Title: Healthy Living after Cancer+Text: A text message-delivered, extended contact intervention targeting healthy weight, diet and physical activity behaviour
Authors: Jennifer R Job, Elizabeth G Eakin, Marina M Reeves, Brianna S Fjeldsoe
Keywords: mHealth, health behaviour, cancer
Background: Text message-delivered interventions have shown potential as a broad-reach method to extend contact with participants following lifestyle interventions and provide support to prevent weight regain and maintain behaviours.
Aims: To evaluate (in a historical controlled trial) the acceptability, implementation and effectiveness of a 6-month text message-delivered, extended contact intervention for participants completing Healthy Living after Cancer (HLaC). HLaC is a 6-month, telephone-delivered intervention for adult cancer survivors, offered by Cancer Councils in Australia.
Methods: HLaC completers received either: no further intervention (control n=144) or; extended contact (HLaC+Txt n=78; accrual target = 103) via 1–11 personalised text messages/fortnight for 6-months. Participants (88.2% female, 63.5% breast-, 7.9% colorectal-/bowel-, 28.6% other cancers) had mean age 58.1 years (SD=17.9), BMI=28.7 kg/m2 (SD=6.3) and mean time since diagnosis of 1.9 years (SD=2.8). Acceptability was assessed using qualitative interviews. Implementation was quantified as text message dose. Linear regression, adjusting for baseline, quantified the effectiveness of extended contact relative to historic controls concerning changes in self-report: weight, moderate-vigorous physical activity (MVPA), fruit and vegetable intake between HLaC completion (baseline) and 6-month follow-up. Data collection will be complete in January 2019.
Results: To date, HLaC+Txt participants (n=78) found texting acceptable, although had suggestions for program improvement, and requested an average of 6.6 text messages/fortnight. No large or significant (two-tailed p<0.05) difference in outcomes were seen in HLaC+Txt relative to controls. Between group effects were small: -0.1 kg weight (95%CI -1.0, 0.8); 2 min/week MVPA (95%CI -53, 57); 0.1 fruit serves (95%CI -0.1, 0.3); and, -0.0 vegetable serves (95%CI -0.45, 0.41).
Conclusion: The program was feasible to deliver and broadly acceptable. However, interim results did not support its effectiveness concerning the maintenance of weight, MVPA, fruit and vegetable intake, and the qualitative findings suggested reasons for this. Final results will inform future delivery of the program.