Designing more engaging computer-tailored physical activity behaviour change interventions for breast cancer survivors: lessons from the iMove More for Life study



Participating in regular physical activity is a recommended cancer recovery strategy for breast cancer survivors. However, tailored support services are not widely available and most survivors are insufficiently active to obtain health benefits. Delivering tailored programs via the Internet offers one promising approach. However, recent evaluations of such programs suggest that major improvements are needed to ensure programs meet the needs of users and are delivered in an engaging way. Understanding participants’ experiences with current programs can help to inform the next generation of systems.


The purposes of this study are to explore breast cancer survivor’s perspectives of and experiences using a novel computer-tailored intervention and to describe recommendations for future iterations.


Qualitative data from a sub-sample of iMove More for Life study participants were analysed thematically to identify key themes. Participants long-term goals for participating in the program were explored by analysing open-ended data extracted from action plans completed during the intervention (n = 370). Participants negative and positive perceptions of the website and recommendations for improvement were explored using data extracted from open-ended survey items collected at the immediate intervention follow-up (n = 156).


The majority of participants reported multi-faceted goals, consisting of two or more outcomes they hoped to achieve within a year. While clear themes were identified (e.g. ‘being satisfied with body weight’), there was considerable variability in the scope of the goal (e.g. desired weight loss ranged from 2 to 30 kg). Participants’ perceptions of the website were mixed, but clear indications were provided of how intervention content and structure could be improved.


This study provides insight into how to better accommodate breast cancer survivors in the future and ultimately design more engaging computer-tailored interventions.

This is a preview of subscription content, log in to check access.


  1. 1.

    Eakin EG, Youlden DR, Baade PD, Lawler SP, Reeves MM, Heyworth JS, Fritschi L (2006) Health status of long-term cancer survivors: results from an Australian population-based sample. Cancer Epidemiology Biomarkers Prevention 15(10):1969–1676

    Article  Google Scholar 

  2. 2.

    Baade PD, Fritschi L, Eakin E (2006) Non-cancer mortality among people diagnosed with cancer. Cancer Causes Control 17:287–297

    Article  Google Scholar 

  3. 3.

    Fong D, Ho J, Hui B, Lee A, Macfarlane D, Leung S, Cerin E, Chan W, Leung I, Lam S, Taylor A, Cheng K (2012) Physical activity for cancer survivors: meta-analysis of randomised controlled trials. British Medical Journal:344. doi:10.1136/bmj.e70

    Article  Google Scholar 

  4. 4.

    Battaglini CL, Mills RC, Phillips BL, Lee JT, Story CE, Nascimento MGB, Hackney AC (2014) Twenty-five years of research on the effects of exercise training in breast cancer survivors: a systematic review of the literature. World Journal of Clinical Oncology 5(2):177–190. doi:10.5306/wjco.v5.i2.177

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, Bandera EV, Hamilton KK, Grant B, McCullough M, Byers T, Gansler T (2012) Nutrition and physical activity guidelines for cancer survivors. CA: a Cancer Journal for Clinicians:n/a-n/a. doi:10.3322/caac.21142

    Google Scholar 

  6. 6.

    Hayes SC, Spence RR, Galvao DA, Newton RU (2009) Australian Association for Exercise and Sport Science position stand: optimising cancer outcomes through exercise. J Sci Med Sport 12(4):428–434

    Article  Google Scholar 

  7. 7.

    Schmitz K, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen VE, Schwartz AL, American College of Sports Medicine (2010) American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42(7):1409–1426. doi:10.1249/MSS.0b013e3181e0c112

    Article  Google Scholar 

  8. 8.

