User Experiences of an Internet-Based Stepped-Care Intervention for Individuals With Cancer and Concurrent Symptoms of Anxiety or Depression (the U-CARE AdultCan Trial): Qualitative Study

Abstract

Background The internet-based stepped-care intervention iCAN-DO, used in the multicenter randomized controlled trial AdultCan, was developed for adult patients undergoing treatment for cancer and concurrently experiencing anxiety or depressive symptoms. iCAN-DO aimed to decrease symptoms of anxiety or depression. Step 1 comprises access to a library with psychoeducational material and a peer-support section, as well as the possibility to pose questions to a nurse. Step 2 of the intervention offers treatment consisting of internet-based cognitive behavioral therapy (iCBT) to participants still experiencing anxiety or depression at 1, 4, or 7 months after inclusion. Objective The study aimed to explore user experiences of delivery, design, and structure of iCAN-DO from the perspective of people with cancer. Methods We studied user experiences by interviewing 15 informants individually: 10 women with breast cancer (67%), 4 men with prostate cancer (27%), and 1 man with colorectal cancer (7%) with a mean age 58.9 years (SD 8.9). The interviews focused on informants' perceptions of ease of use and of system design and structure. Informants had been included in iCAN-DO for at least 7 months. They were purposefully selected based on activity in Step 1, participation in iCBT (ie, Step 2), gender, and diagnosis. Results Of the 15 informants, 6 had been offered iCBT (40%). All informants used the internet on a daily basis, but 2 (13%) described themselves as very inexperienced computer users. The analysis revealed three subthemes, concerning how user experiences were affected by disease-specific factors and side effects (User experience in the context of cancer), technical problems (Technical struggles require patience and troubleshooting), and the structure and design of iCAN-DO (Appealing and usable, but rather simple). Conclusions The results indicate that user experiences were affected by informants’ life situations, the technical aspects and the design of iCAN-DO, and informants’ preferences. The results have generated some developments feasible to launch during the ongoing study, but if iCAN-DO is to be used beyond research interest, a greater level of tailoring of information, features, and design may be needed to improve user experiences. The use of recurrent questionnaires during the treatment period may highlight an individual’s health, but also function as a motivator showing improvements over time.

Developing Internet Interventions to Improve Psychosocial Outcomes in Breast Cancer Survivors : Attitudes and practices in Portuguese cancer settings

“…Participants anticipated that such a strategy could facilitate the handling of the program and the assessment of BCS treatment progress, promoting their engagement to iNNOVBC. These findings echo many of the limitations and development requirements gathered in previous research aiming at developing digital programs for supporting cancer survivors (232,237,238,240,(301)(302)(303)(304).…”

“…Adding labels and preview options to the most used functionalities was also considered important to increase the discoverability of the program. Previous research has yielded comparable results (232,237,240,301,302), suggesting that single-page websites or apps that enable properly labelled interactions and that make use of different colour depths, familiar icons, and images, are more usable and acceptable to cancer survivors.…”

Development and Evaluation of the Usefulness, Usability, and Feasibility of iNNOV Breast Cancer: Mixed Methods Study

“…Likewise, the use of a more dynamic color scheme and greater use of icons, images, and shortcuts were appointed as necessary to facilitate the recognition of the program’s affordances and facilitate its use. Previous research has yielded comparable results [ 64 , 65 , 69 - 71 ], suggesting that single-page websites or apps that enable properly labeled interactions and make use of different color depths, familiar icons, and images are more usable and acceptable to cancer survivors.…”

Conducting Digital Health Care Research: Document Analysis of Challenges Experienced During Intervention Development and Feasibility Study Setup of an Internet-Administered Intervention for Parents of Children Treated for Cancer

“…However, rapid technical evolution is not easily compatible with traditional research approaches such as randomized controlled trials (RCTs) [85], and translating traditional clinical trial procedures to digital form may require the complete re-engineering of trial design and processes [36]. The Portal was developed to support traditional health care research, for example, RCTs and observational studies, and multiple RCTs of internet-administered cognitive behavioral therapy interventions have been conducted on the Portal [87][88][89][90]. The Portal was originally designed to deliver two internet-administered cognitive behavioral therapy interventions [87,88]; however, over time, the Portal has been developed to support the needs of different studies and has experienced a continuous flow of technical requirements from researchers since its conception in 2010 [22,23].…”

“…The Portal was developed to support traditional health care research, for example, RCTs and observational studies, and multiple RCTs of internet-administered cognitive behavioral therapy interventions have been conducted on the Portal [87][88][89][90]. The Portal was originally designed to deliver two internet-administered cognitive behavioral therapy interventions [87,88]; however, over time, the Portal has been developed to support the needs of different studies and has experienced a continuous flow of technical requirements from researchers since its conception in 2010 [22,23]. However, the time taken to design and conduct traditional health care research is not in line with fast-paced technical advances [91].…”