Acceptability of Narrative Visualization with Physical Activity Monitoring Among Breast Cancer Survivors

Abstract Purpose: Physical activity (PA) levels are low among breast cancer survivors. Narrative visualization (NV) is a technique that uses drawings, photographs, and text to contextualize data, which may increase integrated regulation, or motivation for PA by relating it to personal values and identity. The purpose of this study was to determine the acceptability of a NV intervention for older breast cancer survivors.Methods: Participants completed an NV workbook for 7 days using the provided instant camera, art supplies including a variety of stickers, and a wearable electronic activity monitor. The workbook pages prompted participants to re-draw their daily activity graphs from the monitor’s mobile app, then annotate them with text, photographs, stickers, etc. to reflect what the data meant to them. Thematic analysis and content analysis were used to identify emergent themes. Results: Of the 20 consented women (mean age 67±5 years, 45% non-Hispanic White), 17 participants completed all study procedures. Participants showed high levels of engagement (e.g., mean of 9 photos taken; mean of 56 stickers used over 7 days; all workbook questions completed) supporting intervention acceptability. Themes within the photos included family, specific locations, everyday objects, religion, and friends. Themes within the written portions of the workbook included family, chores and obligations, health, personal reflection, hobbies, and shopping. Weight loss was not a major theme. Conclusions: Breast cancer survivors successfully used NV techniques to reflect on their PA data and behavior. These techniques show promise for promoting integrated regulation in activity monitoring interventions.Trial Registration: NCT03612596

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Breast Cancer Survivors’ Perspectives on Motivational and Personalization Strategies in Mobile App–Based Physical Activity Coaching Interventions: Qualitative Study

JMIR mhealth and uhealth ◽

10.2196/18867 ◽

2020 ◽

Vol 8 (9) ◽

pp. e18867

Author(s):

Francisco Monteiro-Guerra ◽

Gabriel Ruiz Signorelli ◽

Octavio Rivera-Romero ◽

Enrique Dorronzoro-Zubiete ◽

Brian Caulfield

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Qualitative Study ◽

Cancer Survivors ◽

Perceived Control ◽

Breast Cancer Survivors ◽

White Women ◽

Mobile App ◽

Disease Stage ◽

Dynamic Adjustment

Background Despite growing evidence supporting the vital benefits of physical activity (PA) for breast cancer survivors, the majority do not meet the recommended levels of activity. Mobile app–based PA coaching interventions might be a feasible strategy to facilitate adherence of breast cancer survivors to the PA guidelines. To engage these individuals, PA apps need to be specifically designed based on their needs and preferences and to provide targeted support and motivation. However, more information is needed to understand how these technologies can provide individual and relevant experiences that have the ability to increase PA adherence and retain the individual’s interest in the long term. Objective The aim of this study is to explore insights from breast cancer survivors on motivational and personalization strategies to be used in PA coaching apps and interventions. Methods A qualitative study was conducted, using individual semistructured interviews, with 14 breast cancer survivors. The moderator asked open-ended questions and made use of a slideshow presentation to elicit the participants’ perspectives on potential mobile app–based intervention features. Transcribed interviews were evaluated by 3 reviewers using thematic content analysis. Results Participants (mean age 53.3, SD 8.7 years) were White women. In total, 57% (8/14) of the participants did not adhere to the PA guidelines. In general, participants had access to and were interested in using technology. The identified themes included (1) barriers to PA, (2) psychological mediators of PA motivation, (3) needs and suggestions for reinforcing motivation support, (4) personalization aspects of the PA coaching experience, and (5) technology trustworthiness. Motivational determinants included perceived control, confidence and perceived growth, and connectedness. Participants were interested in having a straightforward app for monitoring and goal setting, which would include a prescribed activity program and schedule, and positive communication. Opinions varied in terms of social and game-like system possibilities. In addition, they expressed a desire for a highly personalized coaching experience based on as much information collected from them as possible (eg, disease stage, physical limitations, preferences) to provide individualized progress information, dynamic adjustment of the training plan, and context-aware activity suggestions (eg, based on weather and location). Participants also wanted the app to be validated or backed by professionals and were willing to share their data in exchange for a more personalized experience. Conclusions This work suggests the need to develop simple, guiding, encouraging, trustworthy, and personalized PA coaching apps. The findings are in line with behavioral and personalization theories and methods that can be used to inform intervention design decisions. This paper opens new possibilities for the design of personalized and motivating PA coaching app experiences for breast cancer survivors, which might ultimately facilitate the sustained adherence of these individuals to the recommended levels of activity.

