RESUMO
BACKGROUND: Extending contact with participants after the end of an initial weight loss intervention has been shown to lead to maintained weight loss and related behavioral change. Mobile phone text messaging (short message service, SMS) offers a low-cost and efficacious method to deliver extended contact. In this rapidly developing area, formative work is required to understand user perspectives of text message technology. An extended contact intervention delivered by text messages following an initial telephone-delivered weight loss intervention in breast cancer survivors provided this opportunity. OBJECTIVE: The aim of this study was to qualitatively explore women's perceptions of participation in an extended contact intervention using text messaging to support long-term weight loss, physical activity, and dietary behavioral change. METHODS: Following the end of an initial 6-month randomized controlled trial of a telephone-delivered weight loss intervention (versus usual care), participants received a 6-month extended contact intervention via tailored text messages. Participant perceptions of the different types of text messages, the content, tailoring, timing, and frequency of the text messages, and the length of the intervention were assessed through semistructured interviews conducted after the extended contact intervention. The interviews were transcribed verbatim and analyzed with key themes identified. RESULTS: Participants (n=27) were a mean age of 56.0 years (SD 7.8) and mean body mass index of 30.4 kg/m2 (SD 4.2) and were at a mean of 16.1 months (SD 3.1) postdiagnosis at study baseline. Participants perceived the text messages to be useful behavioral prompts and felt the messages kept them accountable to their behavioral change goals. The individual tailoring of the text message content and schedules was a key to the acceptability of the messages; however, some women preferred the support and real-time discussion via telephone calls (during the initial intervention) compared with the text messages (during the extended contact intervention). CONCLUSIONS: Text message support was perceived as acceptable for the majority of women as a way of extending intervention contact for weight loss and behavioral maintenance. Text messages supported the maintenance of healthy behaviors established in the intervention phase and kept the women accountable to their goals. A combination of telephone calls and text message support was suggested as a more acceptable option for some of the women for an extended contact intervention.
RESUMO
BACKGROUND: Extending contact with participants after the end of an initial intervention is associated with successful maintenance of weight loss and behavior change. However, cost-effective methods of extending intervention contact are needed. OBJECTIVE: This study investigated whether extended contact via text message was efficacious in supporting long-term weight loss and physical activity and dietary behavior change in breast cancer survivors. METHODS: Following the end of an initial 6-month randomized controlled trial of a telephone-delivered weight loss intervention versus usual care, eligible and consenting intervention participants received a 6-month extended contact intervention via tailored text messages targeting a range of factors proposed to influence the maintenance of behavior change. In this single-group, pre-post designed study, within group changes in weight, moderate-to-vigorous physical activity (Actigraph GT3X+ accelerometers), and total energy intake (2x24 hour dietary recalls) were evaluated from baseline to end of initial intervention (6 months), end of extended contact intervention (12 months), and after a no-contact follow-up (18 months) via linear mixed models. Feasibility of implementation was assessed through systematic tracking of text message delivery process outcomes, and participant satisfaction was assessed through semistructured interviews. RESULTS: Participants at baseline (n=29) had a mean age of 54.9 years (SD 8.8), body mass index of 30.0 kg/m(2) (SD 4.2), and were recruited a mean 16.6 months (SD 3.2) post diagnosis. From baseline to 18 months, participants showed statistically significantly lower mean weight (-4.2 kg [95% CI -6.0 to -2.4]; P<.001) and higher physical activity (mean 10.4 mins/day [95% CI 3.6-17.2]; P=.003), but no significant differences in energy intake (P=.200). Participants received a mean of 8 text messages every 2 weeks (range 2-11) and reported a high rate of satisfaction. CONCLUSIONS: In comparison to interventions without extended contact, results suggest text message-delivered extended contact may support the attenuation of weight regain and promote the maintenance of physical activity.
RESUMO
PURPOSE: Maintaining physical activity and dietary improvements achieved during an intervention is important for the long-term health outcomes of breast cancer survivors. This review aimed to determine: (a) the proportion of physical activity and/or dietary intervention trials in breast cancer survivors that assessed post-intervention maintenance of outcomes, (b) the proportion of trials that achieved successful post-intervention maintenance of outcomes, and (c) the sample, intervention, and methodological characteristics common among trials that achieved successful post-intervention maintenance of outcomes. METHODS: A structured search of PubMed, CINAHL, Medline via Ovid, Web of Science, CENTRAL, and PsycInfo was conducted for articles published until March 2012. Included trials had to evaluate a randomized controlled trial of a physical activity and/or dietary behavior change intervention that targeted breast cancer survivors and report on between-group differences of behavioral outcomes at end-of-intervention and at least 3 months post-intervention follow-up. Methodological quality of included trials was also assessed. RESULTS: The search resulted in 1,298 publications. Of 63 identified trials that assessed end-of-intervention outcomes, 10 (16 %) assessed post-intervention maintenance of outcomes; four of these 10 trials achieved successful maintenance. Due to the limited number and heterogeneity of the four trials, few commonalities in sample, intervention, and methodological characteristics were identified. CONCLUSION: Assessing post-intervention maintenance of physical activity and dietary outcomes in breast cancer survivors is rare. There is a pressing need to direct more attention to this issue to inform the development of interventions to improve the long-term health outcomes for the growing number of breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: For breast cancer survivors, maintaining regular physical activity and a healthy diet are important to enhancing health and well-being over the long-term. More research is needed to identify the best ways of supporting survivors to make and maintain these lifestyle changes.
