Lessons for Uptake and Engagement of a Smartphone App (SURE Recovery) for People in Recovery From Alcohol and Other Drug Problems: Interview Study of App Users

Abstract

Background Mobile health apps promoting health and well-being have substantial potential but low uptake and engagement. Barriers common to addiction treatment app uptake and engagement include poor access to mobile technology, Wi-Fi, or mobile data, plus low motivation among non–treatment-seeking users to cut down or quit. Working with people who used substances, we had previously designed and published an app to support recovery from alcohol and other drug problems. The app, which is available for free from the Apple App Store and Google Play, is called SURE Recovery. Objective The aim of this paper is to undertake a qualitative study to ascertain end users’ views and experiences of the SURE Recovery app, including how it might be improved, and present the findings on uptake and engagement to assist other researchers and app developers working on similar apps for people experiencing alcohol and other drug problems. Methods Semistructured telephone interviews were conducted with 20 people (n=12, 60%, men and n=8, 40%, women aged 25-63 years; all identifying as White British) who had varied patterns of using the app. The audio recordings were transcribed, and the data were coded and analyzed through Iterative Categorization. Results Analyses identified three main factors relevant to uptake (discoverability of the app, personal relevance, and expectations and motivations) and three main factors relevant to engagement (the appeal and relevance of specific features, perceived benefits, and the need for improvements). The findings on uptake and engagement were largely consistent with our own earlier developmental work and with other published literature. However, we additionally found that uptake was strongly affected by first impressions, including trust and personal recommendations; that users were attracted to the app by their need for support and curiosity but had relatively modest expectations; that engagement increased if the app made users feel positive; and that people were unlikely to download, or engage with, the app if they could not relate to, or identify with, aspects of its content. Conclusions Incorporating end-user views into app design and having a network of supportive partners (ie, credible organizations and individuals who will champion the app) seem to increase uptake and engagement among people experiencing alcohol and other drug problems. Although better digital literacy and access to devices and mobile data are needed if addiction recovery apps are to reach their full potential, we should not evaluate them based only on observable changes in substance use behaviors. How using an app makes a person feel is more transient and difficult to quantify but also relevant to uptake and engagement.

Digital tools to support the implementation of self-care among people with problematic substance use: An integrative literature review

“…The research articles for the final review numbered 18 [53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69][70]. The PRISMA flowchart for literature search is presented in Figure 1.…”

“…In many of the articles the background data collected included the age, gender, educational background and/or employment status of those using the application [56,58,[61][62][63][64]68]. Rather than on changes in substance abuse, our research interest centred more on non-demographic factors predisposing to the use of the application even though research has shown that both gender [68] and age [53,70] frequently need to be considered regarding…”

“…FinJeHeW 2023;15(3) 266 the content of applications. Present and previous modes of substance abuse may also be of significance in the successful adoption of the application and of self-care [53,57,58,63,64,67]. For example, the substances abused, the duration of the abuse and the severity of the problem may be significant aspects and affect a person's avoidance of risk in substance abuse.…”

“…For example, the substances abused, the duration of the abuse and the severity of the problem may be significant aspects and affect a person's avoidance of risk in substance abuse. Moreover, cognitive skills [53] and digital literacy [57,60,64] influence the use of digital applications. Mental health problems may also pose challenges to the implementation of digital self-care [53,[57][58][59]62,67].…”

“…Motivation and commitment to using the application are increased by the suitability of its content and its technical properties, which at their best support the fluency of use and user-friendliness. Expectations of the application [64] affect choices, especially in the initial phase. The content of the application may consist of various activities [66], and gaming and offering varying tasks increases teenagers' commitment to using the application [53].…”