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Predictors of initial engagement with an asynchronous cognitive behavioral stress management website among older women with nonmetastatic breast cancer

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Abstract

Purpose

Digital interventions, like websites, offer greater access to psychosocial treatments; however, engagement is often suboptimal. Initial use may be a target to “hook” participants. Few studies examine engagement with cognitive behavioral stress management (CBSM). We tested predictors of engagement in the first week of using a CBSM website among women with breast cancer (BC).

Methods

Older women (≥ 50 years) with nonmetastatic BC enrolled in an on-going trial (8/2016–4/2022, #NCT03955991) and were randomized to receive 10 synchronous, virtual CBSM group sessions immediately (n = 41) or after a 6-month waitlist (n = 34). All received simultaneous access to an asynchronous website, where supplemental videos and resources were released weekly. Engagement was tracked via breadth (features used) and depth (clicks within content). Multilevel modeling tested predictors of engagement (i.e., time, condition, age, daily stress, depression, race, ethnicity, disease stage).

Results

Breadth decreased over the first week of CBSM (b = -0.93, p < .01), and women with more advanced stage disease engaged with more breadth (b = 0.52, p < .01) and depth (b = 14.06, p < .01) than women with earlier stage disease. Non-Hispanic (b = -0.59, p = .03) and White (b = -0.97, p < .01) women engaged with more features. Cancer stage and intervention timing interacted. Women with more advanced cancer stage who received CBSM later engaged with the most depth (b = -11.73, p = .04). All other characteristics did not predict engagement.

Conclusions

Disease stage, race, ethnicity, and intervention timing predicted engagement with a CBSM website in older BC patients.

Implications for cancer survivors

Delivering CBSM later in cancer treatment may mitigate competing demands. Fostering greater engagement in racial/ethnic minorities is needed.

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Data availability

Deidentified data generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

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Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Florida Department of Health (#6BC06) and Sylvester Comprehensive Cancer Center Bridge Grant (#PG014720).

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Authors and Affiliations

  1. Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Fifth Floor Coral, Gables, FL, 33146, USA

    Emily A. Walsh, Paula J. Popok, Molly Ream, Sierra Bainter, Estefany Saez-Clarke & Michael H. Antoni

  2. Department of Psychiatry & Behavioral Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA

    Dolores Perdomo

  3. Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Chloe Taub

  4. Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA

    Estefany Saez-Clarke, Susan Kesmodel, Bonnie B. Blomberg & Michael H. Antoni

  5. Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA

    Susan Kesmodel

  6. Department of Microbiology/Immunology, Miller School of Medicine, University of Miami, Miami, FL, USA

    Bonnie B. Blomberg

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  1. Emily A. Walsh
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Contributions

Emily Walsh, Sierra Bainter, and Michael Antoni contributed to the study conception and design. Michael Antoni acquired study funding. Material preparation and data collection were performed by Emily Walsh, Molly Ream, Dolores Perdomo, Chloe Taub, and Paula Popok. Data analysis was conducted and performed by Emily Walsh. The first draft of the manuscript was written by Emily Walsh, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Emily A. Walsh.

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Competing interests

Emily A. Walsh: None. Paula J. Popok: None. Molly Ream: Paid clinical intern for Blue Note Therapeutics (5/2022-8/2022). Sierra Bainter: None. Dolores Perdomo: None. Chloe Taub: Paid consultant of Blue Note Therapeutics. Estefany Saez-Clarke: None. Susan Kesmodel: None. Bonnie B. Blomberg: None. Michael H. Antoni: Inventor of cognitive behavioral stress management (CBSM) intervention which is filed as UMIP 483 by the University of Miami and licensed by Blue Note Therapeutics, a digital health company. Paid consultant for Blue Note Therapeutics and Atlantic Healthcare.

Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Board of the University of Miami (project #20160525).

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Written informed consent was obtained from all individual participants included in the study.

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Walsh, E.A., Popok, P.J., Ream, M. et al. Predictors of initial engagement with an asynchronous cognitive behavioral stress management website among older women with nonmetastatic breast cancer. Support Care Cancer 31, 466 (2023). https://doi.org/10.1007/s00520-023-07939-5

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