The Effects of Utilizing Smartphone Application Peer Support on Health Behavior and Body Mass Index among Breast Cancer Survivors

Gaeun Park; Haejung Lee; Hyun Yul Kim

doi:10.4040/jkan.2019.49.5.550

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Park, Lee, and Kim: The Effects of Utilizing Smartphone Application Peer Support on Health Behavior and Body Mass Index among Breast Cancer Survivors

Original Article

J Korean Acad Nurs 2019;49(5):550-561.

Published online: 15 January 2019

DOI: https://doi.org/10.4040/jkan.2019.49.5.550

The Effects of Utilizing Smartphone Application Peer Support on Health Behavior and Body Mass Index among Breast Cancer Survivors

Gaeun Park¹, Haejung Lee^2,, Hyun Yul Kim³

¹Department of Nursing, Pusan National University Yangsan Hospital, Yangsan

²College of Nursing, Pusan National University, Yangsan

³Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea

Address reprint requests to : Lee, Haejung College of Nursing, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan 50612, Korea Tel: +82-51-510-8344 Fax: +82-51-510-8308 E-mail: haejung@pusan.ac.kr

Received 14 February 2019 Revised 4 July 2019 Accepted 15 July 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

This study aimed to identify the effects of utilizing Smartphone Application Peer Support (SAPS) on health behavior and body mass index (BMI) among overweight or obese breast cancer survivors (BCS).

Methods

A nonequivalent control group with a non-synchronized design was utilized and 36 participants (experimental group 14, control group 22) were recruited from August 2017 to September 2018. Participants were 40~65 years old, overweight or obese, had completed primary cancer treatment within the 12 months prior to the study, and had not done regular exercise during the last 6 months. The 3-month SAPS consisted of exercise and diet education (once p/2 weeks), peer support (once p/week), and self-monitoring using smartphone applications (5 times p/week). All participants underwent assessments at baseline, right after SAPS, and at 3 months after SAPS. Data were analyzed using repeated measures ANOVA.

Results

At the completion of SAPS significant differences were found between groups in motivation for exercise (t=-3.24, p=.005), physical activity (t=-4.15, p<.001), total calorie intake (t=3.42, p=.002), calories from fat (t=-3.01, p=.005), intake of vegetables (t=-2.83, p=.008), and BMI (t=5.21, p<.001). Significant differences in BMI (t=4.13, p<.001) remained up to 3 months after SAPS completion. No significant differences was shown between groups in self-efficacy for exercise, either immediately after or 3 months after SAPS.

Conclusion

The SAPS has the potential to improve motivation for exercise, health behavior, and BMI of BCS. However, special efforts are required to encourage participants to complete the intervention and maintain long-term effects for future trials.

Keywords: Peer Group, Smartphone, Breast Neoplasms, Health Behavior, Body Mass Index

References

1. Kroenke CH, Chen WY, Rosner B, Holmes MD. Weight, weight gain, and survival after breast cancer diagnosis. Journal of Clinical Oncology. 2005; 23(7):1370–1378. https://doi.org/10.1200/jco.2005.01.079.

2. Phillips SM, McAuley E. Associations between self-reported post-diagnosis physical activity changes, body weight changes, and psychosocial well-being in breast cancer survivors. Supportive Care in Cancer. 2015; 23(1):159–167. https://doi.org/10.1007/s00520-014-2346-5.

3. Seo JS, Park HA, Kang JH, Kim KW, Cho YG, Hur YI, et al. Obesity and obesity-related lifestyles of Korean breast cancer survivors. Korean Journal of Health Promotion. 2014; 14(3):93–102. https://doi.org/10.15384/kjhp.2014.14.3.93.

4. Ministry of Health and Welfare. Prevalence of obesity [Internet]. Sejong: Ministry of Health and Welfare;c2016. [cited 2016 Apr 20]. Available from:. http://kosis.kr/statHtml/statH-tml.do?orgId=117&tblId=DT_11702_N101&conn_path=I2.

