A Prospective Pilot Study Evaluating Feasibility and Preliminary Effects of Breathe Easier: A Mindfulness-based Intervention for Survivors of Lung Cancer and Their Family Members (Dyads).

Objective: Symptom burden remains a distressing problem for survivors with non-small-cell lung cancer (stages I-IIIa). This pilot study evaluated feasibility and preliminary effects of a tailored mindfulness-based intervention, Breathe Easier, which encompasses meditation, 2 levels of mindful hatha yoga, breathing exercises, and participant interaction. METHODS: Participants were recruited from 2 cancer programs in the US Southeast. A family member was required for participation. Sixty-two participants enrolled (20% recruitment) and 49 completed the intervention (79% retention). Participants chose level 1 yoga (basic) or level 2 (more advanced). Of the completers, survivors were 39% male and 65% Black. A community-based participatory research framework helped identify the specific needs and interests of potential participants and foreseeable barriers to implementation. A 2-month prospective, 1-group, pre-post design evaluated feasibility. Intervention dosage was measured using written protocols. Attendance and completion of daily home assignments measured adherence. Acceptability was assessed using a 10-item questionnaire, completed at three time points. Preliminary outcome data collected pre- and post-intervention tested the hypothesis that participants who received the 8-week intervention Breathe Easier would, post-intervention, demonstrate (a) less dyspnea, (b) less fatigue, (c) less stress, (d) improved sleep, (e) improved anxiety and depression, and (f) improved functional exercise capacity. Exit interviews were conducted, transcribed verbatim, and analyzed for content using descriptive statistics. RESULTS: Quantitative and qualitative measures indicated strong feasibility. Over time, level 1 participants had statistically less dyspnea, fatigue and improved exercise capacity, as well as improved sleep, and stress scores. Level 2 participants experienced slightly increased dyspnea and fatigue but improved sleep, stress, and exercise capacity. All participants experienced anxiety and depression within normal limits pre- and post-intervention. Five major themes emerged out of exit interviews: Learning to Breathe Easier; Interacting with Others as a Personal Benefit; Stretching, Releasing Tension, and Feeling Energized; Enhancing Closeness with Committed Partners; Refocusing on Living; and Sustaining New Skills as a Decision. CONCLUSIONS: The study offers insight into the feasibility of an 8-week in-person mindfulness-based intervention with a unique subset of understudied survivors of lung cancer and family members. Outcome data interpretation is limited by the 1-group design and sample size.

A Focus Group Evaluation of Breathe Easier: A Mindfulness-Based mHealth App for Survivors of Lung Cancer and Their Family Members.

PURPOSE: To explore attitudes and acceptance (i.e., intent for future adoption) of survivors of lung cancer and their family members toward a dyad-focused mHealth mindfulness-based intervention (MBI). APPROACH: Focus groups. SETTING: Community hospital setting in South Carolina. PARTICIPANTS: Survivors n = 11 (M = 64.6 years; 73% female; 64% African American) of non-small cell lung cancer (stage I-IIIa) and their family members, n = 8 (M = 58.6 years; 38% female; 75% African American). INTERVENTION: A fully functional prototype mHealth app to deliver a tailored MBI for survivors of lung cancer and their family members. METHOD: Semi-structured focus groups were conducted and assessed using thematic data analysis to identify the benefits, concerns, needs, and expectations of the app. RESULTS: Convenience and health were the top benefits of using the app, while cost and difficulty of use were the top concerns. Survivors mentioned benefits more than their family members did. Participants felt positively about adding a community network to the app. Finally, participants expected to hear about Breathe Easier from their care provider. CONCLUSION: Participants perceived a benefit to having credible health information delivered through an mHealth app. Guidance and credible health information regarding lung cancer survivorship should be accessible and convenient for everyone impacted by the disease. Thus, future research should explore platforms for a virtual support system and understanding dissemination of mHealth apps through health care providers.

A Qualitative Cultural Sensitivity Assessment of the Breathe Easier Mobile Application for Lung Cancer Survivors and Their Families.

