Skip to main content

Advertisement

SpringerLink
Log in

A Pilot and Feasibility Mobile Health Intervention to Support Healthy Behaviors in African American Breast Cancer Survivors

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

African American breast cancer (AA BC) survivors are more likely to have cancer-related comorbidities compared with other women, ultimately putting them at higher risk for overall mortality and breast cancer-specific mortality. Survivorship care guidelines emphasize the importance of attention to obesity, weight management, and physical activity. Mobile technologies have been effective for improving health behaviors among cancer survivors, though few studies have focused on AA BC survivors. Creating Healthy Actions through Technology (CHAT) was a 4-week pilot intervention that employed an ecological momentary assessment (EMA) to improve survivors’ physical activity and diet behaviors. We evaluated the acceptability, feasibility, and impact of a mHealth intervention for AA BC survivors. Participants (N = 22) were randomized to intervention (n = 13) or control (n = 9). All participants completed daily EMAs via smartphone for 4 weeks and wore accelerometers for seven consecutive days at baseline, 4, and 8 weeks. Intervention participants additionally received tailored health messages. Diet was measured using a self-reported questionnaire and physical activity with accelerometers. Participant engagement was high. Of 84 EMA assessments, the average response was 63 (SD 16.1). Participant accelerometer wear was at least 6 of the 7 days (SD 1.7) for each assessment. Eighty-five percent of participants reported the intervention helped change behaviors. Intervention participants reduced their sedentary time by 4.37 (SD = 7.14) hours/day versus controls (p = .05), reduced fast food intake by 1.5 servings (p = 0.008), and increased vigorous activity by 0.56 (SD = 28.10) minutes, which was non-significant (p = 0.959). Findings show feasibility and acceptability and potential of the intervention to positively impact physical activity among AA BC survivors.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Tammemagi CM, Nerenz D, Neslund-Dudas C, Feldkamp C, Nathanson D. Comorbidity and survival disparities among black and white patients with breast cancer. Jama. 2005;294(14):1765–72.

    Article  CAS  PubMed  Google Scholar 

  2. Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat. 2010;123(3):627–35.

    Article  PubMed  Google Scholar 

  3. Demark-Wahnefried W, Campbell KL, Hayes SC. Weight management and its role in breast cancer rehabilitation. Cancer. 2012;118(8 Suppl):2277–87.

    Article  PubMed  Google Scholar 

  4. Paxton RJ, Phillips KL, Jones LA, Chang S, Taylor WC, Courneya KS, et al. Associations among physical activity, body mass index, and health-related quality of life by race/ethnicity in a diverse sample of breast cancer survivors. Cancer. 2012;118(16):4024–31.

    Article  PubMed  Google Scholar 

  5. Harvie M. The importance of controlling body weight after a diagnosis of breast cancer: the role of diet and exercise in breast cancer patient management. New York: Springer; 2010.

    Google Scholar 

  6. Gross AL, May BJ, Axilbund JE, Armstrong DK, Roden RBS, Visvanathan K. Weight change in breast cancer survivors compared to cancer-free women: a prospective study in women at familial risk of breast cancer. Cancer Epidemiol Biomark Prev. 2015;24(8):1262–9.

    Article  CAS  Google Scholar 

  7. Denlinger CS, Ligibel JA, Are M, Baker KS, Demark-Wahnefried W, Dizon D, et al. Survivorship: nutrition and weight management, version 2.2014. Clinical practice guidelines in oncology. J Natl Compr Cancer Netw. 2014;12(10):1396–406.

    Article  Google Scholar 

  8. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62(4):243–74.

    Article  PubMed  Google Scholar 

  9. Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012;62(1):30–67.

    Article  PubMed  Google Scholar 

  10. Ligibel JA, Alfano CM, Courneya KS, Demark-Wahnefried W, Burger RA, Chlebowski RT, et al. American Society of Clinical Oncology position statement on obesity and cancer. J Clin Oncol. 2014;32(31):3568–74.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Doyle C, Kushi LH, Byers T, Courneya KS, Demark-Wahnefried W, Grant B, et al. Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin. 2006;56(6):323–53.

    Article  PubMed  Google Scholar 

  12. Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307(5):491–7.

    Article  PubMed  Google Scholar 

  13. Rock CL, et al. Factors associated with weight gain in women after diagnosis of breast cancer. Women’s healthy eating and living study group. J Am Diet Assoc. 1999;99(10):1212–21.

