JMIR Publications

ABSTRACT

Background:

Exercise and healthy diet can improve quality of life and prognosis in prostate cancer survivors, but there have been limited studies on the feasibility of web-based lifestyle interventions in this population.

Objective:

To develop a data-driven grounded theory of web-based engagement by prostate cancer survivors based on their experience in Community of Wellness, a 12-week randomized clinical trial (RCT) designed to support healthy diet and exercise habits.

Methods:

True NTH’s Community of Wellness was a 4-arm pilot study of men with prostate cancer (N=202) who received progressive levels of behavioral support (Level 1: website; Level 2: website with individualized diet and exercise recommendations; Level 3: website with individualized diet and exercise recommendations, Fitbit and text messages; and Level 4: website with individualized diet and exercise recommendations, Fitbit and text messages, and separate phone calls with an exercise trainer and a registered dietician). The primary aim of the study was to determine feasibility and estimate effects on behaviors (results reported in a separate paper). Following the 12-week intervention, we invited participants to participate in four focus groups, one for each intervention level. In this report, we used grounded theory analyses, including open, axial, and selective coding to generate codes and themes from the focus group transcripts. Categories were refined across levels using embodied categorization and constant comparative methods.

Results:

In total, 20 men with prostate cancer participated in the focus groups; 5, 4, 5, and 6 from levels 1-4, respectively. Participants converged on five common factors influencing engagement with the intervention: 1) environment (home environment, competing priorities, other lifestyle programs) 2) motivation (accountability, discordance experienced within the healthcare system); 3) preparedness (tech literacy, health literacy, trust, readiness to change); 4) program design (communication, materials, customization); 5) program support (education, ally, community). Each of these factors influenced the survivors’ long-term impressions and habits. We propose a grounded theory associating these constructs to describe the components contributing to the intuitiveness of a web-based lifestyle intervention

Conclusions:

These analyses suggest that web-based lifestyle interventions are more intuitive when we optimize participants’ technology and health literacy; tailor interface design, content, and feedback; and leverage key motivators (i.e. healthcare providers, family members, web-based coach) and environmental factors (i.e. familiarity with other lifestyle programs). Together, these grounded-theory based efforts may improve engagement with web-based interventions designed to support prostate cancer survivorship.