Effects of Psychoeducational Interventions Using Mobile Apps and Mobile-Based Online Group Discussions on Anxiety and Self-Esteem in Women With Breast Cancer: Randomized Controlled Trial

Abstract

Background Psychoeducation has turned into an effective tool in taking care of cancer patients and improving their psychophysical symptoms and quality of life. Despite the growing use of mobile phone apps in medical settings for improving health, evidence supporting their effectiveness in the psychoeducation of patients with breast cancer is rarely available. Objective This study was conducted to investigate the effect of psychoeducational interventions on anxiety and self-esteem in women with breast cancer using a mobile app and an online support group. Methods An unblinded randomized controlled trial based on mobile phones was conducted in Shiraz, Iran. A research assistant recruited 82 women with nonmetastatic breast cancer aged 20 to 60 years were from clinics during a face-to-face visit at the point of care and randomly assigned to an intervention group (n=41) and a wait-list control group (n=41) through blocked randomization. The intervention group received psychoeducational interventions through a mobile phone app and participated in nurse-assisted online mobile support sessions for a total four weeks, whereas the control group was put on a waiting list. The State-Trait Anxiety Inventory (STAI) and the Rosenberg Self-Esteem Scale (RSES) were used to measure the levels of anxiety and self-esteem as the main outcomes at baseline and one week after the intervention. Results A total of 82 patients with a mean age of 46.45 (SD 9.29) years recruited in Winter 2016 were randomly assigned to a wait-list control group (n=41) and intervention group (n=41). Five patients dropped out for different reasons. Comparing the postintervention mean scores of anxiety and its subscales using the independent t test showed statistically significant differences between the mobile psychoeducation group and controls (P<.001). The paired t test used to compare the postintervention mean scores of anxiety with its preintervention scores in the intervention group showed significant reductions in the scores of anxiety (95% CI –17.44 to –8.90, P<.001, d=1.02) and its two subscales (state anxiety: 95% CI –9.20 to –4.21, P<.001, d=0.88 and trait anxiety: 95% CI –8.50 to –4.12, P<.001, d=0.94). Comparing the postintervention mean scores of self-esteem showed statistically insignificant differences between the control and intervention groups (16.87 vs 17.97, P=.24). In contrast with the controls, using the paired t test showed that the increase in the postintervention mean scores of self-esteem were statistically significant in the intervention group compared with the preintervention scores (mean difference 2.05, 95% CI 1.28 to 2.82, P<.001). Conclusions This study demonstrated the key role of mobile apps in decreasing anxiety and improving self-esteem in women with breast cancer through psychoeducational interventions. Similar studies with longer follow-ups are recommended that be conducted in this context. Trial Registration Iranian Registry of Clinical Trials IRCT2015072123279N2; https://en.irct.ir/trial/19882

Effect of mHealth interventions on psychological issues experienced by women diagnosed with breast cancer receiving chemotherapy: A systematic review and meta-analysis

“…The 10 included studies were conducted in nine countries: Sweden [47], Japan [48], Taiwan [49], Iran [50, 54], South Korea [51], the United States [52], China [53], Canada [55], and Slovenia [56]. All the studies included a total of 1,548 women with BC undergoing chemotherapy.…”

“…Five of the studies recruited only women with BC undergoing chemotherapy [47-49, 53, 55], the remaining five recruited those receiving other treatments (radiotherapy, surgery, and hormonal therapy) alongside chemotherapy [50-52,54,56].…”

“…Nurses were the interveners in six studies [47-50, 54, 55], whereas in other studies the interventions were delivered by both nurses and doctors [53], a medical doctor [50], graduate-level health professionals [51] and oncologist [56].…”

“…We identified four major components of interventions. All except two [43,56] of the studies had a component for BC education; five had a component for expert consultation [48-50, 53, 54], four had a component for group interaction [49,52-54], and five had a component for the self-reporting of symptoms [47-49, 55, 56]. One intervention also had a game-based learning component [51].…”

Correlation Between Self-management Efficacy and Supportive Care Needs Among Patients With Breast Cancer Receiving Chemotherapy

“…The reason for this may be that the con dence of patients in coping with the disease varies depending on the type of disease. For example, breast cancer and its treatment destroy the secondary sex characteristics of women, and is more likely to cause psychological problems (e.g., physical pain and low self-esteem) seriously affecting the con dence of patients to actively respond to diseases (i.e., self-management e cacy) compared with head and neck malignant tumors [25].…”