Breast, prostate and colorectal cancer survivors’ experiences of using publicly available physical activity mobile apps: a qualitative study

Background: Physical activity (PA) can improve a range of outcomes following a cancer diagnosis. These include an improvement in experience of side effects of treatment (e.g. fatigue) and management of comorbid conditions. PA may also increase survival and reduce recurrence. Digital interventions have shown potential for PA promotion among cancer survivors, but most in a prior review were web-based and few studies used smartphone applications (apps). There are many PA apps available for general public use but it is unclear whether these are suitable as a PA intervention after a cancer diagnosis. Objective: This study sought post-treatment, non-metastatic, breast, prostate and colorectal cancer survivors’ opinions of using smartphone apps to promote PA and gathered their views on existing publicly available PA apps to inform a future intervention. Methods: Each participant was randomly assigned to download two of four apps (Human, The Walk, The Johnson & Johnson Official 7 Minute Workout, and Gorilla Workout). Participants used each app for one week consecutively. In-depth semi-structured telephone interviews were then conducted to understand participants’ experiences of using the apps and how app-based PA interventions could be developed for cancer survivors. The interviews were analysed using thematic analysis. Results: 32 participants took part: 16 (50%) had prostate cancer, 8 (25%) had breast and 8 (25%) had colorectal cancer. Three core themes were identified. The first theme was that multiple factors affect engagement with PA apps and this is highly personalised. Factors affecting engagement included participants’ perceptions of i) the advantages and disadvantages of using apps to support PA; ii) the relevance of the app to the user (e.g. in terms of cancer-related factors, their PA goals, the difficulty level of the app, the way in which they interact with their smartphone and the extent to which the app fits with their self-identity), iii) the quality of the app (e.g. usability, accuracy, quality of production, scientific evidence-base), and of iv) the behaviour change techniques used to promote PA. In the second theme, participants recommended that apps that promote walking are most appealing, as walking removes many barriers to PA. Finally, the participants suggested that PA apps should be integrated into cancer care, as they valued guidance and recommendations from healthcare professionals. Conclusions: This sample of breast, prostate and colorectal cancer survivors were receptive to the use of apps to promote PA. Although no publicly available PA app was deemed wholly suitable, many suggestions for adaptation and intervention development were provided. The results can inform the development of an app-based PA intervention for cancer survivors. They also highlight the wide-ranging and dynamic influences on engagement with digital interventions, which can be applied to other evaluations of mHealth products in other health conditions and other health behaviours.