Effect of mHealth interventions on psychological issues experienced by women undergoing chemotherapy for breast cancer: A systematic review and meta-analysis

Mapping the Evidence on the Impact of mHealth Interventions on Patient-Reported Outcomes in Patients With Breast Cancer: A Systematic Review

PURPOSE

To comprehensively synthesize the existing evidence concerning mHealth interventions for patients with breast cancer (BC).

DESIGN

On July 30, 2023, we searched PubMed, PsycINFO, and Google Scholar for articles using the following inclusion criteria: evaluation of mHealth interventions in patients with cancer, at least 30 participants with BC, randomized control trials or prospective pre-post studies, determinants of health (patient-reported outcomes [PROs] and quality of life [QoL]) as primary outcomes, interventions lasting at least 8 weeks, publication after January 2015. Publications were excluded if they evaluated telehealth or used web-based software for desktop devices only. The quality of the included studies was analyzed with the Cochrane Collaboration Risk of Bias Tool and the Methodological Index for Non-Randomized Studies.

RESULTS

We included 30 studies (20 focused on BC), encompassing 5,691 patients with cancer (median 113, IQR, 135.5). Among these, 3,606 had BC (median 99, IQR, 75). All studies contained multiple interventions, including physical activity, tailored information for self-management of the disease, and symptom tracker. Interventions showed better results on self-efficacy (3/3), QoL (10/14), and physical activity (5/7). Lifestyle programs (3/3), expert consulting (4/4), and tailored information (10/11) yielded the best results. Apps with interactive support had a higher rate of positive findings, while interventions targeted to survivors showed worse results. mHealth tools were not available to the public in most of the studies (17/30).

CONCLUSION

mHealth interventions yielded heterogeneous results on different outcomes. Identifying lack of evidence on clinical scenarios (eg, patients undergoing systemic therapy other than chemotherapy) could aid in refining strategic planning for forthcoming research endeavors within this field.

Knowledge, attitude and perception of cesarean section among pregnant women attending antenatal clinic at Babcock University Teaching Hospital, Ilishan-Remo, Ogun State

Background: While the rate of Cesarean Section (CS) has been increasing in developed countries, the same cannot be said about developing countries, especially Nigeria. Despite the various indications of CS that may arise, the CS rate in Nigeria has remained as low as 2.7% as against the 15% acceptable upper limit according to the World Health Organization. The level of knowledge, perception, and attitude toward CS among pregnant women have been found to significantly influence the women's decision to utilize this life-saving means. Hence, the researchers conducted this study among pregnant women attending the antenatal clinic at Babcock University Teaching Hospital (BUTH), Ogun State, to assess their level of knowledge, perception and attitude toward CS.Methodology: A descriptive cross-sectional design was utilized. A questionnaire designed by the researchers was used to collect data from 200 respondents, and the data were analyzed with Statistical Package for the Social Sciences version 25. Results were reported with frequencies, mean scores and percentages.Results: Findings of the study showed that 78.5% had a high level of knowledge of CS, 67.5% had a good perception of CS, and 93% had a positive attitude toward CS. Around average (52.5%) considered CS a safe procedure, and 78.5% would agree to have CS if medically indicated. The majority (76.5%) believed that opting for a CS could save the life of the mother or the child.Discussion: In conclusion, the findings of this study show that although majority of the respondents had good knowledge and perception of CS, and were willing to accept CS when medically indicated, around one-third had poor perception of CS and around two-tenths would not agree to have it if medically indicated. Hence, nurses and other stakeholders are thus encouraged to always include CS lessons in antenatal teachings to ensure that every woman is knowledgeable enough to accept CS, especially when medically indicated.

Co-design of a Mobile App for Engaging Breast Cancer Patients in Reporting Health Experiences: Qualitative Case Study

BACKGROUND

The World Health Organization recommends incorporating patient-reported experience measures and patient-reported outcome measures to ensure care processes. New technologies, such as mobile apps, could help report and monitor patients' adverse effects and doubts during treatment. However, engaging patients in the daily use of mobile apps is a challenge that must be addressed in accordance with the needs of people.

OBJECTIVE

We present a qualitative case study documenting the process of identifying the information needs of breast cancer patients and health care professionals during the treatment process in a Chilean cancer institution. The study aims to identify patients' information requirements for integration into a mobile app that accompanies patients throughout their treatment while also providing features for reporting adverse symptoms.

METHODS

We conducted focus groups with breast cancer patients who were undergoing chemotherapy (n=3) or who completed chemotherapy between 3 months and 1 year (n=1). We also surveyed health care professionals (n=9) who were involved in patient care and who belonged to the oncology committee of the cancer center where the study took place. Content analysis was applied to the responses to categorize the information needs and the means to satisfy them. A user interface was designed according to the findings of the focus groups and was assessed by 3 trained information system and user interaction design experts from 2 countries, using heuristic evaluation guidelines for mobile apps.

