Development of a Peer-Led, Narrative-Based, and Mobile-Supported Intervention to Enhance Linkage to Outpatient Treatment for Opioid Use Disorder: Formative and Pilot Research (Preprint)

BACKGROUND The ongoing opioid epidemic has been associated with increases in emergency department visits and hospitalizations for drug overdose and injection-related infections. These encounters with the healthcare system provide an opportunity to offer drug treatment linkage and support for people with opioid use disorder (PWOUD). There is a need for interventions that enhance linkage to and engagement in treatment with medications for OUD (MOUD) for PWOUD identified in hospital settings as they transition back to community settings. OBJECTIVE The mTools4life study aimed to develop and evaluate a peer-led intervention integrating narrative-based health communication into a mobile health (mHealth) application to increase post-hospitalization engagement in MOUD and reduce substance use. METHODS The formative phase of the study consisted of semi-structured interviews with PWOUD and clinicians who provide care to PWOUD. Interviews sought to identify salient content to include in visual narratives within the mHealth application and information that may increase motivations for behavior change related to MOUD engagement. The intervention was developed in accordance with the Information-Motivation-Behavioral Skills Model, transportation theory, and the transtheoretical model. The pilot phase of mTools4Life aimed to evaluate acceptability and usability of the intervention. PWOUD were recruited from the Johns Hopkins Hospital Emergency Department and consented to receive the intervention for a 3-month period. Participants completed a study survey at baseline and a 3-month follow-up. Data on demographics, past 30 day substance use, MOUD, and intervention appropriateness and acceptability were obtained at both time points. Additional data on intervention uptake and frequency of use were collected at follow-up. Dependent samples t-tests were conducted on continuous data and Fisher’s exact tests were conducted on count data. RESULTS Twenty PWOUD piloted the intervention. The sample was mostly male (65.0%) and white (65%) with a mean age of 41.1 (SD=8.7). Most participants (80.0%) completed the 3-month follow-up. Fewer participants reported opioid use at follow-up (56.3%) compared to baseline (100.0%) (p=.001), and mean days of opioid use out of the past 30 days declined from baseline (19.9, SD=11.7) to follow-up (8.3, SD=11.4) (p=.002). MOUD treatment in the prior 3 months was reported by 65.0% of participants at baseline and 81.3% at follow-up (p=.46). Most participants used the app (68.8%) or engaged with their peer navigator (62.5%) during the intervention period. At follow-up, mean (SD) acceptability and appropriateness scores (scale 0-5; higher score indicating greater acceptability or appropriateness) were 4.5 (0.5) and 4.3 (0.8), respectively. CONCLUSIONS This study demonstrates feasibility of the development and deployment of a narrative-based mHealth intervention to support OUD care engagement and preliminary data in support of the intervention’s acceptability, appropriateness, and effectiveness.