Electronic Health Technologies to Improve Support for Women with Breast Cancer

Background: After active breast cancer treatment (surgery, chemotherapy, radiation), many women suffer long-term side effects, making managing health challenging. In-person health support is cost and labour intensive. Electronic health (eHealth) support strategies (websites, apps, text messages) are promising low-cost and scalable alternatives. This thesis aims to investigate if eHealth interventions are effective, feasible, and acceptable for improving women’s post-treatment self-efficacy for managing health, quality of life (QOL) and health outcomes. Methods: Systematic review of randomised controlled trials (RCTs) with meta-analyses (Chapter 2); narrative literature review (Chapter 3); iterative co-design process of the EMPOWER-SMS lifestyle-focused text message program (Chapter 4); RCT (N=160) testing efficacy, usefulness, and acceptability of EMPOWER-SMS (n=80) versus usual care (n=80) at 6-months (Chapters 5-7). Primary outcome: self-efficacy. Secondary outcomes included QOL, depression, anxiety, physical activity, and endocrine therapy medication adherence. Results: eHealth self-management strategies, namely websites, were acceptable, useful, and effective for improving QOL, self-efficacy, distress, and fatigue among women with breast cancer (Chapters 2-3). But co-designed interventions tested in high-quality RCTs were limited. The co-design process was feasible, and improved message content (Chapter 4). Self-efficacy did not differ between groups, but medication adherence was significantly higher in the EMPOWER-SMS group compared to control at 6-months. Also, EMPOWER-SMS was feasible, acceptable, useful, low-cost, and resource-light (Chapters 5-7). Conclusion: This thesis provides emerging evidence that eHealth interventions are effective, feasible, and acceptable for supporting QOL, self-efficacy, mental (distress) and physical (fatigue, medication adherence) health among diverse breast cancer survivors. Large-scale RCTs with longer follow-up are needed