5. Mehta LS, Watson KE, Barac A, Beckie TM, Bittner V, Cruz-Flores S, et al. Cardiovascular disease and breast cancer: Where these entities intersect: A scientific statement from the American Heart Association. Circulation. 2018; 137(8):e30–e66. https://doi.org/10.1161/CIR.0000000000000556.

6. Korean Breast Cancer Society. Dietary guideline for breast cancer survivors [Internet]. Seoul: Korean Breast Cancer Society;c2009. [cited 2017 Apr 20]. Available from:. http://www.kbcs.or.kr/journal/common_sense_14.html.

7. Goodwin PJ, Segal RJ, Vallis M, Ligibel JA, Pond GR, Robi-doux A, et al. Randomized trial of a telephone-based weight loss intervention in postmenopausal women with breast cancer receiving letrozole: The LISA trial. Journal of Clinical Oncology. 2014; 32(21):2231–2239. https://doi.org/10.1200/jco.2013.53.1517.

8. Han SH. Factors of stages of exercise for patients with breast cancer based on the trans-theoretical model. Korean Journal of Sport Psychology. 2004; 15(2):139–160.

9. Park M, Hwang E, Moon HG, Noh DY, Lee JE. Dietary intake status among Korean female breast cancer survivors. Korean Journal of Community Nutrition. 2014; 19(2):163–175. https://doi.org/10.5720/kjcn.2014.19.2.163.

10. Kim MK, Lee WY, Kang JH, Kang JH, Kim BT, Kim SM, et al. 2014 Clinical practice guidelines for overweight and obesity in Korea. Endocrinology and Metabolism. 2014; 29(4):405–409. https://doi.org/10.3803/EnM.2014.29.4.405.

11. Bandura A. Organisational applications of social cognitive theory. Australian Journal of Management. 1988; 13(2):275–302. https://doi.org/10.1177/031289628801300210.

12. Greenlee H, Gaffney AO, Aycinena AC, Koch P, Contento I, Karmally W, et al. ¡Cocinar para su salud!: Randomized controlled trial of a culturally based dietary intervention among Hispanic breast cancer survivors. Journal of the Academy of Nutrition and Dietetics. 2015; 115(5):709–723.e3. https://doi.org/10.1016/j.jand.2014.11.002.

13. Rock CL, Flatt SW, Byers TE, Colditz GA, Demark-Wahne-fried W, Ganz PA, et al. Results of the exercise and nutrition to enhance recovery and good health for you (ENERGY) trial: A behavioral weight loss intervention in overweight or obese breast cancer survivors. Journal of Clinical Oncology. 2015; 33(28):3169–3176. https://doi.org/10.1200/JCO.2015.61.1095.

14. Choi PB. Influence of a regular aerobic exercise on body composition and immune cell in breast cancer patients undergoing surgery. The Korea Journal of Sports Science. 2013; 22(4):961–970.

15. Lee MK, Yun YH, Park HA, Lee ES, Jung KH, Noh DY. A web-based self-management exercise and diet intervention for breast cancer survivors: Pilot randomized controlled trial. International Journal of Nursing Studies. 2014; 51(12):1557–1567. https://doi.org/10.1016/j.ijnurstu.2014.04.012.

16. Kim YW, Sung GD, Baek YH. Effect of 12 weeks combined exercise and nutrition education on body composition and metabolic syndrome in breast cancer patients. Journal of the Korean Society of Living Environmental System. 2013; 20(1):1–9.

17. Cherrington AL, Willig AL, Agne AA, Fowler MC, Dutton GR, Scarinci IC. Development of a theory-based, peer support intervention to promote weight loss among Latina immigrants. BMC Obesity. 2015; 2:17. https://doi.org/10.1186/s40608-015-0047-3.

