Study On Mobile Health Intervention Based On Pattern Of Physical Activity Of Breast Cancer Patients During Chemotherapy

?Objective?Patients with breast cancer would get benefit from physical activity(PA)during chemotherapy and the following long-term rehabilitation.We aim to explore patients' PA behavioral pattern in this project through three steps.Firstly,to have a thorough understanding of the current PA behavioral characteristics of breast cancer patients during chemotherapy and its sub-population traits;secondly,to learn bout their PA longitudinal behavior trajectory;thirdly,to interview patients and health professionals about their experiences and cognition of PA.Combining the above three parts results,we will get an idea of patients' PA performance pattern during chemotherapy.Based on this,to construct and develop a PA mobile health intervention and then to evaluate the effectiveness,thus to enhance patients' awareness of PA,improve their PA behavior changing,further to improve their experience during chemotherapy and quality of life.?Methods?The study is divided into three parts:1.Exploration of PA behavior pattern of breast cancer patients during chemotherapy(1)Investigation of physical activity status and sub-population traits of breast cancer patients during chemotherapyBased on the previous literature and theoretical studies,the variables included in the cross-sectional study were established.Then 435 breast cancer patients were surveyed to find out the status of their physical activity during the chemotherapy,and the sub-population characteristics of the patients' physical activity behaviors were explored through the latent class model.(2)The study of longitudinal behavior trajectory of breast cancer patients during chemotherapyUsing longitudinal study design,a total of 153 breast cancer patients were surveyed about the PA behavior at the four time points T1-T4,before chemotherapy,after the firstchemotherapy,6 weeks after chemotherapy,and three months after the chemotherapy.The growth mixed model was used to identify the different PA growing type.(3)Qualitative study to get the knowledge of experiences and cognition of participating in PA during chemotherapy among breast cancer patients and medical staffUsing qualitative research methods,qualitative interviews were conducted with 18 breast cancer patients and 14 medical staff,respectively to understand their experiences and cognition of PA during chemotherapy,to collect clinical practice experiences related to PA.Meantime,to explore the facilitators and barriers of PA and advice for future mobile PA intervention.2.Construction of a mobile health intervention program for breast cancer patients during the chemotherapy based on the behavioral pattern of PABased on the previous findings of PA pattern during the chemotherapy,under the guidance of the framework of social cognitive theory,self-efficacy theory,and planned behavior theory,to draft the content of PA intervention program.An expert working group meeting was held and conducted.Experts were consulted to revise and confirm the details of the program,the key points of the later technical issues.3.Development and application of a mobile phone application for breast cancer patient(1)Development and testing of the mobile phone application for breast cancer patientBased on the needs of mobile health intervention for breast cancer patients discovered from previous phases of research,apply agile development model to develop the app.The software engineering and researchers worked together to develop and test iOS systems,Android systems,and PC-side background data management systems.Three researchers performed functional tests during the development process.After the software development was completed,four breast cancer patients were included in the functional testing of the beta version and the application program was initially evaluated.(2)A pilot study of the mobile health intervention programs delivered by application for breast cancer patients undergoing chemotherapyUsing “Breast Care” mobile phone application program as the main technical means,applying mixed research methods,20 breast cancer patients undergone chemotherapy were intervened.Quantitative study was conducted to confirm the effect of this protocol on improving breast cancer patients' PA.Also,qualitative interviews were performed to get a knowledge about patients' experience during intervention programs and evaluation for theapplication.?Result?1.Exploration of PA behavior pattern of breast cancer patients during chemotherapy(1)Investigation of physical activity status and sub-population traits of breast cancer patients during chemotherapyThe cross-sectional survey results showed that the average overall activity level of breast cancer patients during the chemotherapy was 1441.94±1880.703 MET-min/w,and the length of time keeping sedentary lifestyle per week was about 5 hours,and proportion of sedentary people occupied 43.7%.Only 15 patients in the study had high intensity physical activity and 176 cases reported medium intensity PA.The number of people meeting PA guidelines were 40.9%.The latent class analysis results showed that the study subjects were identified as three sub-populations.They were named poor physical performance with sleep disorder group(N=69),moderate and low level PA with fatigue group(N=108),moderate and low level PA with no other obvious symptoms(N=258).