A Stress Management App Intervention for Cancer Survivors: Design, Development, and Usability Testing

Abstract

BackgroundDistress is prevalent in cancer survivors. Stress management interventions can reduce distress and improve quality of life for cancer patients, but many people with cancer are unfortunately not offered or able to attend such in-person stress management interventions.ObjectiveThe objective of this study was to develop an evidence-based stress management intervention for patients living with cancer that can be delivered electronically with wide reach and dissemination. This paper describes the design and development process of a technology-based stress management intervention for cancer survivors, including the exploration phase, intervention content development, iterative software development (including design, development, and formative evaluation of low- and high-level prototypes), and security and privacy considerations.MethodsDesign and development processes were iterative and performed in close collaboration with key stakeholders (N=48). In the exploration phase, identifying needs and requirements for the intervention, 28 participants gave input, including male and female cancer survivors (n=11) representing a wide age range (31-81 years) and cancer diagnoses, healthcare providers (n=8) including psychosocial oncology experts, and eHealth experts (n=9) including information technology design and developers. To ensure user involvement in each phase various user-centered design and service design methods were included, such as interviews, usability testing, and think aloud processes. Overall, participants were involved usability testing in the software development and formative evaluation phase, including cancer survivors (n=6), healthy volunteers (n=7), health care providers (n=2), and eHealth experts (n=5). Intervention content was developed by stress management experts based on well-known cognitive behavioral stress management strategies and adjusted to electronic format through multiple iterations with stakeholders. Privacy and security issues were considered throughout.ResultsThe design and development process identified a variety of stakeholder requirements. Cancer survivors preferred stress management through a mobile app rather than through a personal computer (PC) and identified usefulness, easy access, user friendliness, use of easily understandable language, and many brief sections rather than longer ones as important components of the intervention. These requirements were also supported by recommendations from health care providers and eHealth experts. The final intervention was named StressProffen and the hospital Privacy and Security Protection Committee was part of the final intervention approval to also ensure anchoring in the hospital organization.ConclusionsInterventions, even evidence-based, have little impact if not actively used. This study illustrates how user-centered design and service design can be applied to identify and incorporate essential stakeholder aspects in the entire design and development process. In combination with evidence-based concepts, this process facilitated ...

Results from a randomized controlled trial testing StressProffen; an application‐based stress‐management intervention for cancer survivors

“…In the current study, cancer survivors receiving StressProffen , 26,27 an app‐based cognitive‐behavioral stress‐management intervention program, reported significant reductions in perceived stress compared with cancer survivors receiving care as usual only. Results demonstrate that 3‐months access to an app‐based program, delivered in a blended health‐care delivery model (ie, a single face‐to‐face introduction session, two telephone follow‐up calls, and availability of telephonic support assist with technology use) can significantly improve cancer distress.…”

“…In addition, project team, including the licensed clinical health psychologist (ie, last author), met weekly to further ensure fidelity to the intervention protocol for the introductory sessions and follow‐up phone calls. For more details about StressProffen please see Børøsund and colleagues 2018, 2019 26,27 …”

“…The 10 modules in StressProffen are also described elsewhere 26 and included the following themes (see Figure 1 for screenshots): (a) What is stress; (b) stress, QoL and planning; (c) thoughts, feelings and self‐care; (d) mindfulness, rational thought‐replacement and guided imagery; (e) stress and coping; (f) Social support, humor and meditation; (g) anger management and conflict style awareness; (h) assertiveness and communication; (i) health behaviors and setting goals; and (j) review and summary. Participants could choose between reading and listening to the program at any time.…”

“…Based on existing research and the potential of psychosocial eHealth interventions to reach a high number of cancer survivors, the current research team developed StressProffen TM© , an app‐based cognitive‐behavioral stress‐management intervention program for cancer survivors 26,27 . The current study aimed to examine preliminary results from an RCT testing the StressProffen intervention program.…”

INNOVATIVE eHEALTH INTERVENTIONS IN NURSING RESEARCH. HOW TO UTILIZE A MIXED METHOD APPROACH TO DESIGN, DEVELOPMENT, EVALUATION AND IMPLEMENTATION

“…It is also important to adapt the intervention to health care providers' work flow and the organization of intended use. As examples, when health care researchers and a software team developed appbased programs for stress management in cancer and chronic pain self-management, patients, health care providers, eHealth experts, and the hospital privacy and security department were involved in the development process (18,19) . The Center for eHealth Research and Disease Management comprehensive roadmap (CEHRES ROADMAP) (20) was used to guide the development process as it recommends a multidisciplinary approach and a continuous systematic evaluation throughout the development process.…”