18. Turner-McGrievy GM, Beets MW, Moore JB, Kaczynski AT, Barr-Anderson DJ, Tate DF. Comparison of traditional versus mobile app self-monitoring of physical activity and dietary intake among overweight adults participating in an mHealth weight loss program. Journal of the American Medical Informatics Association. 2013; 20(3):513–518. https://doi.org/10.1136/amiajnl-2012-001510.

19. van der Weegen S, Verwey R, Spreeuwenberg M, Tange H, van der Weijden T, de Witte L. It’s LiFe! Mobile and web-based monitoring and feedback tool embedded in primary care increases physical activity: A cluster randomized controlled trial. Journal of Medical Internet Research. 2015; 17(7):e184. https://doi.org/10.2196/jmir.4579.

20. Chung BY, Oh EH, Song SJ. Mobile health for breast cancer patients: A systematic review. Asian Oncology Nursing. 2017; 17(3):133–142. https://doi.org/10.5388/aon.2017.17.3.133.

21. Allen JK, Stephens J, Dennison Himmelfarb CR, Stewart KJ, Hauck S. Randomized controlled pilot study testing use of smartphone technology for obesity treatment. Journal of Obesity. 2013; 2013:1–7. https://doi.org/10.1155/2013/151597.

22. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hoboken (NJ): Elsevier Science;2013. p. 273–379.

23. Lee R, Lee KS, Oh EG, Kim SH. A randomized trial of dyadic peer support intervention for newly diagnosed breast cancer patients in Korea. Cancer Nursing. 2013; 36(3):E15–E22. https://doi.org/10.1097/ncc.0b013e3182642d7c.

24. Choi M, Ahn S, Jung D. Psychometric evaluation of the Korean version of the self-efficacy for exercise scale for older adults. Geriatric Nursing. 2015; 36(4):301–305. https://doi.org/10.1016/j.gerinurse.2015.03.005.

25. Resnick B, Jenkins LS. Testing the reliability and validity of the self-efficacy for exercise scale. Nursing Research. 2000; 49(3):154–159. https://doi.org/10.1097/00006199-200005000-00007.

26. Yu J, Kim J. Effects of a physical activity program using ex-ergame with elderly women. Journal of Korean Academy of Nursing. 2015; 45(1):84–96. https://doi.org/10.4040/jkan.2015.45.1.84.

27. McAuley E, Duncan T, Tammen VV. Psychometric properties of the intrinsic motivation inventory in a competitive sport setting: A confirmatory factor analysis. Research Quarterly for Exercise and Sport. 1989; 60(1):48–58. https://doi.org/10.1080/02701367.1989.10607413.

28. Chun MY. Validity and reliability of Korean version of international physical activity questionnaire short form in the elderly. Korean Journal of Family Medicine. 2012; 33(3):144–151. https://doi.org/10.4082/kjfm.2012.33.3.144.

29. Bandura A. Social foundations of thought and action: A social cognitive theory. Englewood Cliffs (NJ): Prentice-Hall;1986. p. 390–449.

30. Kim SH. Effects of a volunteer-run peer support program on health and satisfaction with social support of older adults living alone. Journal of Korean Academy of Nursing. 2012; 42(4):525–536. https://doi.org/10.4040/jkan.2012.42.4.525.

31. Kim EJ, Hyun JS, Han JH, Kim N. Analysis of nursing needs of home-dwelling breast cancer patients based on counselling contents. Journal of Korean Public Health Nursing. 2016; 30(3):420–433. https://doi.org/10.5932/JKPHN.2016.30.3.420.

Figure 1.

Flow chart of the enrollment of the participants.

Table 1.

