Designing mHealth Apps for Substance Use Recovery Through Real-World Co-Design and Deployment: Mixed Methods Study

BACKGROUND: Mobile health (mHealth) apps have shown promise to support recovery from substance use disorders. However, evidence on engagement and efficacy is still inconclusive. OBJECTIVE: This study aims to identify design considerations for optimizing engagement in mHealth apps for those recovering from problematic substance use, by analyzing real-world experiences with co-designed app features. METHODS: We co-designed, deployed, and evaluated an mHealth app. Initial co-design interviews with 14 individuals in recovery led to 3 new features integrated into an existing mHealth app. The app was deployed for a 6-week trial with 53 participants using it during their daily routines without researcher supervision. Usage patterns were analyzed throughout the trial period, and follow-up interviews with 12 app users foregrounded subjective usage experiences and considerations for future design. RESULTS: We developed 3 new features following co-design interviews: a goal-setting feature, a craving tracker, and a meetings log. Usage metrics revealed mixed engagement, with 45.3% (24/53) of users actively engaging with the app throughout the trial. These active users opened the app 27.1 unique times on average, with a retention rate after 30 days among active users of 45.8% (11/24), exceeding the typical mobile app retention benchmark of 7% after 30 days. Interviews revealed that participants preferred app functionality to extend beyond substance use domains to support other dimensions of their lives not directly pertaining to substance use, such as general goals and daily routines. Participants further suggested that recovery apps should act as private digital journals while also providing a sense of community and connection to broader recovery ecosystems. Additionally, mHealth designs that allow users to configure their own personalized recovery pathways in the app can benefit some users who appreciate increased autonomy, while others may become overwhelmed by a lack of prescriptive guidance. CONCLUSIONS: It is valuable to incorporate iterative co-design methodologies into digital health and recovery app research to help optimize engagement. Furthermore, recovery apps can benefit from flexible designs with customizable degrees of user autonomy. Future designers can better cater to individual user preferences by personalizing mHealth designs so that they strike a balance between system control and user control over digital recovery pathways.