JMIR Publications

ABSTRACT

Background:

Mobile phone applications (‘apps’) designed for the prevention and management of breast cancer have the potential to extend current healthcare efforts. Theoretically-designed mHealth breast cancer interventions have shown success in achieving positive behavior change. However, little is known about the theoretical underpinnings of breast cancer apps available to the general public.

Objective:

Given that theories may strengthen mHealth interventions, the aim of this study was to identify breast cancer apps designed to support behavior change and disease management, to assess the extent to which they address content along the cancer-care continuum and contain theory-based constructs, and the degree to which user-rating is related to theory-based design.

Methods:

Using a criteria-based screening process, we searched two major app stores for breast cancer apps designed to promote behavior change. Apps were coded for content along the cancer-care continuum and analyzed for behavior change theories. A correlation analysis was used to examine the relationship between apps’ user ratings and use of behavior change theories.

Results:

The search resulted in a total of 302 apps, of which 108 were identified as including breast cancer content. Only 30 (10%) apps met inclusion criteria for supporting behavior change and were further analyzed. These apps were disproportionally focused on behaviors to enhance early detection, particularly self-exams, whereas only a few apps supported care management, treatment, and post-treatment behaviors. In regard to theories, the majority of apps customized content to users (63%), established a health-behavior link (70%), and provided instructions on how to change behavior (80%). Fifteen apps (50%) prompted intention formation, while less than half included goal setting (30%) and goal reviewing (23%). Most apps did not provide information on peer behavior (23%) or allowed for social comparison (20%). None of the apps mobilized social norms (0%). Only half of all apps had user ratings, and the results of the Pearson r correlation suggested that there was a significant positive correlation between user ratings and use of theories at .422 (p = .022). The analysis of behavioral theories used in apps reveals significant shortcomings in apps’ use of goal setting and social influence features.

Conclusions:

Our findings indicate that commercially-available breast cancer apps have not yet fully realized their potential to promote behavior change, with only a minority of apps focusing on behavior change, and even fewer including theoretical design to support behavior along the cancer continuum. These shortcomings are likely limiting apps’ effectiveness in improving public health. More attention needs to be paid to the involvement of users and professionals in app development and adherence to theories and best practices on the cancer continuum in the design of mHealth apps to provide individuals with the support they need along the cancer-care continuum.