Contents of the Smartphone Application Peer Support

Wk	Education	Peer support	Self monitoring
1	•Providing PA and dietary guidelines	▶ Every week	1) Exercise monitoring
2	-	1) Sharing success experiences	•Time, intensity, and frequency
3	•Enhancing PA and dietary behavior	2) Sharing strategies to overcome barriers
4	-	3) Exchange positive feedbacks	2) Diet monitoring
5	•Benefits of weight management on recurrence and survival		•Total energy
		▶ Every 2 weeks when group meets	•Meat
6	-	4) Review peer support strategy book	•Fish
7	•Benefits of weight management on mental health	5) Watch video stories of exemplary peer supporters	•Vegetable
			•Fruit
8	-	•Dr. Lee’s story
9	•Physical consequences of PA and balanced diet	•Ms. Kim’s story of diet
		•Ms. Kim’s tips to overcome laziness
10	-	•Ms. Song’s story of exercises
11	•Mental consequences of PA and balanced	•Ms. Kim’s tips to overcome depression
	diet	•Ms. Kim’s tips to make exercise more enjoyable
12	-
Frequency	Once p/2 weeks	Once p/week	5 times p/week
Duration	10 min	40~50 min	30~40 min
Mode	Group meeting	Group meeting or Smartphone Apps	Smartphone Apps
Strategies	VP	ME, MDL, VE, VP	ME

Apps=Applications; BCS=Breast Cancer Survivors; MDL=Modelling; ME=Mastery Experience; min=minutes; PA=Physical Activity; VE=Vicarious Experience; VP=Verbal Persuasion; Wk=week.

Table 2.

Homogeneity Test for General Characteristics between Groups

Characteristics	Classification	Exp. (n=14)	Cont. (n=22)	χ² or t	p
Characteristics	Classification	n (%)	n (%)	χ² or t	p
Age (yr) (range 40~65)	40~49	4 (28.6)	6 (27.3)	1.05	.731^†
	50~59	10 (71.4)	14 (63.6)
	60~65	0 (0.0)	2 (9.1)
	M±SD	51.57±4.35	53.09±6.06	0.81	.422
Spouse	Yes	11 (78.6)	20 (90.9)	1.09	.357^†
	No	3 (21.4)	2 (9.1)
Employed		8 (57.1)	10 (45.5)	0.47	.494
Current smoking		0 (0.0)	0 (0.0)	-	-
Current alcohol consumption		2 (14.3)	8 (36.4)	2.08	.255^†
Menopause		12 (85.7)	19 (86.4)	<0.01	>.999^†
Time since diagnosis (year)	1~<4	11 (78.6)	12 (54.5)	3.03	.220^†
	4~<7	2 (14.3)	9 (40.9)
	≥7	1 (7.1)	1 (4.5)
Clinical stage	0	2 (14.3)	7 (31.8)	3.97	.304^†
	I	6 (42.8)	3 (13.6)
	II	4 (28.6)	8 (36.4)
	III	2 (14.3)	4 (18.2)
Type of surgery	BCS	4 (28.6)	6 (27.3)	<0.01	>.999^†
	Including reconstruction	10 (71.4)	16 (72.7)
Received radiotherapy		10 (71.4)	16 (72.7)	<0.01	>.999^†
Received chemotherapy		9 (64.3)	13 (59.1)	0.10	.755
Cyclophosphamide		9 (100.0)	13 (100.0)	-	-
Anthracycline		8 (88.9)	13 (100.0)	1.51	.409^†
Taxane		5 (55.6)	11 (84.6)	2.26	.178^†
Received hormone therapy		9 (64.3)	14 (63.6)	<0.01	.968
Tamoxifen		8 (88.9)	11 (78.6)	0.41	>.999^†
Aromatase Inhibitor		1 (11.1)	3 (21.4)	0.41	>.999^†

BCS=Breast Conservative Surgery; Cont.=Control group; Exp.=Experimental group; M=Mean; SD=Standard deviation.

^† Fisher’s exact test.

Table 3.

