P-102 - (Poster #102) Living with Pain, Engaging with Purpose: Use and Usefulness of a Digital ACT-Based Self-Management App

Chronic pain affects nearly 20% of U.S. adults—approximately 50 million people—and is a leading reason adults seek medical care. Poorly managed pain can interfere with daily functioning and psychological wellbeing, reduce quality of life, contribute to patient dissatisfaction, and may lead to increased healthcare utilization and costs.  

 
Due to growing concerns about the opioid epidemic, national guidelines now recommend behavioral and psychological interventions as first-line or complementary treatments. While evidence-based behavioral and psychological treatments exist, numerous barriers reduce access to these treatments. Treatments that require clinician involvement present access challenges, given that clinicians have significant time constraints and often report inadequate training for delivering chronic pain related behavioral treatments. Patient use of behavioral strategies for chronic pain may increase with access to digital app programs that can be self-administered and include evidence-based solutions. 

Purpose/Objectives:

As part of a National Institute of Health funded Small Business Innovation Research grant, 2Morrow, Inc. designed and developed Salty for Chronic Pain, a novel behavioral digital app designed to provide chronic pain education, coaching, and self-management. This presentation explores patients’ experience, namely their utilization and ratings of usefulness. Understanding how patients engage with the app and rate various aspects of the program may provide useful information about patients' likelihood of adoption.

Methods:

As part of a small randomized controlled feasibility trial, eligible patients were assigned to either usual care or access to a digital behavioral health app. This analysis examined patterns of app use and participants’ self-reported perceptions of its usefulness.

About the App
The app delivered Acceptance and Commitment Therapy (ACT)–informed content, in-app coaching, self-monitoring, and values-based behavioral strategies. It featured 58 core lessons across four thematic sections, plus bonus content. Using a metaphorical journey, it guided users through physical, emotional, and social dimensions of pain and supported strategies to reduce pain interference and improve quality of life. Users earned “passport stamps” (up to 12) for completing app use milestones.

Recruitment
Adults receiving primary care for chronic pain in Washington or Idaho who reported pain interference, spoke English, and had smartphone access were invited. Participants completed baseline surveys and received instructions to download the app.

Measurements and Analysis
Baseline surveys included demographics and pain history. Follow-up surveys at 3 months included the mHealth App Usability Questionnaire (MAUQ), satisfaction, and likelihood to recommend. Engagement was assessed via app analytics, including features accessed, usage patterns, and milestone completion. Descriptive statistics were calculated for participants who activated the app.

Results: Of 49 participants who enrolled in the study and completed the baseline survey, 40 (82%) activated the app. Over 12 weeks, users averaged 27 days of app use (range: 2–118) and completed an average of 25.5 core lessons (range: 1–58). Core lessons were delivered in a time locked protocol that limited people to a maximum of three core lessons each day, and modules needed to be completed before unlocking a new module. Engagement highlights include: 43% completed the full “Hometown” module; 25% completed all 58 core lessons; 35% accessed bonus content; 50% completed daily check-ins. All users earned at least one passport stamp, and 25% were classified as high-engagement users based on days of use and stamps earned (≥50 days of use and ≥9 stamps). Usability ratings based on the MAUQ (n=35) were generally positive in terms of ease of use and satisfaction, with highest scores related to the app being easy to use and learn and overall satisfaction.  Lower scores were related to features not designed in the app, e.g., improving access to health care services and communication with health care providers.

Conclusions/Implications for future research and/or clinical care: App use rates based on days of use were consistent with the instructions provided to participants at the start of the program. Findings suggest that most patients engaged in an ACT-based digital app solution for chronic pain found it useful for addressing pain concerns, easy to use and satisfactory. Digital tools like Salty may improve patient use of evidence-based behavioral strategies for pain self-management while improving patients’ access to these strategies. Future studies should assess clinical outcomes, evaluate unlocking all content for users and the use of reminders and nudges, explore long-term engagement, and evaluate integration into primary care workflows.