BackgroundAcute Lymphoblastic Leukemia (ALL) is the most common childhood malignancy. Caring for children with ALL is challenging for parents. A mHealth supportive care intervention was developed to meet parents' needs. ObjectivesTo evaluate the potential effectiveness of this mHealth supportive care intervention on emotional distress, social support, care burden, uncertainty, quality of life and knowledge. MethodsA quasi-experimental pre-/post-design study was conducted form June 2015 to January 2016.In total, 101 parents were enrolled in the study, with 50 in the observation group and 51 in the intervention group. Parents in the observation group received the standard health education and were observed for 3 months. Parents in the intervention group received the mHealth supportive care intervention, in addition to the standard health education. The intervention consisted of two parts: an Android smartphone app "Care Assistant (CA)" and a WeChat Official Account. The CA with eight modules (Personal Information, Treatment Tracking, Family Care, Financial and Social Assistance, Knowledge Center, Self-Assessment Questionnaires, Interactive Platform, and Reminders) was the main intervention tool, while WeChat Official Account was the supplementary to update information and to realize interaction between parents and healthcare providers. Data of parents' social support, anxiety, depression, care burden, uncertainty in illness, quality of life, their existing knowledge of ALL and care, and knowledge need were collected before and after the 3-month study period in both groups. For the intervention group, parents' experience of receiving the intervention was also collected through individual interviews. Results Forty P<.001).Qualitative results showed that parents were satisfied with the intervention and their role in the caregiving process. ConclusionsThe mHealth intervention in supporting parents of children with ALL is effective. This study is informative for other future studies on providing mHealth supportive care for parents of children with cancer.

Background Self-efficacy is a crucial variable that is related to quality of life. Patients who have high self-efficacy will exert sufficient effort and have better health outcomes and improved quality of life. Appropriate and precise measurement of self-efficacy can help promote better care. The Breast Cancer Survivor Self-efficacy Scale (BCSES) is designed to measure the perceived confidence of breast cancer patients in managing the tasks for self-management. Originally developed in America, it has not been used in China. Objectives The aims of this study were to translate BCSES into Chinese and assess its psychometric properties among Chinese patients. Methods In phase 1, the translation of BCSES closely followed the Principles of Good Practices. In phase 2, data on reliability and validity were evaluated in terms of internal consistency, item-total correlations, test-retest reliability, criterion validity, and construct validity. A total sample of 630 native Chinese-speaking patients from 5 hospitals in China participated, including a pilot sample of 182 and a validation sample of 448. Results Minor modifications in 5 items were recommended after translation. Both exploratory and confirmatory factor analyses suggested a 2-factor structure was more ideal than the original 1-factor model. Cronbach's α coefficient for the Chinese version of BCSES was .82, intraclass correlation coefficient was 0.97, and item-total correlations were from 0.61 to 0.76. Conclusions The Chinese version of BCSES appears to be culturally appropriate, reliable, and valid for assessing self-efficacy among patients with breast cancer in China. Implication for Practice The Chinese version of BCSES could help measure the breast cancer patients' self-efficacy and provide evidence to develop culturally sensitive interventions for Chinese patients.

Background Self-management plays an important role in improving quality of life among patients with breast cancer. Self-management behaviors change with treatment periods, and the trajectory varies in patients with different demographic and psychosocial characteristics. However, the trajectory patterns and the predictive factors have not been fully studied. Objectives The aim of this study was to identify the trajectory patterns of self-management behaviors in Chinese patients with breast cancer and their predictive factors. Methods A total of 128 patients with breast cancer were recruited. Demographic and disease-related information, self-management behaviors, self-efficacy, coping modes, emotional distress, and social support were investigated across 5 time points. Growth mixture modeling was used to identify the trajectory patterns of self-management behaviors. Logistic regression was used to determine the predictors for membership. Results The best-fit growth mixture modeling revealed a 2-class model; model fit indices were all in acceptable ranges. Class 1 and 2 were named as the group of “stable” (34.38%) and the group of “sharply decreased” (65.62%), respectively, based on the tendency of change. Modified radical mastectomy, avoidance coping mode, anxiety, and low self-efficacy level were predictors of the patients' membership to the sharply decreased group. Conclusion Our study proved the heterogeneity of self-management behaviors and the influencing effect of treatment and psychosocial factors on the development of self-management behaviors in Chinese patients with breast cancer. Implications for Practice Health professionals should pay more attention to patients who are at higher risk of developing a poor self-management pattern. Targeted interventions should be developed across subpopulations and treatment periods accordingly.

