Simple SummaryMobile applications are an effective method to promote self-monitoring of various diseases and disorders. However, maintaining active engagement and adherence in mobile applications can be difficult. We found that using an incentive based system increased an individual’s usage of the mobile application in multiple areas (e.g., number of articles read, number of goals set). In keeping individuals engaged in the mobile application they were more apt to review and use the content to learn how to self-monitor their pain symptoms and reduce their chronic pain. We suggest implementing incentive based systems to increase engagement and adherence for mobile applications.AbstractIntroduction: Neurofibromatosis Type 1 (NF1) is an autosomal dominant genetic condition in which chronic pain is a predominant issue. Given the rarity of the disease, there are limited psychosocial treatments for individuals with NF1 suffering with chronic pain. Using mobile applications can facilitate psychosocial treatments; however, there are consistent issues with engagement. Utilizing a mixed methodology, the current study evaluated the customized iCanCope mobile application for NF1 on increasing engagement through the usage of contingency management. Methods: A mixed methods study from a subset of data coming from a randomized clinical trial that occurred from January 2021 to August 2022 was undertaken. Two groups (iCC and iCC + CM) were exposed to the customized iCanCope mobile application in which engagement data were captured in real-time with daily check-ins for interference, sleep, mood, physical activity, energy levels, goal setting, and accessing article content (coping strategies). Additionally, semi-structured interviews were conducted to gain insight into the participants’ experience at the end of the trial. Results: Adults (N = 72) were recruited via NF patient advocacy groups. Significant differences were noted between the groups in total articles read (p= 0.002), goals achieved (p= 0.017), and goals created (p= 008). Additionally, there were significant differences observed between user-generated goals and those that were app recommended (p< 0.001). Both groups qualitatively reported positive feedback on the customized mobile application, indicating that continued usage and engagement of the mobile application were acceptable. Conclusions: Employing customized mobile applications for adults with NF1 along with contingency management can leverage self-managed pain treatments while providing auxiliary resources to this population.