    Bluethmann SM, Basen-Engquist K, Vernon SW, Cox M, Gabriel KP, Stansberry SA, Carmack CL, Blalock JA, Demark-Wahnefried W (2015) Grasping the ‘teachable moment’: time since diagnosis, symptom burden and health behaviors in breast, colorectal and prostate cancer survivors. Psycho-Oncology 24(10):1250–1257. doi:10.1002/pon.3857

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Martin EC, Basen-Engquist K, Cox MG, Lyons EJ, Carmack CL, Blalock JA, Demark-Wahnefried W (2016) Interest in health behavior intervention delivery modalities among cancer survivors: a cross-sectional study. JMIR Cancer 2(1):e1. doi:10.2196/cancer.5247

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Puszkiewicz P, Roberts AL, Smith L, Wardle J, Fisher A (2016) Assessment of cancer survivors’ experiences of using a publicly available physical activity mobile application. JMIR Cancer 2(1):e7. doi:10.2196/cancer.5380

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    White S, McAuley E, Estabrooks P, Courneya K (2009) Translating physical activity interventions for breast cancer survivors into practice: an evaluation of randomized controlled trials. Ann Behav Med 37(1):10–19. doi:10.1007/s12160-009-9084-9

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Kelders MS, Kok NR, Ossebaard CH, Van Gemert-Pijnen EWCJ (2012) Persuasive system design does matter: a systematic review of adherence to web-based interventions. J Med Internet Res 14(6):e152. doi:10.2196/jmir.2104

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Short CE, Rebar AL, Plotnikoff RC, Vandelanotte C (2015) Designing engaging online behaviour change interventions: a proposed model of user engagement. The European Health Psychologist 17(1):32–38

    Google Scholar 

  14. 14.

    Brouwer W, Kroeze W, Crutzen R, de Nooijer J, de Vries KN, Brug J, Oenema A (2011) Which intervention characteristics are related to more exposure to internet-delivered healthy lifestyle promotion interventions? A systematic review. J Med Internet Res 13(1):e2. doi:10.2196/jmir.1639

    Article  PubMed  PubMed Central  Google Scholar 

  15. 15.

    Perski O, Blandford A, West R, Michie S (2016) Conceptualising engagement with digital behaviour change interventions: a systematic review using principles from critical interpretive synthesis. Behav Med Pract Policy Res:1–14. doi:10.1007/s13142-016-0453-1

    Article  Google Scholar 

  16. 16.

    Yardley L, Spring BJ, Riper H, Morrison LG, Crane DH, Curtis K, Merchant GC, Naughton F, Blanford A (2016) Understanding and promoting effective engagement with digital behavior change interventions. Am J Prev Med:1–28

  17. 17.

    Morrison LG (2015) Theory-based strategies for enhancing the impact and usage of digital health behaviour change interventions: a review. Digital Health 1

  18. 18.

    Vandelanotte C, Muller AM, Short CE, Hingle M, Nathan N, Williams SL, Lopez ML, Parekh S, Maher CA (2016) Past, present, and future of eHealth and mHealth research to improve physical activity and dietary behaviors. J Nutr Educ Behav 48(3):219–228 e211. doi:10.1016/j.jneb.2015.12.006

    Article  PubMed  Google Scholar 

  19. 19.

    Yardley L, Morrison L, Bradbury K, Muller I (2015) The person-based approach to intervention development: application to digital health-related behavior change interventions. J Med Internet Res 17(1):e30. doi:10.2196/jmir.4055

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Short C, Rebar A, James E, Duncan M, Courneya K, Plotnikoff R, Crutzen R, Vandelanotte C (2016) How do different delivery schedules of tailored web-based physical activity advice for breast cancer survivors influence intervention use and efficacy? Journal of Cancer Survivorship:1–12. doi:10.1007/s11764-016-0565-0

    Article  Google Scholar 

  21. 21.

    Short CE, James E, Girgis A, D'souza M, Plotnikoff RC (2015) Main outcomes of the Move More for Life Trial: a randomised controlled trial of the effects of tailored and targeted-print materials on physical activity, sitting-time and quality of life among post-treatment breast cancer survivors. Psycho-Oncology 24(7):771–778

    Article  Google Scholar 

  22. 22.