    Article  CAS  PubMed  Google Scholar 

  14. Hebert ET, et al. An ecological momentary intervention for smoking cessation: the associations of just-in-time, tailored messages with lapse risk factors. Addict Behav. 2018;78:30–5.

    Article  PubMed  Google Scholar 

  15. Prince SA, Saunders TJ, Gresty K, Reid RD. A comparison of the effectiveness of physical activity and sedentary behaviour interventions in reducing sedentary time in adults: a systematic review and meta-analysis of controlled trials. Obes Rev. 2014;15(11):905–19.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kendzor DE, Shuval K, Gabriel KP, Businelle MS, Ma P, High RR, et al. Impact of a smartphone intervention to reduce sedentary behavior in a community sample of adults: a quasi-experimental evaluation. J Med Internet Res. 2016;18(1):e19.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Bond DS, Thomas JG, Raynor HA, Moon J, Sieling J, Trautvetter J, et al. B-MOBILE--a smartphone-based intervention to reduce sedentary time in overweight/obese individuals: a within-subjects experimental trial. PLoS One. 2014;9(6):e100821.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  18. Muller AM, et al. The effectiveness of e-& mHealth interventions to promote physical activity and healthy diets in developing countries: a systematic review. Int J Behav Nutr Phys Act. 2016;13(1):109.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Hawkes AL, Chambers SK, Pakenham KI, Patrao TA, Baade PD, Lynch BM, et al. Effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes in survivors of colorectal cancer: a randomized controlled trial. J Clin Oncol. 2013;31(18):2313–21.

    Article  PubMed  Google Scholar 

  20. Reeves MM, Terranova CO, Eakin EG, Demark-Wahnefried W. Weight loss intervention trials in women with breast cancer: a systematic review. Obes Rev. 2014;15(9):749–68.

    Article  CAS  PubMed  Google Scholar 

  21. Spark LC, Fjeldsoe BS, Eakin EG, Reeves MM. Efficacy of a text message-delivered extended contact intervention on maintenance of weight loss, physical activity, and dietary behavior change. JMIR Mhealth Uhealth. 2015;3(3):e88.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Smith, S.A., et al., Lifestyle modification experiences of African American breast cancer survivors: a needs assessment. JMIR Cancer, 2015. 1(2).

  23. Hawkes Al CS, Pakenham KI, Patrao TA, Baade PD, Lynch BM, et al. Effects of a telephone-delivered multiple health beahvior change intervention (CanChange) on health and behavioral outcomes in survivors of colorectal cancer: a randomized controlled trial. J Clin Oncol. 2013;31(18):2313–21.

    Article  PubMed  Google Scholar 

  24. Stone AA, Schwartz JE, Neale JM, Shiffman S, Marco CA, Hickcox M, et al. A comparison of coping assessed by ecological momentary assessment and retrospective recall. J Pers Soc Psychol. 1998;74(6):1670–80.

    Article  CAS  PubMed  Google Scholar 

  25. Fukuoka Y, Kamitani E, Dracup K, Jong SS. New insights into compliance with a mobile phone diary and pedometer use in sedentary women. J Phys Act Health. 2011;8(3):398–403.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Direito A, Carraça E, Rawstorn J, Whittaker R, Maddison R. mHealth technologies to influence physical activity and sedentary behaviors: behavior change techniques, systematic review and meta-analysis of randomized controlled trials. Ann Behav Med. 2017;51(2):226–39.

    Article  PubMed  Google Scholar 

  27. Stephenson A, M.S., Murphy MH, Nugent CD, Mair JL, Using computer, mobile and wearable technology enhanced interventions to reduce sedentary behaviour: a systematic review and meta-analysis. Int J Behav Nutr Phys Act., 2017. 14(1).

  28. Hakala S. R.a., Immonen J, Karvanen J, Heinonen a, Sjogren T, Effectiveness of technology-based distance interventions promoting physical activity: systematic review, meta-analysis and meta-regression. J Rehabil Med. 2017;49(2):97–105.

    Article  PubMed  Google Scholar 

  29. McCarrol ML, Armbruster S, Pohle-Krauza RJ, Lyzen AM, Min S, Nash DW, et al. Feasibility of a lifestyle intervention for overweight/obese endometrial and breast cancer survivors using an interactive mobile application. Gynecol Oncol. 2015;137(3):508–15.

