress, gets mind off pain.

(xi) When I put on the seeds for the first time, I had the best sleep in years. Has been getting good sleep since. Also noticed I am more consistent with my daily exercise because I do not wake up with pain anymore.

(xii) It [APA] helped me sleep better.

(xiii) Sleep quality is better, do not wake up with pain.

(xiv) ∗Participant responses related to perceived benefits as to better control of pain, less use of pain medications, and expectations for pain relief are noted in Table 3.

Potential Barriers

(i) Hard to find pressure point to place APA, need someone help place the seeds.

(ii) Seeds and tape fall off at times.

(ii) Tapes are irritating, itchy, and sore sometimes.

(iv) Sore after pressing but soreness goes away, would rather have soreness on the ear from APA than have pain.

(v) Nothing.