title: Mobile Health Physical Activity Intervention Preferences in Cancer Survivors: A Qualitative Study.
abstract: BACKGROUND
  Cancer survivors are at an elevated risk for several negative health outcomes, but physical activity (PA) can decrease those risks. Unfortunately, adherence to PA recommendations among survivors is low. Fitness mobile apps have been shown to facilitate the adoption of PA in the general population, but there are limited apps specifically designed for cancer survivors. This population has unique needs and barriers to PA, and most existing PA apps do not address these issues. Moreover, incorporating user preferences has been identified as an important priority for technology-based PA interventions, but at present there is limited literature that serves to establish these preferences in cancer survivors. This is especially problematic given the high cost of app development and because the majority of downloaded apps fail to engage users over the long term.
  
  
  OBJECTIVE
  The aim of this study was to take a qualitative approach to provide practical insight regarding this population's preferences for the features and messages of an app to increase PA.
  
  
  METHODS
  A total of 35 cancer survivors each attended 2 focus groups; a moderator presented slide shows on potential app features and messages and asked open-ended questions to elicit participant preferences. All sessions were audio recorded and transcribed verbatim. Three reviewers independently conducted thematic content analysis on all transcripts, then organized and consolidated findings to identify salient themes.
  
  
  RESULTS
  Participants (mean age 63.7, SD 10.8, years) were mostly female (24/35, 69%) and mostly white (25/35, 71%). Participants generally had access to technology and were receptive to engaging with an app to increase PA. Themes identified included preferences for (1) a casual, concise, and positive tone, (2) tools for personal goal attainment, (3) a prescription for PA, and (4) an experience that is tailored to the user. Participants reported wanting extensive background data collection with low data entry burden and to have a trustworthy source translate their personal data into individualized PA recommendations. They expressed a desire for app functions that could facilitate goal achievement and articulated a preference for a more private social experience. Finally, results indicated that PA goals might be best established in the context of personally held priorities and values.
  
  
  CONCLUSIONS
  Many of the desired features identified are compatible with both empirically supported methods of behavior change and the relative strengths of an app as a delivery vehicle for behavioral intervention. Participating cancer survivors' preferences contrasted with many current standard practices for mobile app development, including value-based rather than numeric goals, private socialization in small groups rather than sharing with broader social networks, and interpretation of PA data rather than merely providing numerical data. Taken together, these insights may help increase the acceptability of theory-based mHealth PA interventions in cancer survivors.
authors.affiliation: Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX, United States.|Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States.
authors.forename: Michael C
authors.identifier: http://orcid.org/0000-0002-2240-014X
authors.initials: MC
authors.lastname: Robertson
authors.affiliation: Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX, United States.|Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States.
authors.forename: Edward
authors.identifier: http://orcid.org/0000-0002-5363-9145
authors.initials: E
authors.lastname: Tsai
authors.affiliation: Department of Nutrition and Metabolism, University of Texas Medical Branch, Galveston, TX, United States.
authors.forename: Elizabeth J
authors.identifier: http://orcid.org/0000-0003-1695-2236
authors.initials: EJ
authors.lastname: Lyons
authors.affiliation: Epidemiology, Human Genetics & Environmental Sciences, University of Texas School of Public Health, Houston, TX, United States.
authors.forename: Sanjana
authors.identifier: http://orcid.org/0000-0002-1439-1052
authors.initials: S
authors.lastname: Srinivasan
authors.affiliation: Center for Recovery, Physical Activity and Nutrition, Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, United States.
authors.forename: Maria C
authors.identifier: http://orcid.org/0000-0002-4069-3089
authors.initials: MC
authors.lastname: Swartz
authors.affiliation: Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Miranda L
authors.identifier: http://orcid.org/0000-0003-0700-1586
authors.initials: ML
authors.lastname: Baum
authors.affiliation: Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Houston, TX, United States.
authors.forename: Karen M
authors.identifier: http://orcid.org/0000-0001-7299-0646
authors.initials: KM
authors.lastname: Basen-Engquist
keywords: focus groups; mHealth; physical activity; smartphone; survivors; technology