JMIR Publications

ABSTRACT

Background:

Melanoma is a cancer of the skin with high 5-year survival rate. However, melanoma survivors are burdened by frequent checks following treatment. Even though survivors are advised to perform the total skin self-examinations (TSSEs) at home to identify potential melanoma recurrences, these checks are underperformed and unstructured. The Achieving Self-Directed Integrated Cancer Aftercare in melanoma intervention (ASICA) is a digital app designed to support and guide melanoma survivors through their monthly TSSEs and allows them to raise any skin concerns with a dermatology nurse. The results from a randomised control trial of the ASICA app showed that 32% of the concerns submitted were resolved remotely. Digital apps have the potential to help patients understand treatment and promote prevention, but adherence to them is quite poor. Results from the ASICA trial showed that approximately a third of the participants did not adhere to using the app at all and a third discontinued use after 6 months.

Objective:

This study investigates the ASICA trial participants’ perceptions of barriers and facilitators to app adherence.

Methods:

Semi-structured interviews and one focus group were conducted with individuals who had previously participated in the ASICA trial. These were analysed in combination with a secondary analysis of semi-structured interviews which took place during the trial itself. All transcripts were recorded, transcribed, and analysed thematically.

Results:

Twelve interviews from participants in the original ASICA RCT intervention group were subjected to secondary analysis. Three participants attended the focus group and 11 were interviewed over the phone. The following main themes around adherence were identified and are discussed in detail: technology, role of others, tailoring, disease journey, and competing priorities. In the theme about technology the participants discussed their technological struggles, their views on artificial intelligence and ease of use to the app. In the role of others, participants expressed views on access to a HCP, the help they receive from other people and the sense of duty they feel towards others to continue with the study. Personalisation of the information provided to them was the main point of discussion in tailoring. Disease journey focused on how the participants viewed their circumstances based on their journey since their diagnosis and competing priorities focused on the elements that would take participants away from completing their TSSEs.

Conclusions:

Participants identified barriers and facilitators to using the digital ASICA app. Improving adherence to regular and structured TSSEs will allow melanoma recurrences to be identified and treated earlier. Further research is needed into an improved version of ASICA informed by the opinions of melanoma survivors to investigate how to improve adherence. Clinical Trial: ClinicalTrials.gov NCT03328247