JMIR Publications

ABSTRACT

Background:

Psycho-education has turned into an effective tool in taking care of cancer patients and improving their psychophysical symptoms and quality of life. Despite the growing utilization of mobile phone applications in medical settings for improving health, evidence supporting their effectiveness in the psycho-education of patients with breast cancer is rarely available.

Objective:

The present study was conducted to investigate the effect of psycho-educational interventions on anxiety and self-esteem in women with breast cancer using a mobile application and an online support group.

Methods:

An unblinded randomized controlled trial based on mobile phones was conducted in Shiraz, Iran. A research assistant selected eighty-two women with non-metastatic breast cancer aged 20-60 years were from clinics during a face-to-face visit at the point of care and randomly assigned to an intervention group (n=41) and a wait-list control group (n=41) through blocked randomization. The intervention group received psycho-educational interventions through a mobile phone application and participated in nurse-assisted online mobile support sessions for a total four weeks, whereas the control group was put on a waiting list. The state-trait anxiety inventory (STAI) developed by Spielberger and the Rosenberg self-esteem scale (RSES) were respectively used to measure the levels of anxiety and self-esteem as the main outcomes in the two groups at baseline and one week after the intervention. The data collected using paper-based instruments were analyzed in IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, N.Y., USA).

Results:

Eighty two patients with a mean age of 46.45 (SD 9.29) years recruited in winter 2016 were randomly assigned to the wait-list control group (n=41) and the intervention group (n=41). Five patients dropped out for different reasons. Comparing the post-intervention mean scores of anxiety and its two subscales using the independent t-test showed statistically-significant differences between the mobile psycho-education group and the controls (P<.001). The paired t-test used to compare the post-intervention mean scores of anxiety with its pre-intervention scores in the intervention group showed significant reductions in the scores of anxiety (95% CI -17.4 to -8.9, P<.001, d=1.02) and its two subscales (state anxiety: 95% CI -9.2 to -4.21, P<.001, d=0.88 and trait anxiety: 95% CI -8.5 to -4.12, P<.001, d=0.94). Comparing the post-intervention mean scores of self-esteem showed statistically-insignificant differences between the control and intervention groups (16.78 versus 17.97, P=.24). In contrast to in the controls, using the paired t-test showed that the increase in the post-intervention mean scores of self-esteem were statistically significant in the intervention group compared to the pre-intervention scores (mean difference 2.05, 95% CI 1.28 to 2.82, P<.001). No statistically-significant differences were observed in anxiety (mean difference 0.61, 95% CI −0.69 to 1.9, P=.34) and self-esteem scores (mean difference 0.23, 95% CI -0.24 to 0.71, P=.33) in the control group between before and after the intervention.

Conclusions:

The present study demonstrated the key role of mobile applications in decreasing anxiety and improving self-esteem in women with breast cancer through psycho-educational interventions. Similar studies with longer follow-ups are recommended that be conducted in this context. Clinical Trial: Iranian Registry of Clinical Trials IRCT20150721232279N2 (https://en.irct.ir/trial/19882)