Fitbit and App Intervention for Diverse Cancer Survivors: Usability and Considerations for Clinic Implementation (Preprint)

BACKGROUND Despite the known benefits of physical activity, cancer survivors remain insufficiently active. Prior trials have adopted digital health methods, though several have been pedometer-based and enrolled mainly female, non-Hispanic White, and more highly educated survivors of breast cancer. OBJECTIVE The objective of this study was to test a previously developed mobile health system consisting of a Fitbit activity tracker and the MyDataHelps smartphone app for feasibility in a diverse group of cancer survivors, with the goal of refining the program and setting the stage for a larger future trial. METHODS Participants were identified from one academic medical center’s electronic health record, referred by a clinician, or self-referred to participate in the study. Participants were screened for eligibility, enrolled, provided a Fitbit activity tracker, and instructed to download the Fitbit: Health & Wellness and MyDataHelps apps. They completed usability surveys at baseline, 1-, and 3-months. Interviews were conducted at the end of the 3-month intervention with participants and cancer care clinicians to assess acceptability of the intervention and implementation of the intervention into clinical practice, respectively. Descriptive statistics were calculated for demographics, usability surveys, and Fitbit adherence and step counts. Rapid qualitative analysis was used to identify key findings from interview transcriptions. RESULTS Of the 100 patients with cancer who were screened for eligibility, 31 enrolled in the trial, achieving a response rate of 31%. The mean (SD) age of participants was 64.8 (11.1) years. The two most frequent cancer diagnoses were prostate and breast cancer. Participants provided positive feedback on the MyDataHelps app usability; the overall app quality received a mean score of 3.79 (SD 0.82) on a Likert scale from 1 to 5, (1 = worst, 5 = best). Overall, participants felt the Fitbit activity tracker and MyDataHelps app were easy to use, but also benefited from the technical assistance of the research team. Clinicians appreciated the idea of having an objective measure of physical activity data but expressed a desire to receive training on using Fitbit data, as well as having a standard workflow in place for prescribing the Fitbit activity tracker for physical activity. CONCLUSIONS Implementing a remotely-delivered, light-intensity physical activity program was feasible and acceptable in a population of diverse cancer survivors. Future studies should consider registry-based methods and work with clinicians to engage hard-to-reach survivor populations who have low physical activity levels and disproportionately high adverse health outcomes.