Mindfulness Texting for Medication Adherence and Chronic Pain Management

Engagement with the mindfulness text messages is assessed using one binary item asking whether participants thought about or used any suggestion from the MiMA Study text messages since that morning and one 11-point rating (0 = not at all to 10 = very much) assessing the extent to which participants thought about or used the suggestions. Participants also rate the extent to which the mindfulness text messages helped them manage pain, opioid craving, medication adherence, and withdrawal symptoms (0 = not at all to 10 = very much).

Acceptability will be assessed using an adapted message fatigue questionnaire and intervention engagement scale. Items are rated on 5-point Likert scales, with mean scores greater than 3 indicating acceptable levels of intervention satisfaction.

Feasibility will be evaluated using recruitment, retention, and survey completion rates. Prespecified benchmarks include recruitment of at least 50% of eligible participants and retention rates of at least 75%, 65%, and 55% at Weeks 3, 6, and 12, respectively. Responding to EMA on 25%, 50%, and 75% of days will indicate a low, medium, and high level of feasibility, respectively.

Participants indicate how much they believe the mindfulness text messages helped them engage in valued activities, engage in everyday activities, be mindful, and accept thoughts and situations without judgement (response range: 0=not at all, 10=very much).

Mindfulness will be assessed through a 6-item EMA scale that measures state mindfulness in the past 15 minutes. Responses are made on a 5-point response scale ranging from 1 (not at all) to 5 (very much).

Pain is assessed using a single-item asking participants to rate their current pain compared to their typical pain level. Responses are made on a 10-point response scale ranging from 0 (a lot less than usual) to 10 (a lot more than usual). A response of 5 represents "about the same as usual".

Pain interference is assessed using two items assessing interference with what participants are doing and their enjoyment of life. Responses are made on an 11-point response scale ranging from 0 (not at all) to 10 (very much).

Medication adherence will be assessed using daily self-report of medication for opioid use disorder (MOUD) use. Within-participant adherence will be calculated as the percentage of study days on which participants reported taking their medication as prescribed. Participants taking medication on at least 80% of study days will be classified as adherent.

Craving is assessed using two items asking participants to rate the strength of their urge and their need to use opioids on an 11-point response scale ranging from 0 (not at all) to 10 (very much).

Self-efficacy is assessed using a single item asking participants to rate their confidence in their ability to not use opioids on an 11-point response scale ranging from 0 (not at all) to 10 (very much).

Values-based living is assessed using two items adapted from the Values Tracker for ecological momentary assessment (EMA). The items measure engagement in actions that contribute to participants' quality of life and progress toward life areas that are important to them. Responses are made on an 11-point scale ranging from 0 (not at all) to 10 (extremely).

Opioid misuse is assessed using a single item asking participants to endorse whether or not they have used non-prescription or prescription opioids more frequently than prescribed since they last completed a survey.

Withdrawal symptoms are assessed using one binary item asking whether participants experienced opioid withdrawal symptoms since the previous assessment and one 11-point rating assessing current withdrawal severity (0 = not at all to 10 = very much).