Table 2 Intervention themes, subthemes, and supplemental quotes
Intervention themes | Subthemes | Quote |
|---|---|---|
1. Experiences and expectations of treatment | Intractable pain | “Long. Years. Of misery. And still no results.” [Participant 12, Black male in his 50′s] |
Helpless re: pain | “But I mean, when it’s not the weather it’s still, you know it’s still there. The showers and the baths not gonna do anything.” [Participant 6, Black female in her 50′s] | |
Treatment history and temporary results | “I’m just tired of taking pills and it’s not working. You know what I’m saying? It’s like okay I sit here, I don’t do nothing. I take the pills and it you know, it sustains some and so it gives me a little bit of motivation but like still. It’s just constant pain. It’s just constant pain. It gets aggravating.” [Participant 12, Black male in his 50′s] | |
Barriers to care | “Well, I uh plan to go to acupuncture very soon. […] So I hope I’m one of the people they can actually get in because it’s on a first come first serve basis. Get there early and you know, get some acupuncture.” [Participant 5, Black female in her 50′s] | |
Treatment expectations | “A lot of people want the instant results. And if they don’t see the instant results, ‘pfft, what I’m I doing it for?’ […] The individual, the individual themselves has to realize it’s not a microwave. Everything can’t be done quick.” [Participant 3, Black male in his 30′s] | |
2. Reasons for drinking | Enjoyment/relaxation | “I feel comfortable with it [current amount of drinking]. Like it just gets me where I want to be. I mean I don’t want to get drunk drunk. I just want to be mellow and then after that go to bed.” [Participant 1, White Hispanic male in his 60′s] |
Social interaction | “it’s more of a social thing as opposed to an addiction or becoming a problem for me.” [Participant 10, Black female in her 40′s] | |
Routine | “I just go home, I drink, and then I go to bed.” [Participant 4, Black female in her 60′s] | |
Sleep | “And sometimes for sleep I know I would drink alcohol to help me sleep you know cause the pain pills is hard to get. Especially these days […] So right now my pain is probably worse when I’m trying to go to sleep so if I tend to drink alcohol, that’s probably why. Cause it helps me go to sleep.” [Participant 7, Black male in his 50′s] | |
Mood | “I was in a lot of pain, like as far as physically and emotionally, you know. Like I lost a sibling so it was you know, I would say maybe I was kind of self-medicating with like alcohol. Cause at that point I used to drink to the point where I would pass out. So that I wouldn’t have to feel anything.” [Participant 11, Black Hispanic female in her 30′s] | |
Distraction | “I’m thinking about stopping the drinking, going through the program, stop the smoking you know? But I got to do- my limbs gotta be good so I could try and do other stuff to occupy that time. Cause all of that is part of that addictive behavior, you know what I’m saying? I got to substitute it with something, you know what I’m saying? I got to be able to walk in the park, do something just, you know what I’m saying? When you get that urge or that crave, you know what I’m saying? You can occupy the mind with something else, you know what I’m saying?” [Participant 12, Black male in his 50′s] | |
Numbing | “I was just drinking to block everything. It’s pretty much a self-medication. I get a numbness from it. Like you’re not there, the pain is not really there.” [Participant 4, Black female in her 60′s] | |
3. Motives to change drinking | Low readiness to change | “I haven’t quit where it was full me. Where I made the decision. It’s been either the decision was made for me, as in um, a ruined relationship where I felt like if I quit drinking because the relationship ended I could be better in the next relationship. And I quit for… I quit for my ex more than I quit for me.” [Participant 3, Black male in his 30′s] |
Reasons to change | “ And I’m trying not to drink that much cause you know, some people use alcohol to suppress their depression. So I don’t want to fall in that category. You know, bad enough I can barely walk and imagine barely walking and walking around drunk or… you’re an accident waiting to happen. I got to take care of myself at the end of the day. You know? Not too much else I can do.” [Participant 12, Black male in his 50′s] | |
Barriers to change | “Not really, I know the dangers of it and I know I probably shouldn’t but right now it’s what works for me.” [Participant 7, Black male in his 50′s] | |
4. Use and perceived value of technology | Limited computer access | “No, I have to go to somebody to get on one [a computer].” [Participant 2, Black male in his 60′s] |
Daily smartphone use | “I use at least 4 apps, at least 3 times a day.” [Participant 5, Black female in her 50′s] | |
Videochatting/messaging | “I do like it. Especially now that my grandson- I have two grandkids, so they Facetime me every day so, I love it.” [Participant 8, White Hispanic female in her 50′s] | |
5. Barriers to a smartphone-based intervention | ||
5a. Lack of familiarity with and fear of new technology are key barriers to smartphone intervention | Unfamiliar and disorienting | “No, my friends does that. I don’t- you gotta download a plan or something in your phone they told me. Why people gotta see you? While I’m talking to them?” [Participant 12, Black male in his 50′s] |
Openness to learning | “No, cause I don’t know how to do that yet [watch videos on phone]. And I wish I did.” [Participant 6, Black female in her 50′s] | |
5b. Critical need for privacy, trust, and some limited contact with a provider | Security, privacy, legitimacy | “I don’t think I trust it. I would like the human opinion. Not this kind- I don’t go for that. Just as a whole- I, I don’t trust that.” [Participant 1, White Hispanic male in his 60′s] |
Desire for in-person contact | “But like I said every now and then I want to sit down and just talk. Face-to-face.” [Participant 2, Black male in his 60′s] | |
6. Ways to increase engagement and adherence | ||
6a. Support, results, and positive reinforcement | From coach | “I think it would be very helpful. I mean, you know to help you reach your goal, and you know, like just knowing that someone was helping you to reach the goal. Whether it’s managing pain or not drinking, you know.” [Participant 5, Black female in her 50′s] |
From content of intervention | “I think having a set time, you know? And like a, a certain number of days that you actually do it could be helpful because sometimes I just don’t feel like doing things but if it’s something that I really should do, then I just push myself to do it.” [Participant 5, Black female in her 50′s] | |
From rewards | “If they offered something that’s real. Not just giving you a gold star, you know? I think that’ll make people do even more.” [Participant 1, White Hispanic male in his 60′s] | |
From incentives | “Incentives inspire, inspire everybody […] When you’re setting your goal, give yourself a goal but give yourself an incentive to get to that goal.” [Participant 3, Black male in his 30′s] | |
6b. Importance of autonomy and choice | Value of having choices | “I think all that you have to offer [in regards to health coach interaction options]. The texting, or even a phone call. Yeah. Cause some people might not want to just talk.” [Participant 10, Black female in her 40′s] |
Value of convenience | “Yeah, I said that because you can- you’re home, and you ain’t gonna go nowhere, and they showing a fist [progressive muscle relaxation tutorial]. That’s something you can do easily. Anywhere in any part of the house you can do that. You know? Just out on the porch you know, just by yourself.” [Participant 7, Black male in his 50′s] |