Mobile Health Applications, Cancer Survivors and Lifestyle Modification: An Integrative Review (Preprint)

BACKGROUND In 2016, there were 15.5 million cancer survivors in the United States. Survivors’ mortality and well-being are threatened by the risk of cancer recurrence and the prevalence of chronic diseases resulting from cancer treatments. Improving lifestyle behaviors attenuates these risks. Traditional approaches to lifestyle modification (i.e., counseling), are expensive, require significant human resources, and are difficult to scale. Mobile health (mHealth) interventions offer a novel alternative to traditional approaches. Although mHealth interventions are a relatively new phenomenon (c. 2010), their presence and use have increased exponentially in the last few years. However, to date, systematic reviews have failed to examine the use of mHealth interventions in lifestyle behavior change among cancer survivors. OBJECTIVE : The specific objectives of this integrative review were to (1) identify and synthesize the research in the use of mHealth apps for lifestyle behavior modification among cancer survivors; (2) critically appraise the scientific literature; (3) examine the use of theory in mHealth app design, development and testing; and (4) identify cancer survivors’ preferences in using mHealth apps for lifestyle behavior change. METHODS The review process was guided by Whittemore and Knafl’s framework and the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. We searched 8 databases and 3 journals for studies reported between January 1, 2007, and April 15, 2019, using concepts associated with mobile health, cancer, and lifestyle behaviors. The inclusion of studies and study quality were assessed by at least two research team members, using pre-established criteria and validated tools. We assessed theory use with a coding scheme developed by Michie and Prestwich. RESULTS Of the 1,351 manuscripts retrieved, 19 articles (17 studies) met eligibility requirements. Ten articles reported on the use of mHealth interventions while 9 described mHealth features and functions important to survivors. No RCTs were identified and only 2 quasi-experimental studies were included. Breast cancer survivors were over-represented in the studies as was the lifestyle behavior of physical activity (PA) (n=15). The 2 non-PA studies included in this review focused on stress. Survivors’ perceptions about using mHealth were synthesized into 6 common themes: App Functionality & Features, Social Relationships & Support, Provider Relationships, Support & Communications, Content, Acceptability, and Barriers to Use. The overall quality of the studies was low, except for 3 pilot studies (2 moderate, 1 strong). Only 1 study reported the use of theory in the design, development, or testing of the mHealth intervention. CONCLUSIONS Overall, the low-quality of studies included in this review validated a need for rigorous, theory-based pilot and efficacy studies before use of mHealth interventions can be safely and effectively recommended and used to improve lifestyle behaviors in cancer survivors.