JMIR Publications

ABSTRACT

Background:

Physical activity can confer many and varied benefits to cancer survivors. Unfortunately, many cancer survivors are not sufficiently active. The efficacy of physical activity interventions for this population may be increased by grounding them in Self-Determination Theory (SDT). Combining game design elements with wearable technologies may be a useful and scalable approach to targeting SDT constructs to promote cancer survivors’ physical activity.

Objective:

The primary objective of this study was to evaluate the feasibility and acceptability of Steps2Health, a novel physical activity intervention for cancer survivors. We also investigated the intervention’s effects on motivation, physical activity, and step count.

Methods:

We randomized 78 insufficiently active cancer survivors to an experimental or comparison group. All participants received a physical activity tracker. Experimental group participants also received Multimedia Messaging Service (MMS) messages. Messages were triggered by step counts in real time and presented information about a virtual journey. They included photographs and vivid descriptions of locations along the journey to increase autonomous motivation. Additional messages targeted perceptions of relatedness (e.g., via role modeling) and competence (e.g., by facilitating mastery experiences). We administered pre- and post-intervention surveys and conducted 15 individual interviews to evaluate the intervention. We performed a directed content analysis of qualitative data and conducted mixed effects linear modeling to investigate participants’ changes in motivation, self-reported physical activity, and device-measured step counts.

Results:

There was minimal loss to follow up (4%), the device wear rate was high (83.5% of days), and technical problems with messaging based on real-time step counts were limited. Our qualitative data analysis revealed 3 overarching themes: accessibility, autonomous motivation, and relatedness. Participants successfully navigated the technological aspects and game design elements of the intervention. Participants found messages targeting autonomous motivation and competence/self-efficacy to be enjoyable and compelling, but one feasibility criterion for participant engagement (response rate to text messages) was not met. Messages targeting relatedness were less highly rated than the messages targeting autonomous motivation and competence/self-efficacy. During the intervention, both groups increased their motivation for physical activity (B = 0.16; 95% confidence interval [CI] 0.01 to 0.30; P = 0.040; d = 0.49), and assignment to the experimental group was associated with increased self-reported physical activity (B = 10.78, 95% CI 3.54 to 18.02; P = 0.005; d = 0.64). The experimental group had greater increases in daily step counts over time (B = 322.08; 95% CI 54.01 to 590.15; P = 0.019; d = 0.28).

Conclusions:

This study supports the feasibility of using real-time game design elements to target SDT constructs and increase cancer survivors’ physical activity. Our findings generally support the acceptability of the Steps2Health intervention, but fostering active participant engagement and targeting relatedness may present additional challenges. Steps2Health may help cancer survivors increase their physical activity levels.