(2)The study of longitudinal behavior trajectory of breast cancer patients during chemotherapyA descriptive study of longitudinal data of PA among 153 women with breast cancer showed that,with the exception of T4,the overall mean PA level of the patient at T1-T3 was all lower than the mean level of PA the cross-sectional survey.And,after the first chemotherapy,the level of PA dropped to the lowest level.The PA level classification results showed that: the proportion of patients stayed in sedentary at T1 and T2 was the largest,accounting for 44.7% and 68.8% respectively;patients were more active at T3 and T4,and the proportion was 44.4% and 56.8%,respectively.The growth mixed model identified the population as two categories: individuals with category 1(N = 99)had higher initial values of physical activity and slowly increased with time;individuals with category2(N = 54)had lower initial values of physical activity than category 1,and then dropped to the lowest point after first chemotherapy and then slowly increased.(3)Qualitative study to get the knowledge of experiences and cognition of participating in PA during chemotherapy among breast cancer patients and medical staffThrough qualitative interviews with 18 breast cancer patients,four themes were revealed: interruption of normal life and lack of motivation to participate in activities;challenges of side effects relevant to chemotherapy and existing barriers to physicalactivity;prominent physical and psychological problems associated with chemotherapy resulting in financial and social problems;and self-growth with adaptation on chemotherapy and mental comfort through social support.The following topics were analyzed through qualitative interviews with 14 medical staff: physical activity needs of patients were highlighted,potential benefits were gradually perceived;physical activity-related guidance is lacking,continuous professional care support needs to be strengthened;physical activity interventions that promoted personalized safety were recommended,and multiple perspectives enhancing patient compliance and engagement were mentioned.2.Construction of a mobile medical intervention program for breast cancer patients during the chemotherapy based on the behavioral pattern of PAThe final draft of the intervention program established after expert group meeting and expert consultation included the following contents: the proposed goal of intervention,core content of intervention,and other intervention elements(intervention duration,settings,object,means,process,strategies and evaluation tools,etc).Established software development functions included user terminals and background data management platforms.3.Development and application of a mobile phone application for breast cancer patient(1)Development and testing of the mobile phone application for breast cancer patientAfter several rounds of testing and revising by 3 software engineers and researchers and patients,the "Breast Care" mobile application eventually had been developed and contained five main pages: Home,Calendar,Interaction,Exercise,Personal Center.The background data management system can implement functions such as user management,knowledge management,feedback and comment management,short message sending,and data export.Four breast cancer patients were investigated and interviewed to evaluate the app in terms of system usefulness,information quality,interface quality and overall evaluation.The post-study system usability questionnaire scores were 4.5,4.33,4.78,and4.5,respectively.(2)A pilot study of the mobile health intervention programs delivered by application for breast cancer patients undergoing chemotherapyTwenty subjects were included in the intervention,and 12 of them reported their preference for PA was walking.According to their baseline assessment results,they weredivided into active groups(N = 12)and sedentary groups(N = 8).Accumulated user minutes were 40 minutes per person per week,and each person logged in to the App for 3times per week.Quantitative findings indicated that the overall level PA of the patient had improved,and the overall PA had increased by an average of 945.70 MET-min/w.Before and after the intervention,the patients had statistically significant differences in traffic-related physical activity,leisure time physical activity,walking,and overall PA level.Results of qualitative research suggested that patients had a high degree of recognition of intervention programs and had a good evaluation of usefulness and ease of use for the apps.?Conclusion?The overall level of PA of breast cancer patients during the chemotherapy is low,and the number of patients meeting guidelines are inadequate.According to the sub-population identified by LCA,different PA behavioral trajectory identified by GMM,and qualitative findings from interview,construction of the mobile health intervention program are evidence-based and scientific.It can facilitate PA behavior changing of breast cancer patients,improve their awareness of being active and experience during chemotherapy.Mobile phone application developed by researchers is acceptable,easy to use and effective.