Designing digital health interventions for opioid use disorder: Perspectives on iENDURE.

Objective: iENDURE is an eight-week, combined computer and text-messaging intervention, designed to augment medication-based treatment for opioid use disorder (OUD) by enhancing motivation to engage in treatment/recovery and promoting tolerance of distress. The present study examines participants' experience using iENDURE. Methods: Adults engaged in outpatient buprenorphine treatment were recruited as part of a larger randomized controlled trial and completed semi-structured interviews with trained study team members. Interviews were audio-recorded and transcribed by a professional agency. The transcripts were coded into a consensus framework matrix by two authors. Results: iENDURE was well-received by participants, who enjoyed receiving the motivational reminders and daily questions. Engagement with certain features was highly dependent on participants' recovery stage. Nearly half of the sample highlighted the program's ease of use. Further, offering daily skill recommendations through a text-message format allowed for easy access to evidence-based content. All participants but one (29/30) completed the eight-week intervention. Half the sample engaged with iENDURE each day, and the daily provision of support was deemed by most participants as their favorite part of iENDURE. Conclusions: Overall, participants were receptive to the iENDURE intervention as a daily digital supplement to their treatment plans. Recommendations for further optimization and refinement include: personalization in content and delivery structure, accessibility in engagement recommendations, and ease of use of the intervention.