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A Personalized Physical Activity Coaching App for Breast Cancer Survivors: Design Process and Early Prototype Testing (Preprint)

10.2196/preprints.17552 ◽

2019 ◽

Author(s):

Francisco Monteiro-Guerra ◽

Gabriel Ruiz Signorelli ◽

Shreya Tadas ◽

Enrique Dorronzoro Zubiete ◽

Octavio Rivera Romero ◽

...

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Behavior Change ◽

Cancer Survivors ◽

Real Time ◽

Design Process ◽

Breast Cancer Survivors ◽

Rating Scale ◽

Mobile App ◽

System Usability Scale

BACKGROUND Existing evidence supports the many benefits of physical activity (PA) in breast cancer survival. However, few breast cancer survivors adhere to the recommended levels of activity. A PA coaching app that provides personalized feedback, guidance, and motivation to the user might have the potential to engage these individuals in a more active lifestyle, in line with the general recommendations. To develop a successful tool, it is important to involve the end users in the design process and to make theoretically grounded design decisions. OBJECTIVE This study aimed to execute the design process and early prototype evaluation of a personalized PA coaching app for posttreatment breast cancer survivors. In particular, the study explored a design combining behavioral theory and tailored coaching strategies. METHODS The design process was led by a multidisciplinary team, including technical and health professionals, and involved input from a total of 22 survivors. The process comprised 3 stages. In stage 1, the literature was reviewed and 14 patients were interviewed to understand the needs and considerations of the target population toward PA apps. In stage 2, the global use case for the tool was defined, the features were ideated and refined based on theory, and a digital interactive prototype was created. In stage 3, the prototype went through usability testing with 8 patients and was subjected to quality and behavior change potential evaluations by 2 human-computer interaction experts. RESULTS The design process has led to the conceptualization of a personalized coaching app for walking activities that addresses the needs of breast cancer survivors. The main features of the tool include a training plan and schedule, adaptive goal setting, real-time feedback and motivation during walking sessions, activity status through the day, activity history, weekly summary reports, and activity challenges. The system was designed to measure users’ cadence during walking, use this measure to infer their training zone, and provide real-time coaching to control the intensity of the walking sessions. The outcomes from user testing and expert evaluation of the digital prototype were very positive, with scores from the system usability scale, mobile app rating scale, and app behavior change scale of 95 out of 100, 4.6 out of 5, and 15 out of 21, respectively. CONCLUSIONS Implementing a user-centered design approach for the development and early evaluation of an app brings essential considerations to tailor the solution to the user’s needs and context. In addition, informing the design on behavioral and tailored coaching theories supports the conceptualization of the PA coaching system. This is critical for optimizing the usability, acceptability, and long-term effectiveness of the tool. After successful early in-laboratory testing, the app will be developed and evaluated in a pilot study in a real-world setting.

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A Personalized Physical Activity Coaching App for Breast Cancer Survivors: Design Process and Early Prototype Testing

JMIR mhealth and uhealth ◽

10.2196/17552 ◽

2020 ◽

Vol 8 (7) ◽

pp. e17552

Author(s):

Francisco Monteiro-Guerra ◽

Gabriel Ruiz Signorelli ◽

Shreya Tadas ◽

Enrique Dorronzoro Zubiete ◽

Octavio Rivera Romero ◽

...

