The Development of a Patient-Centered Digital Health Care Technology for Young Adults in Opioid Use Disorder Treatment: Qualitative Study.

Background: Young adults, defined as individuals between the ages of 18 and 29 years, drop out of opioid use disorder (OUD) treatment more often than older adults. Premature treatment drop-out substantially increases fatal overdose risk. Self-monitoring through text messaging has been researched extensively among people with OUD to identify drop-out risk factors. Self-monitoring could potentially improve methadone treatment engagement among young adults, who are a population that is both hard to reach and more likely to use technology compared to older adults. Self-monitoring can increase risk factor awareness and help patients and counselors develop targeted coping strategies and treatment plans. However, embedding a discussion of risk factor information into existing counseling sessions has been limited and may offer a promising opportunity to improve engagement among young adults. Objective: This pilot proof-of-concept study examined the implementation of self-monitoring intervention, AWARE (Awareness and Response to the Environment), designed to bring attention to treatment drop-out risk factors among young adults and create discussion about risk factors with their existing treatment counselor. Methods: In this formative research, a convenience sample (N=8) of young adults (n=3, 38%) in methadone treatment, their counselors (n=3, 38%), and clinic leadership (n=2, 25%) were recruited from an opioid treatment program after referral from treatment staff. Participants were interviewed to obtain feedback as AWARE was developed. In semistructured interviews, perspectives regarding barriers to treatment for young adults and AWARE utility were obtained. Concurrently, 3 dyads of young adults (n=3, 38%) and counselors (n=3, 38%) piloted the intervention daily for 4 weeks. Results: The 3 consented young adults with OUD participants (n=2, 67% female; n=2, 67% Latino/a) were sent daily surveys for 28 days (53% overall completion rate). Young adults and counselors found AWARE relevant to their treatment experience and acceptable to complete over 4 weeks. The most reported daily stressors included concerns about the health and well-being of a family member, challenges with staying organized, and feeling overwhelmed by responsibilities without adequate support. In qualitative interviews, counselors and clinic leadership reported that AWARE presented a relevant, new way to engage young adults daily, in addition to weekly counseling sessions. Young adults felt that prompts sent by AWARE offered a type of social support they lacked, like "someone checking in on them." Conclusions: Overall, young adult and counselor participants were able to engage in AWARE in a busy clinic environment, and participants and clinic leadership found it valuable. By addressing common stressors and providing a sense of social connection, AWARE may help fill a gap in support between counseling sessions. However, the study was limited by the small number of young adults engaging in methadone treatment. Further research is needed to refine the measures and methods of AWARE and evaluate its effectiveness.