A qualitative exploration of patient’s experience of mobile telephone-delivered Contingency Management (mCM) to promote adherence to supervised methadone in UK pharmacies

Contingency Management (CM), involving the application of positive reinforcement to promote behaviour change, has a well-established evidence-base demonstrating its effectiveness in promoting substance use related health behaviours, including abstinence and medication adherence. CMs growing research base has highlighted the promising role that technology may play in enhancing the reach of CM and surmounting barriers to implementation (i.e., mobile telephone-delivered Contingency Management; mCM). The aim of this research was to explore how patients with opioid use disorder experience mCM to understand better how it might work and aid development of future interventions.

Participants (N=9) were patients in opioid agonist treatment receiving 12-weeks of mCM as part of an existing UK-based intervention. The mCM consisted of text messages of praise and financial incentives loaded onto a pre-paid debit card to encourage adherence to daily supervised methadone. Longitudinal qualitative interviews were conducted at two and 12-weeks post enrolment and analysed using Framework, to explore how participants interacted with and experienced the mCM intervention over time.

Patients reported positive attitudes and acceptability towards CM and the use of mobile telephones to deliver these interventions remotely. Patients perceived mCM as a strong motivator, encouraging their adherence to methadone. The findings suggest the development of a connection with the mCM, one that in many aspects resembles a therapeutic alliance. These interactions were deemed positive, friendly, and non-critical, with patients expressing a level of confidence, reliance, and trust in the mCMs ability to help in their recovery.

The mCM intervention was deemed acceptable and was well received by patients. The mechanisms of CM operated as intended, despite the remote application and absence of human interaction. The study highlights the difficulties patients face in adhering to their methadone treatment and provides support for the role that CM could play in encouraging their adherence to this effective treatment.