Feasibility and Acceptability of a Text Message Intervention to Promote Adherence to Nutrition and Physical Activity Guidelines in Hispanic Cancer Survivors and their Informal Caregivers (Preprint)

Abstract

Hispanic cancer survivors face unique barriers to meeting American Cancer Society (ACS) nutrition and physical activity guidelines, which reduce the risk of cancer recurrence and mortality and improve quality of life.

The aim of this pilot intervention trial was to evaluate the feasibility and acceptability of a two-week ACS guideline-based nutrition and physical activity text message intervention in a predominantly sample of Hispanic cancer survivors and their informal caregivers.

Over a two-week period, cancer survivors and their informal caregivers received two intervention messages per day (one nutrition and one physical activity), each immediately followed by a polling text message asking participants to rate the usefulness of the text. A mixed methods approach was used to assess feasibility and acceptability of the intervention. Feasibility and acceptability were measured by meeting a-priori cut-offs of >80% for recruitment, retention, and text message response rate. Participants also completed a semi-structured exit interview by telephone that assessed intervention dosing and timing, texting modality satisfaction, content preference, self-reported behavior change, and cultural appropriateness of the intervention. A deductive thematic analysis was used to identify overarching categories while subthemes were identified inductively.

Thirteen cancer survivors and six caregivers (N=19) participated in this pilot study; 78% self-identified as Hispanic. Mean time since treatment completion for survivors was 11.9 years (SD 8.4), and 67% had breast cancer. Of the 24 participants invited to participate, 20 (83%) were enrolled (14 cancer survivors and 6 caregivers), and 19 completed the study (95%). A total of 1,026 messages were sent during the intervention period, of which 494 requested a response, with 451 responses received (response rate of 91%). As assessed by the ratings collected through the polling messages, cancer survivors had a higher acceptability rate for physical activity (94%) compared to nutrition messages (86%), whereas equal acceptability rates were observed for both types of messages among caregivers (91%). Results from the exit interviews supported the quantitative results with the following subthemes identified: 1) dosage and timing of text messages were adequate, 2) high satisfaction with texting modality as it was a convenient and flexible way to receive information, 3) intervention was culturally relevant though hesitancy was noted for messages that included changing cultural food staples, 4) reinforcement of healthy diet behaviors and self-reported adoption of heathy physical activity behaviors, and 5) desire for educational information covering topics on the biological effects of nutrition and physical activity, and symptom management for cancer-related long-term side effects.

Texting interventions are a feasible, acceptable, and a cost-effective strategy that have the potential to promote lifestyle behavior change among Hispanic cancer survivors and caregivers. Such intervention delivery methods have important implications for reducing barriers to intervention engagement, thereby enhancing the scalability and efficacy of future trials seeking to reduce the cancer burden in this population.

ClinicalTrials.gov number NCT04314479.