RESULTS

Patients' information needs were classified into 4 areas: an overview of the disease, information on treatment and day-to-day affairs, assistance on the normality and abnormality of symptoms during treatment, and symptoms relevant to report. Health care professionals required patients to be provided with information on the administrative and financial process. We noted that the active involvement of the following 4 main actors is required to satisfy the information needs: patients, caregivers, social network moderators, and health professionals. Seven usability guidelines were extracted from the heuristic evaluation recommendations.

CONCLUSIONS

A mobile app that seeks to accompany breast cancer patients to report symptoms requires the involvement of multiple participants to handle the reports and day-to-day information needs. User interfaces must be designed with consideration of the patient's social conventions and the emotional load of the disease information.

Awareness and practice of breast self-examination among female staff at Babcock University, Nigeria

Background

Despite the ever-growing breast cancer awareness campaigns in Nigeria, the practice of breast self-examination (BSE) continues to vary widely among women. We aimed to assess breast cancer awareness and practice of BSE among female staff at Babcock University, Ogun State, Nigeria.

Methods

The cross-sectional descriptive design was adopted for this study. Data were collected using a structured questionnaire administered to 160 respondents. Data analysis was done using Statistical Package for Social Sciences version 23.

Results

Although the majority of the respondents were highly aware of breast cancer (78.12%) and had good knowledge about BSE (96.9%), their practice of BSE was low. Only 11.3% always examine their breasts in the mirror by raising their hands over their head, looking at their breasts and examining it in a circular motion; 56% rarely looked for puckering, colour changes and dimpling of the skin when examining their breasts in the mirror, although 53.8% sometimes squeezed their nipples and looked for discharge when they examined their breasts.

Conclusion

Knowledge and positive opinions toward preventive strategies for breast cancer should not be interpreted as readiness for practice. Educational intervention programs emphasising the importance of early detection in managing breast cancer should be reinforced to birth the desirable change.

eHealth literacy was associated with anxiety and depression during the COVID-19 pandemic in Nigeria: a cross-sectional study

Background

Electronic health (eHealth) literacy may play an important role in individuals' engagement with online mental health-related information.

Aim

To examine associations between eHealth literacy and psychological outcomes among Nigerians during the Coronavirus disease-2019 (COVID-19) pandemic.

Methods

This was a cross-sectional study among Nigerians conducted using the 'COVID-19's impAct on feaR and hEalth (CARE) questionnaire. The exposure: eHealth literacy, was assessed using the eHealth literacy scale, and psychological outcomes were assessed using the PHQ-4 scale, which measured anxiety and depression; and the fear scale to measure fear of COVID-19. We fitted logistic regression models to assess the association of eHealth literacy with anxiety, depression, and fear, adjusting for covariates. We included interaction terms to assess for age, gender, and regional differences. We also assessed participants' endorsement of strategies for future pandemic preparedness.

Results

This study involved 590 participants, of which 56% were female, and 38% were 30 years or older. About 83% reported high eHealth literacy, and 55% reported anxiety or depression. High eHealth literacy was associated with a 66% lower likelihood of anxiety (adjusted odds ratio aOR, 0·34; 95% confidence interval, 0·20-0·54) and depression (aOR: 0·34; 95% CI, 0·21-0·56). There were age, gender, and regional differences in the associations between eHealth literacy and psychological outcomes. eHealth-related strategies such as medicine delivery, receiving health information through text messaging, and online courses were highlighted as important for future pandemic preparedness.

Conclusion

Considering that mental health and psychological care services are severely lacking in Nigeria, digital health information sources present an opportunity to improve access and delivery of mental health services. The different associations of e-health literacy with psychological well-being between age, gender, and geographic region highlight the urgent need for targeted interventions for vulnerable populations. Policymakers must prioritize digitally backed interventions, such as medicine delivery and health information dissemination through text messaging, to address these disparities and promote equitable mental well-being.

Coping Experiences of Nigerian Women during Pregnancy and Labour: A Qualitative Study

Background

Pregnancy and labour are defining moments in the lives of women. While these are joyful moments for many, some physical and psychological issues have been reported during labour and pregnancy. This study was conducted to explore the coping experiences of Nigerian women during pregnancy and labour.

Methods

This is an exploratory qualitative study using the content analysis. The study was conducted from November 2021 to January 2022 in Ekiti State and Federal Capital Territory, Nigeria. In-depth interviews were conducted with 30 women selected using the purposive sampling technique. Data collection was stopped when we reached data saturation. Data were analyzed through content analysis using the NVIVO software version 12.

Results

Two themes emerged from the study including coping strategies during pregnancy and trying to endure labour pain. The theme, coping strategies utilized during pregnancy, included obtaining the relatives' experiences, seeking information, religious practices, and engaging in exercise. The theme, trying to endure labour pain, consisted of exercising for pain relief, relying on God, Positive imagination, giving psychological support, and behaving according to the accepted cultural beliefs.

Conclusion

Findings suggested that women utilized many non-pharmacological methods for coping. Interventions to support women during pregnancy and labour should consider these strategies during planning and implementation.