    Article  Google Scholar 

  30. Quintiliani LM, M.D., Puputti M, Quinn E, Bowen DJ, Pilot and feasibilitytest of a mobile health-supported behavioral counseling intervention for weight management among breast cancer survivors. JMIR Cancer, 2016. 2(1): p. e4

  31. Valle CG, Deal AM, Tate DF. Preventing weight gain in African American breast cancer survivors using smart scales and activity trackers: a randomized controlled pilot study. J Cancer Surviv. 2017;11(1):133–48.

    Article  PubMed  Google Scholar 

  32. Goode AD, L.S, Brakenridge CL, Reeves MM. Telephone, print, and Web-based interventions for physical activity, diet and weight control among cancer survivors: a systematic review. J Cancer Surviv. 2015;9:660–82.

    Article  PubMed  Google Scholar 

  33. Phillips SM, Collins LM, Penedo FJ, Courneya KS, Welch W, Cottrell A, et al. Optimization of a technology-supported physical activity intervention for breast cancer survivors: Fit2Thrive study protocol. Contemp Clin Trials. 2018;66:9–19.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Lynch BM, Nguyen NH, Reeves MM, Moore MM, Rosenberg DE, Wheeler MJ, et al. Study design and methods for the ACTIVity and TEchnology (ACTIVATE) trial. Contemp Clin Trials. 2018;64:112–7.

    Article  PubMed  Google Scholar 

  35. Hartman SJ, Nelson SH, Myers E, Natarajan L, Sears DD, Palmer BW, et al. Randomized controlled trial of increasing physical activity on objectively measured and self-reported cognitive functioning among breast cancer survivors: the memory & motion study. Cancer. 2018;124(1):192–202.

    Article  PubMed  Google Scholar 

  36. Ormel HL, van der Schoot GGF, Westerink NDL, Sluiter WJ, Gietema JA, Walenkamp AME. Self-monitoring physical activity with a smartphone application in cancer patients: a randomized feasibility study (SMART-trial). Support Care Cancer. 2018;26(11):3915–23.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Bennett GG, Steinberg DM, Stoute C, Lanpher M, Lane I, Askew S, et al. Electronic health (eHealth) interventions for weight management among racial/ethnic minority adults: a systematic review. Obes Rev. 2014;15(Suppl 4):146–58.

    Article  PubMed  Google Scholar 

  38. Pew Center for Research. African Americans and technology use. 2014 [cited 2018 March 10]; Available from: http://www.pewinternet.org/2014/01/06/africanamericans-and-technology-use/.

  39. Middelweerd A, Mollee JS, van der Wal CN, Brug J, Te Velde SJ. Apps to promote physical activity among adults: a review and content analysis. Int J Behav Nutr Phys Act. 2014:11.

  40. Basen-Engquist K, Carmack CL, Li Y, Brown J, Jhingran A, Hughes DC, et al. Social-cognitive theory predictors of exercise behavior in endometrial cancer survivors. Health Psychol. 2013;32(11):1137–48.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Robertson MC, Lyons E, Song J, Cox-Martin M, Li Y, Green CE, et al. Change in physical activity and quality of life in endometrial cancer survivors receiving a physical activity intervention. Health Quality Life Outcomes. 2019:17(1).

  42. Bandura A. Health promotion by social cognitive means. Health Educ Behav. 2004;31(2):143–64.

    Article  PubMed  Google Scholar 

  43. Carver CS, Scheier MF. Control theory: a useful conceptual framework for personality-social, clinical, and health psychology. Psychol Bull. 1982;92(1):111–35.

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  45. Lyons EJ, Lewis ZH, Mayrsohn BG, Rowland JL. Behavior change techniques implemented in electronic lifestyle activity monitors: a systematic content analysis. J Med Internet Res. 2014;16(8):e192.

    Article  PubMed  PubMed Central  Google Scholar 

  46. O'Reilly GA, Spruijt-Metz D. Current mHealth technologies for physical activity assessment and promotion. Am J Prev Med. 2013;45(4):501–7.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Leon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical research. J Psychiatr Res. 2011;45(5):626–9.

    Article  PubMed  Google Scholar 

  48. Williams MV, Baker DW, Honig EG, Lee TM, Nowlan A. Inadequate literacy is a barrier to asthma knowledge and self-care. Chest. 1998;114(4):1008–15.

    Article  CAS  PubMed  Google Scholar 

  49. Campbell MK, Motsinger BMA, Ingram A, Jewell D, Makarushka C, Beatty B, et al. The North Carolina Black Churches United for better health project: intervention and process evaluation. Health Educ Behav. 2000;27(2):241–53.

