JMIR Publications

ABSTRACT

Background:

As survival rates for children, adolescents and young adults (CAYA) with cancer continue to improve, the management of treatment-related short- and long-term side effects is becoming increasingly important. Enhancing physical activity levels has been shown to be effective to reduce some of these effects. Digital interventions, such as mobile apps, offer engaging tools to promote physical activity in CAYA.

Objective:

This article introduces the “FORTEe Get Strong” app and evaluates its acceptability among childhood cancer patients.

Methods:

The “FORTEe Get Strong” app, developed as part of the multi-centre FORTEe trial (NCT05289739), was created in close collaboration between researchers and a software development company (Nurogames GmbH). The mobile app is based on behaviour change theories and uses gamification to create a child-friendly platform that primarily promotes physical activity while also providing knowledge about health-related behaviours. The user experience was assessed using a self-developed questionnaire consisting of Likert scale questions (1-5: "not at all satisfied" to "very satisfied", 1-3 for participants < 8 years) as well as open-ended questions. The data was analysed using descriptive and qualitative content analysis.

Results:

The “FORTEe Get Strong” app was published in May 2023 for use on Android and iOS devices and is now freely available for download from the App Store® and Google Play ®. Gamification is used to teach health knowledge regarding physical activity incorporating a personalised avatar that can be navigated through a virtual village and explore the interactive elements. Exercise videos provide instructions on how to improve endurance, strength, flexibility, coordination and gait. Feedback on their experience of using the app was provided by 53 patients aged 4-21 years (mean 11.84 ± 4.29 years, 60 % male). The “FORTEe Get Strong” app was generally well-received, with a mean score of 4.14 ± 1.03 points on a Likert scale. Further analysis of various app-related aspects (design, avatar, exercises, FORTEe quiz, informational content, user-friendliness) revealed an average score of 3.98 points. The qualitative analysis provided a wide range of feedback, e.g. positive comments regarding the design and gamification elements, but also concerns of older participants regarding age-appropriateness, the lack of supervision, and adaptability of the exercise programs.

Conclusions:

The present work highlights the potential of the “FORTEe Get Strong” app as a valuable tool for promoting physical activity in childhood cancer patients through interactive and gamified elements. However, the findings also suggest the need for further refinement, particularly in diversifying exercise content and ensuring age-appropriate adaptations, to meet the diverse needs of childhood cancer patients and increase the long-term impact of the app. Digital training solutions seem to provide an accessible, engaging, and personalised way to promote physical activity in childhood cancer patients. Clinical Trial: The “FORTEe Get Strong” app was developed as part of the multi-centre FORTEe trial (NCT05289739).