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Behavior Change ◽

Cancer Survivors ◽

Real Time ◽

Design Process ◽

Breast Cancer Survivors ◽

Rating Scale ◽

Mobile App ◽

System Usability Scale

Background Existing evidence supports the many benefits of physical activity (PA) in breast cancer survival. However, few breast cancer survivors adhere to the recommended levels of activity. A PA coaching app that provides personalized feedback, guidance, and motivation to the user might have the potential to engage these individuals in a more active lifestyle, in line with the general recommendations. To develop a successful tool, it is important to involve the end users in the design process and to make theoretically grounded design decisions. Objective This study aimed to execute the design process and early prototype evaluation of a personalized PA coaching app for posttreatment breast cancer survivors. In particular, the study explored a design combining behavioral theory and tailored coaching strategies. Methods The design process was led by a multidisciplinary team, including technical and health professionals, and involved input from a total of 22 survivors. The process comprised 3 stages. In stage 1, the literature was reviewed and 14 patients were interviewed to understand the needs and considerations of the target population toward PA apps. In stage 2, the global use case for the tool was defined, the features were ideated and refined based on theory, and a digital interactive prototype was created. In stage 3, the prototype went through usability testing with 8 patients and was subjected to quality and behavior change potential evaluations by 2 human-computer interaction experts. Results The design process has led to the conceptualization of a personalized coaching app for walking activities that addresses the needs of breast cancer survivors. The main features of the tool include a training plan and schedule, adaptive goal setting, real-time feedback and motivation during walking sessions, activity status through the day, activity history, weekly summary reports, and activity challenges. The system was designed to measure users’ cadence during walking, use this measure to infer their training zone, and provide real-time coaching to control the intensity of the walking sessions. The outcomes from user testing and expert evaluation of the digital prototype were very positive, with scores from the system usability scale, mobile app rating scale, and app behavior change scale of 95 out of 100, 4.6 out of 5, and 15 out of 21, respectively. Conclusions Implementing a user-centered design approach for the development and early evaluation of an app brings essential considerations to tailor the solution to the user’s needs and context. In addition, informing the design on behavioral and tailored coaching theories supports the conceptualization of the PA coaching system. This is critical for optimizing the usability, acceptability, and long-term effectiveness of the tool. After successful early in-laboratory testing, the app will be developed and evaluated in a pilot study in a real-world setting.

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Feasibility study of “BENECA mHealth”: a mobile system to improve quality of life via energy balance in breast cancer survivors (Preprint)

10.2196/preprints.14136 ◽

2019 ◽

Author(s):

Mario Lozano-Lozano ◽

Irene Cantarero-Villanueva ◽

Lydia Martin-Martin ◽

Noelia Galiano-Castillo ◽

Maria-José Sanchez ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Physical Activity ◽

Energy Balance ◽

Cancer Survivors ◽

User Satisfaction ◽

Breast Cancer Survivors ◽

Rating Scale ◽

Mobile App

BACKGROUND Energy balance is defined as the difference between energy expenditure and energy intake. The current state of knowledge supports the need to better integrate mechanistic approaches through effective studies of energy balance in cancer population, due to it is observed a significant lack of adherence to healthy lifestyle recommendations. In an attempt to stimulate changes in breast cancer survivors (BCS) lifestyles based on energy balance, our group developed BENECA mHealth application, which has been previously validated as a reliable energy balance monitoring system. OBJECTIVE Based on our previous results, the goal of this study was to investigate the feasibility of BENECA mHealth in an ecological clinical setting with breast cancer survivors, studying (1) its feasibility; and (2) pretest-posttest differences with regard to BCS’ lifestyles, quality of life (QoL), and physical activity (PA) motivation. METHODS Eighty BCS were enrolled in this prospective test-retest quasi-experimental study diagnosed with stage I to IIIA and with a body mass index over 25 kg/m2. Patients had to use BENECA mHealth for 8 weeks and were assessed at baseline and post-intervention period. Feasibility main outcomes included percentage of adoption, usage and attrition, user app-quality perception measured with the Mobile App Rating Scale (MARS), satisfaction with Net Promoter Score (NPS), and barriers and facilitators of its use. Clinical main outcomes included quality of life measure with EORT QLQ-C30, PA assess with accelerometry, PA motivation measure with the self-efficacy scale for physical activity (EAF), and body composition with a Dual-energy X-ray absorptiometry. Statistical (paired-sample t-tests was used) and Kaplan-Meier survival curve were analyzed. RESULTS BENECA was considered feasible by the BCS, in terms of use (76.3%; 58/76 BCS) adoption (69%; 80/116), and satisfaction (positive NPS). App quality score did not make it one of the best rated apps (3.71 ± 0.47 points out of 5). BENECA mHealth seems to improve the QoL of BCSs (global health mean difference (MD) 12.83, 95% CI 8.95–16.71, p<.001), as well as EAF score (global MD 36.99, 95% CI 25.52 – 48.46, p<.001), daily moderate-to-vigorous PA (MD 7.38, 95% CI 14.37–0.39, p=.039) and reduce body weight (MD -1.42, 95% CI -1.97 – -0.87, p<.001). CONCLUSIONS BENECA mHealth can be considered feasible in a real clinical context for being able to promote behavioral changes in the lifestyles of BCSs, but it needs to be optimized to improve user satisfaction with use and functionality. This study highlights the importance of the use of mobile applications based on energy balance and how the QoL of BCSs can be improved via monitoring.