Homogeneity Test for Dependent Variables between Groups

Characteristics	Exp. (n=14)	Cont. (n=22)	t	p
Characteristics	M±SD	M±SD	t	p
Self-efficacy for exercise	47.64±13.23	45.45±20.95	-0.35	.730
Motivation for exercise	87.57±15.12	75.41±21.81	-1.82	.077
Health behavior^†
PA (MET-min/week)	1226.00±898.17	769.48±503.34	-1.93	.063
Diet
Total calorie intake (kcal/day)	1644.73±403.24	1617.76±436.92	-0.18	.855
Calories from fat (%)	24.30±7.61	25.21±6.11	0.39	.697
Intake of vegetables (g/day)	287.43±86.84	324.91±135.97	0.91	.368
BMI (kg/m²)	26.62±2.52	26.68±2.55	0.08	.941

BMI=Body Mass Index; Cont.=Control group; Exp.=Experimental group; M=Mean; PA=Physical Activity; MET=Metabolic Equivalent Task; SD=Standard Deviation.

^† Exp. (n=14), Cont. (n=21).

Table 4.

Effects of the SAPS on Dependent Variables (N=36)

Variables	G	^T₁	^T₂	^T₃	S	F	p	T₂-T₁ (M±SD)		T₃-T₁ (M±SD)
Variables	G	M±SD			S	F	p	t	p	t	p
Self-efficacy for exercise	Exp.	47.64±13.23	52.86±16.82	41.86±18.69	G	1.63	.211
	Cont.	45.45±20.95	37.14±15.24	40.86±20.89	T	1.33	.272
					G×T	3.13	.050
Motivation for exercise	Exp.	87.57±15.12	92.07±15.74	84.07±18.24	G	8.86	.005	4.50±15.61		-3.50±17.99
	Cont.	75.41±21.81	65.32±20.87	68.91±19.19	T	2.72	.073	-10.09±7.96		-6.50±11.12
					G×T	6.43	.003	-3.24	.005	-0.62	.539
Health behavior
PA	Exp.	1226.00±898.17	1963.89±1231.20	1371.57±987.59	G	15.03	.001	737.89±916.88		145.57±901.12
(MET-min /week)†	Cont.	791.42±505.68	448.05±401.29	664.47±425.96	T	1.71	.190 -	-316.30±567.54		-31.50±626.75
					G×T	10.90	<.001	-4.15	<.001	-0.68	.503
Diet††
Total calorie intake (kcal/day)	Exp.	1644.73±403.24	1368.78±208.53	1485.81±195.69	G	0.95	.338 -	-275.95±300.60		-158.92±338.39
	Cont.	1617.79±448.27	1627.52±413.60	1600.31±292.30	T	4.77	.012	9.72±186.51		-20.36±237.49
					G×T	5.30	.007	3.42	.002	1.43	.163
Calories from fat (%)	Exp.	24.30±7.61	31.49±8.74	25.32±6.93	G	2.19	.149	7.19±12.82		1.03±8.92
	Cont.	24.92±6.12	22.21±5.03	26.68±7.76	T	1.05	.355	-2.71±6.17		1.30±5.72
					G×T	7.25	.001	-3.01	005	0.11	.912
Intake of vegetables (g/day)	Exp.	287.43±86.84	455.62±189.01	378.06±187.56	G	0.77	.387	168.19±171.17		90.63±178.30
	Cont.	327.29±139.05	349.47±95.52	348.63±140.62	T	5.41	.007	22.17±129.54		31.76±175.99
					G×T	3.16	.049	-2.83	.008	-0.96	.342
BMI (kg/m²)	Exp.	26.62±2.52	25.64±2.72	25.86±2.76	G	0.62	.438	-0.98±0.55		-0.76±0.64
	Cont.	26.68±2.55	26.64±2.74	26.96±2.87	T	10.72	<.001	-0.05±0.51		0.28±0.78
					G×T	13.22	<.001	5.21	<.001	4.13	<.001

BMI=Body Mass Index; Cont.=Control group; Exp.=Experimental group; G=Group; M=Mean; PA=Physical Activity; QoL=Quality of Life; S=Sources; SAPS=Smartphone Application Peer Support; T=Time; SD=Standard Deviation; T₁=Pre-test; T₂=Post-test; T₃=3 month follow-up.

^† Exp. (n=14) Cont. (n=19)

^†† Exp. (n=14) Cont. (n=20).

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