Aim: To identify subgroups of cancer patients with distinct self-care self-efficacy profiles and to explore factors that can be used to predict those at risk of low self-efficacy.Design: A secondary analysis of data pooled from two cross-sectional surveys was performed.Methods: In total, 1,367 Chinese cancer survivors were included in the analysis.Latent profile analysis (LPA) was performed to categorize participants into latent subgroups with distinct self-efficacy profiles. Multinomial logistic regression was conducted to identify predictors of self-care self-efficacy subgroup classification. Results:We identified three distinct subgroups: low, medium and high self-care selfefficacy. Patients with the "low" profile, which was characterized by a low education level, single marital status, complications, late cancer stage and a lower level of social support, had the poorest self-care behaviour.

Background The PROMIS-57 is a commonly used self-reported instrument to solve the lack of generalizable and universal measures required to evaluate common symptoms and functions from patients’ perspectives. This study aimed to translate the PROMIS-57 into Chinese and psychometrically test the translated instrument on patients with breast cancer. Methods Translation, cross‑cultural adaptation, and psychometric evaluation of the instrument were performed from June 2020 to June 2021. Eligible patients were recruited and completed the PROMIS-57, Functional Assessment of Cancer Therapy-Breast (FACT-B), and a sociodemographic questionnaire. Results Data from 602 patients with a mean age of 48.83 years were analyzed. Most domains in the PROMIS-57 showed an absence of floor and ceiling effects. Multi-trait scaling analysis demonstrated acceptable convergent and discriminant validity. The correlations between the PROMIS-57 scores and the selected FACT-B scores supported the criterion validity via the Pearson correlation test. Measurement invariance was supported by the absence of differential item functioning for most items. Cronbach’s α of the domains ranged from 0.85–0.95. The unidimensional factor structure of all domains was supported using confirmatory factor analyses. Additionally, most items showed acceptable item information curves and item characteristics curve matrices. Conclusion The Chinese version of the PROMIS-57 was found to be a reliable and valid tool for assessing common symptoms and functions among patients with breast cancer.

BACKGROUND Physical activity (PA), known as a modifiable protective factor, provides an approach to sustain physical and psycho-social health for breast cancer patients both during and after treatment. Mobile health (mHealth) application targeted promoting health behaviors demonstrates advantages in behavior tracking, knowledge sharing and social connecting and tailored intervention. However, process of mHealth application (App) development is lack of theoretical basis, restricting its sustainable benefits to cancer survivors. OBJECTIVE To construct a theory-based mHealth PA intervention program, and to determine whether this intervention would improve PA behavior change during chemotherapy for breast cancer patients, thus to capture their perspectives and experiences when participate it. METHODS Social cognitive theory (SCT), self-efficacy theory (SET) and the theory of planned behavior (TPB) are referred to construct mHealth intervention strategies. Smartphone application was chosen to implement a pre-post three-month PA intervention. A mixed method was utilized to test the preliminary effectiveness of MPAP. Quantitative results from online records and self-reported questionnaires were collected after intervention. Qualitative feedback through telephone interviewing was recorded to explore patients’ using experiences. RESULTS “Breast care” smartphone application was developed to improve self-management of breast cancer patients including PA. In the end, five main pages covering 6 functions (information delivering, disease tracking, events reminding based on calendar, online interaction, health behavior recording and self-reported assessment) were displayed in the app. In the preliminary evaluation process, twenty participants were recruited. Based on PA capability assessment and baseline PA evaluation, 12 patients were divided into active group, and 8 patients were grouped in sedentary lifestyle. Within three months, participants’ usage behavior identified at portal site indicated the accumulated app usage time is 40 minutes a week, and average login time of each participant was three times a week. The total PA increased 945.70 MET-min/w with a significant improvement(p=0.040) after 3 months. Walking displayed a significant improvement after intervention (904.20 MET-min/w) (p=0.030). Sedentary mean time declined 210 mins/w. Qualitative results showed satisfaction and willingness of breast cancer patients to use app to manage PA and relevant health behaviors. CONCLUSIONS The theory-based mHealth PA intervention has great potential to enhance breast cancer patients’ PA awareness and engagement, meanwhile to facilitate their PA behavior change.

