In the realm of cancer survivorship, physical activity and exercise interventions have traditionally been delivered through face-to-face, facility-based programs. However, these supervised interventions have proven to be expensive, reliant on healthcare practitioners, and lacking scalability. Barriers such as cost, access, and availability often hinder participation and adherence to these programs, leading to a growing demand for alternative approaches. This is where mobile health (mHealth) comes into play.
What is mHealth?
mHealth encompasses the use of mobile technology, including text messaging, mobile applications (Apps), video-conferencing, and online portals, to deliver health-related interventions. With the widespread availability and sophistication of mobile devices, mHealth has transformed the way healthcare services are accessed, delivered, and managed. It offers the potential for highly engaging, personalized interventions that can reach diverse populations of cancer survivors.
What are the Benefits of mHealth?
One of the key advantages of mHealth interventions is their ability to prompt and maintain real-time behavior change through continuous communication. Unlike traditional face-to-face programs, mHealth interventions can deliver comparable clinical outcomes without burdening patients or relying on facility-based resources. By incorporating principles of chronic care management, such as addressing barriers to lifestyle changes, providing coaching and feedback, and facilitating peer support, mHealth interventions have shown great promise in empowering cancer survivors to actively participate in their care and recovery.
Research in mHealth
Research on mHealth interventions has primarily focused on areas such as physical activity promotion, health education, chronic condition management, and smoking cessation. For instance, text message-based interventions have proven effective in reducing sedentary time and increasing physical activity in generally healthy populations. Moreover, mHealth tools have demonstrated the ability to enhance self-monitoring and management of health conditions like blood pressure, blood glucose levels, and obesity.
Goode et al. conducted a systematic review analyzing print, telephone, and web-based interventions for diet, physical activity, and/or weight management among cancer survivors. Interestingly, none of the 27 studies analyzed were delivered via text message. The review highlighted the need to integrate newer technologies, such as mobile text messaging, to deliver interventions to diverse populations of cancer survivors. Haggerty et al. investigated the efficacy of a technology-based weight loss intervention for endometrial cancer survivors with obesity. Participants were randomized into a text message group, telemedicine group, or usual care. The text message group received three to five personalized and interactive text messages daily, delivering feedback, support, prompting, quiz items, and strategies for long-term weight management. The results showed that all groups had a significant reduction in weight, and the telehealth and text message-based intervention improved the quality of life for endometrial cancer survivors with obesity. Similar systematic reviews have highlighted the positive impact of mHealth interventions on cancer patients’ disease management and quality of life.
While there has been substantial research on mHealth interventions targeting physical activity, the focus on reducing sedentary behavior among cancer survivors is still limited. Khoo et al. were the first to conduct a systematic review to identify, evaluate, and synthesize the scientific literature on mHealth interventions to promote PA or reduce sedentary behaviour in cancer survivors. The review analyzed 31 studies, including randomized controlled trials, controlled trials, pre-and-post trials, and crossover trials. Out of these studies, only 10 reported sedentary behavior outcomes. The authors concluded that more research is needed to evaluate the effects of mHealth interventions on reducing sedentary behavior among cancer survivors and to identify strategies for reducing sedentary behavior effectively.
Engagement and Adherence to mHealth Interventions
Engagement and adherence are crucial challenges in digital health behavior change interventions (DBCIs), including mHealth. Retention rates in DBCI programs have been reported to be low, indicating the need for strategies to improve effective engagement. A study conducted by Short et al. showed that retention in their DBCI group at the 3-month follow-up was only 32% and had further reduced to 11% at 6-month follow-up. Individualizing the content and timing of interventions, reducing interaction time and burden, providing real-time information, and establishing a rapport with healthcare professionals are some approaches that have been shown to enhance the effectiveness of DBCIs. Incorporating behavioral change techniques (BCTs) such as cues, prompts, goal setting, and feedback can further encourage engagement and improve adherence.
In conclusion, mHealth interventions have the potential to revolutionize health interventions for cancer survivors. By leveraging mobile technology, these interventions can provide accessible, scalable, and personalized support for behavior change. As the field of mHealth continues to evolve, further research and development are needed to fully realize its potential in improving the well-being and outcomes of cancer survivors.