JMIR Publications

ABSTRACT

Background:

Healthy diet and exercise can improve quality of life and prognosis in men with prostate cancer. Understanding the perceived barriers to lifestyle change and patient preferences in a diverse cohort of men with prostate cancer is necessary to inform mobile health (mHealth) lifestyle interventions and increase health equity.

Objective:

We conducted the multi-site PATH study to understand Preferences, ATtitudes, and Health (PATH) behaviors related to diet and lifestyle in this patient population. This report focuses on the qualitative findings from four virtual focus groups comprising a racially and ethnically diverse group of advanced prostate cancer patients on androgen deprivation therapy.

Methods:

We used grounded theory analyses including open, axial, and selective coding to generate codes. Qualitative data were analyzed as a whole rather than by focus group to optimize data saturation and transferability of results. We present codes and themes that emerged for lifestyle intervention design and provide recommendations and considerations for future mHealth intervention research.

Results:

Fourteen men participated in four racially/ethnically concordant focus groups (White, n=5; Black, n=3; Hispanic/Latinx, n=3; and Asian, n=3). Analyses converged on 7 interwoven categories: 1) Context (home environment, access, competing priorities, lifestyle programs); 2) Motivation (accountability, discordance, feeling supported, fear, temptation); 3) Preparedness (health literacy, technological literacy, technological preferences, trust, readiness to change, identity, adaptability, clinical characteristics); 4) Data-driven design (education, psychosocial factors, quality of life); 5) Program mechanics (communication, materials, customization, holistic); 6) Habits (e.g., dietary habits), and 7) Intervention impressions. These results suggest actionable pathways to increase program intuitiveness. Recommendations for future mHealth intervention design and implementation include but are not limited to: assessment at the individual, household, and neighborhood levels to support a tailored intervention; prioritization of information to disseminate based on individuals’ major concerns, and delivery of information based on health and technological literacy and communication preferences; prescribing a personalized intervention based on individuals’ baseline responses, the home/neighborhood environment, and the individuals’ support network; and incorporating strategies to foster engagement (e.g., responsive and relevant feedback systems) to aid participant decision-making and behavior change.

Conclusions:

Assessing a patient’s social context, motivation, and preparedness are necessary when tailoring a program to each patient’s needs for all racial/ethnic groups. Addressing the patients’ contexts and motivation and preparedness related to diet and exercise including the household, access (to food and exercise), competing priorities, health and technological literacy, readiness to change, and patients’ clinical characteristics will help to customize the intervention to the participant. These data support a tailored approach leveraging the identified components and their interrelationships to ensure that mHealth lifestyle interventions will engage and be effective in racially and ethnically diverse cancer patients.