Aims To describe and synthesize diverse empirical evidence regarding physical activity (PA) in the context of advanced breast cancer (ABC). Design Integrative review guided by the work of Whittemore and Knafl (2005). Data sources Six electronic databases were systematically searched to identify relevant literature published between January 2007–June 2019. Review methods Abstracts of papers that met the inclusion criteria were reviewed by two researchers and full texts of eligible papers were assessed. Data were extracted by two independent researchers and inter‐rater reliability of data extraction established. Quality of papers was evaluated using the Mixed Methods Appraisal Tool. Data were organized according to comprehensive thematic analysis and the biobehavioural model for the study of exercise interventions. Results Of the 532 abstracts, 18 studies met the inclusion criteria which included six randomized controlled trials, one quantitative non‐randomized study, seven quantitative descriptive studies, three mixed method studies and one qualitative study. Results from studies enrolled fell into four domains: PA performance and its influence on survival; barriers and preferences for PA; interventions to enhance PA; perceived benefits of PA from qualitative feedback. Conclusion Evidence suggests that ABC patients are physically inactive. Main barriers of PA are less aerobic fitness and heavy symptom burden. Simple, tailored and specialist‐supervised PA is preferred by ABC patients. Form of joint self‐instructed and group accompanying is advocated as well. PA intervention programmes identified in this review vary on type, intensity, duration and frequency, while generally, are found to be feasible, safe and beneficial to patients’ physical and psychosocial well‐being. Impact The results propose tailored, supervised, group‐based PA programmes are in urgent need for ABC patients. Clinical professionals should manage more feasible and safer PA interventions to help improve patients’ overall health. More research with rigorous methodology design is warranted to explore PA’s effect on long‐term health outcomes.

Background The diagnosis of breast cancer and the subsequent treatment undermine patients’ participation in social activities. This study aimed to carry out a cross-cultural adaption and analysis of the construct validity and reliability of the Chinese version of the PROMIS social function short forms in patients with breast cancer. Methods This study utilized a cross-sectional research design, and was registered in the Chinese Clinical Trial Registry (ChiCTR2000035439). After a standardized cross-cultural adaption process, a psychometric evaluation was performed of the Chinese version of the PROMIS social function short forms. Using convenience sampling, eligible patients with breast cancer from tertiary hospitals in China were enrolled from January 2019 to July 2020. Participants completed the sociodemographic information questionnaire, the PROMIS social function short forms, the Functional Assessment of Cancer Therapy-Breast, the PROMIS emotional support short form and the PROMIS anxiety short form. Results Data were collected from a sample of 633 patients whose mean age was 48.1 years. The measures showed an absence of floor and ceiling effects. Regarding construct validity, the results of confirmatory factor analysis supported the original two-factor structure of the PROMIS social function short forms. In addition, the measures were found to have acceptable known-group validity, measurement invariance, and convergent and discriminate validity. Regarding reliability, the Cronbach’s α was high for all items (> 0.70). Conclusion The Chinese version of the PROMIS social function short forms was demonstrated to be a valid and reliable measure for the assessment of social function in Chinese patients with breast cancer. Additional psychometric evaluation is needed to draw firm conclusions.