    Short CE, James EL, Plotnikoff RC (2013) How social cognitive theory can help oncology-based health professionals promote physical activity among breast cancer survivors. Eur J Oncol Nurs 17(4):482–489. doi:10.1016/j.ejon.2012.10.009

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Short CE, James E, Plotnikoff RC (2013) Theory-and evidence-based development and process evaluation of the Move More for Life program: a tailored-print intervention designed to promote physical activity among post-treatment breast cancer survivors. International Journal of Behavioural Nutrition and Physical Activity 10:124

    Article  Google Scholar 

  24. 24.

    Lustria ML, Noar SM, Cortese J, Van Stee SK, Glueckauf RL, Lee J (2013) A meta-analysis of web-delivered tailored health behavior change interventions. J Health Commun 18(9):1039–1069. doi:10.1080/10810730.2013.768727

    Article  PubMed  Google Scholar 

  25. 25.

    Conner M, Sandberg T, Norman P (2010) Using action planning to promote exercise behavior. Ann Behav Med 40(1):65–76. doi:10.1007/s12160-010-9190-8

    Article  PubMed  Google Scholar 

  26. 26.

    Bandura A (2004) Health promotion by social cognitive means. Health Education and Behavior 31 (2):143-164. doi:10.1177/1090198104263660

    Article  Google Scholar 

  27. 27.

    Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3(2):77–101. doi:10.1191/1478088706qp063oa

    Article  Google Scholar 

  28. 28.

    StataCorp (2009) Stata statistical software: release 11. StataCorp LP, College Station, TX

    Google Scholar 

  29. 29.

    Whitehead S, Lavelle K (2009) Older breast cancer survivors’ views and preferences for physical activity. Qual Health Res 19(7):894–906. doi:10.1177/1049732309337523

    Article  PubMed  PubMed Central  Google Scholar 

  30. 30.

    Sander AP, Wilson J, Izzo N, Mountford SA, Hayes KW (2012) Factors that affect decisions about physical activity and exercise in survivors of breast cancer: a qualitative study. Phys Ther 92(4):525–536. doi:10.2522/ptj.20110115

    Article  PubMed  Google Scholar 

  31. 31.

    Deci EL, Ryan RM (2000) The “what” and “why” of goal pursuits: human needs and the self-determination of behavior. Psychol Inq 11(4):227–268. doi:10.1207/S15327965PLI1104_01

    Article  Google Scholar 

  32. 32

    Rogers LQ, Matevey C, Hopkins-Price P, Shah P, Dunnington G, Courneya KS (2004) Exploring social cognitive theory constructs for promoting exercise among breast cancer patients. Cancer Nurs 27(6):462–473

    Article  Google Scholar 

  33. 33

    Short C, James E, Stacey F, Plotnikoff R (2013) A qualitative synthesis of trials promoting physical activity behaviour change among post-treatment breast cancer survivors. J Cancer Surviv 7(4):570–581. doi:10.1007/s11764-013-0296-4

    Article  PubMed  PubMed Central  Google Scholar 

  34. 34

    Davies C, Spence J, Vandelanotte C, Caperchione C, Mummery W (2012) Meta-analysis of internet-delivered interventions to increase physical activity levels. Int J Behav Nutr Phys Act 9(1):52

    Article  Google Scholar 

  35. 35

    Short CE, Vandelanotte C, Dixon MW, Rosenkranz R, Caperchione C, Hooker C, Karunanithi M, Kolt GS, Maeder A, Ding H, Taylor P, Duncan MJ (2014) Examining participant engagement in an information technology-based physical activity and nutrition intervention for men: the manup randomized controlled trial. JMIR research protocols 3(1):e2. doi:10.2196/resprot.2776

    Article  PubMed  PubMed Central  Google Scholar 

  36. 36

    Short C, James E, Plotnikoff R, Girgis A (2011) Efficacy of tailored-print interventions to promote physical activity: a systematic review of randomised trials. Int J Behav Nutr Phys Act 8(1):113

    Article  Google Scholar 

  37. 37

    Kanera IM, Willems RA, Bolman CAW, Mesters I, Zambon V, Gijsen BC, Lechner L (2016) Use and appreciation of a tailored self-management eHealth intervention for early cancer survivors: process evaluation of a randomized controlled trial. J Med Internet Res 18(8):e229. doi:10.2196/jmir.5975