    Article  CAS  PubMed  Google Scholar 

  50. Campbell MK, et al. Improving multiple behaviors for colorectal cancer prevention among african american church members. Health Psychol. 2004;23(5):492–502.

    Article  PubMed  Google Scholar 

  51. Resnicow K, Kramish Campbell M, Carr C, McCarty F, Wang T, Periasamy S, et al. Body and soul. A dietary intervention conducted through African-American churches. Am J Prev Med. 2004;27(2):97–105.

    Article  PubMed  Google Scholar 

  52. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement: executive summary. Crit Pathw Cardiol. 2005;4(4):198–203.

    Article  PubMed  Google Scholar 

  53. Thompson FE, Midthune D, Subar AF, Kahle LL, Schatzkin A, Kipnis V. Performance of a short tool to assess dietary intakes of fruits and vegetables, percentage energy from fat and fibre. Public Health Nutr. 2004;7(8):1097–105.

    Article  PubMed  Google Scholar 

  54. U.S. Department of Agriculture, Agricultural Research Service. Continuing survey of food intakes by individuals 1994–96, 1998 and Diet and Health Knowledge Survey 1994–96: Documentation (csfii9498_documentationupdated.pdf) or Data Files (csfii9498_data.exe). . 12/03/2016]; Available from: https://www.ars.usda.gov/northeast-area/beltsville-md-bhnrc/beltsville-human-nutrition-research-center/food-surveys-research-group/docs/csfii-1994-1996-1998-and-dhks-1994-1996/.

  55. CDC, Behavioral risk factor surveillance system questionnaire. 2007. p. Section 17: Physical Activity.

  56. Choi L, et al. Validation of accelerometer wear and nonwear time classification algorithm. Med Sci Sports Exerc. 2011;43(2):357–64.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Freedson PS, Melanson E, Sirard J. Calibration of the computer science and applications, Inc accelerometer. Med Sci Sports Exerc. 1998;30(5):777–81.

    Article  CAS  PubMed  Google Scholar 

  58. Troiano RP, et al. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181–8.

    Article  PubMed  Google Scholar 

  59. Smith SA, Whitehead M, Sheats JQ, Fontenot B, Alema-Mensah E, Ansa B. Formative research to develop a lifestyle application (app) for African American breast cancer survivors. J Ga Public Health Assoc. 2016;6:50–9.

    PubMed  PubMed Central  Google Scholar 

  60. Quintiliani, L.M., et al., Pilot and feasibility test of a mobile health-supported behavioral counseling intervention for weight management among breast cancer survivors. JMIR Cancer, 2016. 2(1).

  61. Steinberg DM, Levine EL, Askew S, Foley P, Bennett GG. Daily text messaging for weight control among racial and ethnic minority women: randomized controlled pilot study. J Med Internet Res. 2013;15(11):e244.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We thank our research participants and Sherone Bryant for supporting and facilitating the completion of his work.

Funding Sources

This study was funded by an internal grant from the American Cancer Society and the University of Texas Southwestern Medical Center (IRG-02-196).

Author information

Authors and Affiliations

  1. School of Public Health, University of Texas Health Sciences Center at Houston, Houston, TX, USA

    Marlyn Allicock, Abigail Sedory, Kelley Pettee Gabriel, Michael D. Swartz, Priya Thomas & Joshua S. Yudkin

  2. Department of Health Promotion & Behavioral Sciences, 5323 Harry Hines Blvd., V8.112, Dallas, TX, 75390-9128, USA

    Marlyn Allicock

  3. The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Darla Kendzor

  4. Tobacco Intervention Research Clinic, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA

    Darla Kendzor

  5. Memorial Breast Cancer Center, Memorial Regional Hospital, Memorial Hospital West, Hollywood, FL, USA

    Aeisha Rivers

Authors
  1. Marlyn Allicock
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Darla Kendzor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Abigail Sedory
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kelley Pettee Gabriel
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael D. Swartz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Priya Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joshua S. Yudkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Aeisha Rivers
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marlyn Allicock.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

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

Welfare of Animals

This article does not contain any studies with animals performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Allicock, M., Kendzor, D., Sedory, A. et al. A Pilot and Feasibility Mobile Health Intervention to Support Healthy Behaviors in African American Breast Cancer Survivors. J. Racial and Ethnic Health Disparities 8, 157–165 (2021). https://doi.org/10.1007/s40615-020-00767-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-020-00767-x

Keywords

Search

Navigation