PURPOSE: To evaluate the cultural sensitivity of the Breathe Easier mobile health application for African American lung cancer survivors and their families. Breathe Easier is an intervention designed to teach strategies to combat symptoms related to lung cancer. PARTICIPANTS & SETTING: 12 African American lung cancer survivors and their family members were recruited from an American College of Surgeons-approved cancer program in South Carolina. METHODOLOGIC APPROACH: Participants completed in-depth interviews, which were guided by the Cultural Sensitivity Assessment Tool and the Cultural Sensitivity Checklist. Two researchers performed open and axial coding to conceptually organize the data. FINDINGS: Multiple culturally relevant themes emerged, including benefits, concerns, and suggestions related to content literacy and inclusiveness, as well as acceptability of and motivations for using the mobile application. However, lung cancer survivors and their family members reported being more concerned about accessing accurate survivorship information. IMPLICATIONS FOR NURSING: Attention to health literacy, eHealth literacy, and cultural sensitivity may enhance patient outcomes, and nurses can advocate for patients regarding these communication issues.

Mindfulness-Based Symptom and Stress Management Apps for Adults With Chronic Lung Disease: Systematic Search in App Stores.

BACKGROUND: Up to 70% of lung cancer survivors are affected by chronic obstructive pulmonary disease (COPD), a common, debilitating, comorbid disease. Lung cancer and COPD are both characterized by symptoms such as breathlessness, fatigue, and psychological distress. These distressing chronic symptoms are exacerbated by stress and detract from an individual's quality of life. OBJECTIVE: The aim of this study was to identify and evaluate evidence-based, commercially available apps for promoting mindfulness-based strategies among adults with a COPD or lung cancer history (ie, chronic lung disease). METHODS: For this review, an interdisciplinary research team used 19 keyword combinations in the search engines of Google and iOS app stores in May 2017. Evaluations were conducted on the apps' (1) content, (2) usability heuristics, (3) grade-level readability, and (4) cultural sensitivity. RESULTS: The search resulted in 768 apps (508 in iOS and 260 in Google stores). A total of 9 apps met the inclusion criteria and received further evaluation. Only 1 app had below an eighth-grade reading level; the ninth one did not have enough text to calculate a readability score. None of the 9 apps met the cultural sensitivity evaluation criteria. CONCLUSIONS: This systematic review identified critical design flaws that may affect the ease of using the apps in this study. Few mobile apps promote mindfulness-based strategies among adults with chronic lung disease (ie, COPD or lung cancer or both), but those that exist, overall, do not meet the latest scientific evidence. Recommendations include more stringent regulation of health-related apps, use of evidence-based frameworks and participatory design processes, following evidence-based usability practices, use of culturally sensitive language and images, and ensuring that content is written in plain language.

"We actually care and we want to make the parks better": A qualitative study of youth experiences and perceptions after conducting park audits.

This study explored youths' experiences and perceptions about community engagement as a result of participating in a community-based data collection project using paper and mobile technology park environmental audit tools. In July 2014, youth (ages 11-18, n=50) were recruited to participate in nine focus groups after auditing two parks each using paper, electronic, or both versions of the Community Park Audit Tool in Greenville County, SC. The focus groups explored the youths' experiences participating in the project, changes as a result of participation, suggested uses of park audit data collected, and who should use the tools. Four themes emerged related to youths' project participation experiences: two positive (fun and new experiences) and two negative (uncomfortable/unsafe and travel issues). Changes described as a result of participating in the project fell into four themes: increased awareness, motivation for further action, physical activity benefits, and no change. Additionally, youth had numerous suggestions for utilizing the data collected that were coded into six themes: maintenance & aesthetics, feature/amenity addition, online park information, park rating/review system, fundraising, and organizing community projects. Finally, six themes emerged regarding who the youth felt could use the tools: frequent park visitors, community groups/organizations, parks and recreation professionals, adults, youth, and everyone. This study revealed a wealth of information about youth experiences conducting park audits for community health promotion. Understanding youth attitudes and preferences can help advance youth empowerment and civic engagement efforts to promote individual and community health.