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Breast Cancer Survivors’ Perspectives on Motivational and Personalization Strategies in Mobile App–Based Physical Activity Coaching Interventions: Qualitative Study (Preprint)

10.2196/preprints.18867 ◽

2020 ◽

Author(s):

Francisco Monteiro-Guerra ◽

Gabriel Ruiz Signorelli ◽

Octavio Rivera-Romero ◽

Enrique Dorronzoro-Zubiete ◽

Brian Caulfield

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Qualitative Study ◽

Cancer Survivors ◽

Perceived Control ◽

Breast Cancer Survivors ◽

White Women ◽

Mobile App ◽

Disease Stage ◽

Dynamic Adjustment

BACKGROUND Despite growing evidence supporting the vital benefits of physical activity (PA) for breast cancer survivors, the majority do not meet the recommended levels of activity. Mobile app–based PA coaching interventions might be a feasible strategy to facilitate adherence of breast cancer survivors to the PA guidelines. To engage these individuals, PA apps need to be specifically designed based on their needs and preferences and to provide targeted support and motivation. However, more information is needed to understand how these technologies can provide individual and relevant experiences that have the ability to increase PA adherence and retain the individual’s interest in the long term. OBJECTIVE The aim of this study is to explore insights from breast cancer survivors on motivational and personalization strategies to be used in PA coaching apps and interventions. METHODS A qualitative study was conducted, using individual semistructured interviews, with 14 breast cancer survivors. The moderator asked open-ended questions and made use of a slideshow presentation to elicit the participants’ perspectives on potential mobile app–based intervention features. Transcribed interviews were evaluated by 3 reviewers using thematic content analysis. RESULTS Participants (mean age 53.3, SD 8.7 years) were White women. In total, 57% (8/14) of the participants did not adhere to the PA guidelines. In general, participants had access to and were interested in using technology. The identified themes included (1) barriers to PA, (2) psychological mediators of PA motivation, (3) needs and suggestions for reinforcing motivation support, (4) personalization aspects of the PA coaching experience, and (5) technology trustworthiness. Motivational determinants included perceived control, confidence and perceived growth, and connectedness. Participants were interested in having a straightforward app for monitoring and goal setting, which would include a prescribed activity program and schedule, and positive communication. Opinions varied in terms of social and game-like system possibilities. In addition, they expressed a desire for a highly personalized coaching experience based on as much information collected from them as possible (eg, disease stage, physical limitations, preferences) to provide individualized progress information, dynamic adjustment of the training plan, and context-aware activity suggestions (eg, based on weather and location). Participants also wanted the app to be validated or backed by professionals and were willing to share their data in exchange for a more personalized experience. CONCLUSIONS This work suggests the need to develop simple, guiding, encouraging, trustworthy, and personalized PA coaching apps. The findings are in line with behavioral and personalization theories and methods that can be used to inform intervention design decisions. This paper opens new possibilities for the design of personalized and motivating PA coaching app experiences for breast cancer survivors, which might ultimately facilitate the sustained adherence of these individuals to the recommended levels of activity.

Download Full-text