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End User Participation in the Development of an Ecological Momentary Intervention to Improve Coping With Cannabis Cravings: Formative Study


Anderson MA, Budney AJ, Jacobson NC, et al.


To elicit end user input to improve mindfulness- and distraction-based coping strategy messages for use in an ecological momentary intervention to support young adults with cannabis cravings.


Young adults (aged 19-25 years, N=20) who reported using cannabis (>10 of the last 30 days) and interest in reducing their use were recruited via Facebook ads. Participants completed ratings for 15 mindfulness-based and 15 distraction-based guidance messages for how to cope with cannabis cravings. The messages were initially developed using existing evidence-based interventions and adapted to cannabis use specifically. Participants rated the messages on a scale from 1 to 4 (very low to very high) for understanding, usefulness, and tone. Participants were also asked to provide free response comments for how to further improve each message. After this round of feedback, researchers revised the messages and asked participants to reevaluate using the same process. An example of an initial mindfulness message is "Notice any thoughts you have about your urge to use cannabis. Let these thoughts come into your attention, then just naturally fade away as though they were floating down a stream". For a distraction message, an example is "You have more control over your feelings than you may think. Focus on something else to distract yourself from your urges to use cannabis. Listen to your favorite song and zero in on the lyrics and the beat".


• In the first round of feedback, distraction messages were rated as slightly clearer compared to mindfulness (mean 3.5, SD 0.4 and mean 3.4, SD 0.4, respectively), both were comparable in tone (both mean 3.2, SD 0.5, SD 0.4 respectively); mindfulness messages were rated as more useful compared to distraction messages (mean 3.0, SD 0.5 and mean 2.8, SD 0.6, respectively).
• Twenty-nine of the 30 messages were rated low (≤2 out of 4) on at least one domain by at least 3 participants or received a comment suggesting a change.
• In the second round of feedback, ratings improved significantly for usefulness of distraction messages (t17=2.5, p=.02) and tone for mindfulness messages (t17=2.64, p=.02); no significant changes were found on the other domains.
• Final messages were comparable in clarity, tone, and usefulness and all domains were rated >3.


• The formative process reported upon in this study led to significant improvements in messages.
• A selection of the highest-rated messages was subsequently used in a digital intervention to support young adults in coping with cannabis cravings.
• This study highlights the importance and value of including end users in the formative development of interventions.

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Anderson MA, Budney AJ, Jacobson NC, Nahum-Shani I, Stanger C. End User Participation in the Development of an Ecological Momentary Intervention to Improve Coping With Cannabis Cravings: Formative Study. JMIR Form Res. 2022 Dec 15;6(12):e40139. doi: 10.2196/40139.