Supporting breast cancer survivors via text messages: reach, acceptability, and utility of EMPOWER-SMS

Abstract

Purpose This study aims to evaluate the reach, usefulness, acceptability, and factors influencing engagement with a lifestylefocused text message intervention to support women's mental and physical health after breast cancer treatment. Methods This study uses a mixed-methods process evaluation nested in the EMPOWER-SMS randomised controlled trial (n = 160; intervention n = 80, wait-list control n = 80). Data sources included screening logs, text message delivery software analytics, intervention feedback survey, and focus groups (n = 16), which were summarised thematically based on the framework approach. Results A total of 387 women met the inclusion criteria (mean age ± SD = 59.3 ± 11.6 years). Participants who declined (n = 227) were significantly older than those who enrolled (n = 160; 62.2 ± 11.1 vs 55.1 ± 11.1 years, respectively, p < 0.001). Most intervention participants (64/80; 80%) completed the end-of-study survey, reporting the messages were easy to understand (64/64; 100%), useful (58/64; 91%), and motivating (43/64; 67%). The focus groups (n = 16) revealed five factors influencing engagement: (i) feelings of support/continued care, (ii) convenience/flexibility of message delivery, (iii) weblinks, (iv) information from a credible source, and (v) options to save or share messages. Conclusion A lifestyle-focused text message program was acceptable and useful for women after breast cancer treatment.However, text messaging may be a barrier for women aged over 68 years. Suggestions for program improvements included delivering the program to patients with other cancers, during all stages of treatment, and including more weblinks in text messages. Implications for Cancer Survivors Text message programs offer a low-cost way to deliver post-treatment health support to breast cancer survivors in a noninvasive way. Text messages can improve patient-health professional communication and were found to be acceptable and useful.

Co-design and Development of EndoSMS, a Supportive Text Message Intervention for Individuals Living With Endometriosis: Mixed Methods Study

“…In this case, brief messages were designed to provide reassurance, encourage a positive outlook, and reflect on gratitude. Emerging evidence suggests that these psychologically focused supportive SMS text messaging interventions are very well tolerated and accepted [ 66 ], consistent with evidence from health behavior change–focused SMS text interventions [ 52 , 53 ].…”

“…A key strength of SMS text messaging is its flexibility, allowing a range of content (within the 160-character limit), including psychoeducation, reminders (eg, to exercise or take medication), motivational messages, self-care (eg, stress management tips), and informative links to health-related internet sites [ 51 ]. The simple language format used in texts also increases their accessibility, irrespective of the reading level [ 52 - 55 ]. The ability to send SMS text messages anonymously may help minimize stigma and barriers to accessing health care [ 56 ], which are particularly evident in geographically isolated underserved populations [ 57 ].…”

Experiences of cancer survivors in Europe: Has anything changed? Can artificial intelligence offer a solution?

“…The need for structured support was stressed in many instances during the interviews and even emerged as a theme signifying the importance and value of this aspect of care. In fact, structured support within cancer care has been reported as sparse and some of the available services can be inaccessible to many patients due to several reasons including in person delivery limiting the attendance of people in remote and rural areas, work/family responsibilities, financial stressors or mobility issues ( 38 ). A previous randomised controlled trial aimed to assess the experiences of patients with breast and colorectal cancer of navigation of cancer care services versus usual care.…”

“…Furthermore, a recent study of breast cancer survivors’ perspectives of physical and psychological support intervention after treatment underscored how the survivors really appreciated even a simple and low-cost support program which consisted of text messaging intervention. The survivors showed great appreciation for the feelings of support and continued care and the benefits reflected by this intervention on their lifestyle during the cancer journey including exercise, diet, mental health and medication adherence ( 38 ).…”

“…Second, experiences were sought among survivors with sufficient English communication skills since non-English speaking participants were excluded from the study. Third, conducting the interviews via videoconferencing, telephone or email may have limited some people’s ability to participate due to technology barriers ( 38 ). Fourth, few survivors were included from each of the five countries which also limits the generlisability of the study across the included countries.…”