    Article  PubMed  PubMed Central  Google Scholar 

  38. 38

    Hill JO (2009) Can a small-changes approach help address the obesity epidemic? A report of the Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council. Am J Clin Nutr 89(2):477–484. doi:10.3945/ajcn.2008.26566

    CAS  Article  PubMed  Google Scholar 

  39. 39

    Lee MK, Park H-A, Yun YH, Chang YJ (2013) Development and formative evaluation of a web-based self-management exercise and diet intervention program with tailored motivation and action planning for cancer survivors. JMIR research protocols 2(1):e11. doi:10.2196/resprot.2331

    Article  PubMed  PubMed Central  Google Scholar 

  40. 40

    Vandelanotte C, Short C, Plotnikoff RC, Hooker C, Canoy D, Rebar A, Alley S, Schoeppe S, Mummery WK, Duncan MJ (2015) TaylorActive—examining the effectiveness of web-based personally-tailored videos to increase physical activity: a randomised controlled trial protocol. BMC Public Health 15:1020. doi:10.1186/s12889-015-2363-4

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  41. 41

    De Cocker K, Charlier C, Van Hoof E, Pauwels E, Lechner L, Bourgois J, Spittaels H, Vandelanotte C, De Bourdeaudhuij I (2015) Development and usability of a computer-tailored pedometer-based physical activity advice for breast cancer survivors. European Journal of Cancer Care 24(5):673–682. doi:10.1111/ecc.12225

    Article  PubMed  Google Scholar 

  42. 42

    Forbes CC, Blanchard CM, Mummery WK, KS C (2015) Feasibility and preliminary efficacy of an online intervention to increase physical activity in Nova Scotian cancer survivors: a randomized controlled trial JMIR Cancer 1 ((2):e12)

  43. 43

    Michie S, Abraham C, Whittington C, McAteer J, Gupta S (2009) Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychol 28(6):690–701

    Article  Google Scholar 

  44. 44

    Sadasivam RS, Cutrona SL, Kinney RL, Marlin BM, Mazor KM, Lemon SC, Houston TK (2016) Collective-intelligence recommender systems: advancing computer tailoring for health behavior change into the 21st century. J Med Internet Res 18(3):e42. doi:10.2196/jmir.4448

    Article  PubMed  PubMed Central  Google Scholar 

  45. 45

    Chow S-C, Chang M (2008) Adaptive design methods in clinical trials—a review. Orphanet Journal of Rare Diseases 3:11–11. doi:10.1186/1750-1172-3-11

    Article  PubMed  PubMed Central  Google Scholar 

Download references


CES is supported by an Early Career Fellowship (ID 1090517) from the National Health and Medical Research Council of Australia. ALR is supported by an Early Career Fellowship (ID1105926) from the National Health Medical Research Council. KSC is supported by the Canada Research Chairs Program. CV is supported by a Future Leader Fellowship from the National Heart Foundation of Australia (ID 100427). MJD is supported by a Future Leader Fellowship (ID 100029) from the National Heart Foundation of Australia. RCP is supported by a Senior Research Fellowship Award from the National Health and Medical Research Council of Australia. The authors would like to thank BCNA and Register4 for their assistance recruiting participants, as well as the breast cancer survivors that volunteered their time and perspectives to help us evaluate and hopefully improve the platform.

Author information



Corresponding author

Correspondence to C. E. Short.

Ethics declarations

Ethics approval was obtained from the Central Queensland University’s Human Research Ethics Committee (EC00158).

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Short, C.E., James, E.L., Rebar, A.L. et al. Designing more engaging computer-tailored physical activity behaviour change interventions for breast cancer survivors: lessons from the iMove More for Life study. Support Care Cancer 25, 3569–3585 (2017).

Download citation


  • Breast cancer survivor
  • Computer tailor
  • Intervention
  • Physical activity
  • Qualitative