Abstract
BackgroundAlthough the incidence of breast cancer is lower in African-American women than in White women, African-American women have a decreased survival rate. The difference in survival rate may stem from poor endocrine therapy adherence, which increases breast cancer recurrence. Therefore, accessible and culturally sensitive interventions to increase endocrine therapy adherence are necessary.ObjectiveThe purpose of this concurrent convergent mixed methods study was to provide further data to guide the development of the proposed culturally sensitive mHealth app, STORY+ for African-American women with breast cancer.MethodsWe recruited 20 African-American women diagnosed with estrogen-positive breast cancer and currently prescribed endocrine therapy. We used a concurrent convergent data collection method to (1) assess the use of smartphones and computers related to health care and (2) identify foundational aspects to support endocrine therapy adherence for incorporation in a mobile health app.ResultsOverwhelmingly, the participants preferred using smartphones to using computers for health care. Communicating with health care providers and pharmacies was the most frequent health care use of smartphones, followed by exercise tracking, and accessing the patient portal. We identified 4 aspects of adherence to endocrine therapy and smartphone use for incorporation in app development. The factors that emerged from the integrated qualitative and quantitative data were (1) willingness to use, (2) side effects, (3) social connection, and (4) beliefs about endocrine therapy.ConclusionsFurther research is needed to develop a culturally sensitive app for African-American women with breast cancer to improve adherence to endocrine therapy. Our work strongly suggests that this population would use the app to connect with other African-American breast cancer survivors and manage endocrine therapy.
Highlights
Breast cancer is the second-most common cancer among women in the United States and results in the second-highest cancer death rates [1]
Cancer mobile health (mHealth) apps research has explored functionality and acceptability, but only one evaluated effectiveness or clinical outcomes [17,18,19]. To address these gaps in endocrine therapy adherence and mHealth apps for medication adherence, we propose to extend our earlier teleconferencing work, Sisters Tell Others and Revive Yourself (STORY), a culturally tailored intervention that connected African-American women with breast cancer to support and educated them during initial diagnosis and treatment [27]
The participants used smartphones more frequently than they used computers for health care, especially for social interactions such as social media, messaging, and email. This finding suggests that African-American breast cancer survivors are more likely to use an mHealth app than they are to use a webpage via computer to assist with endocrine therapy adherence
Summary
Breast cancer is the second-most common cancer among women in the United States and results in the second-highest cancer death rates [1]. 10-year breast cancer survival rates [2]; African-American women have decreased survival rates and higher mortality rates compared to White women despite lower incidence rates [3]. One potential explanation for the differences in survival rates and mortality among women with estrogen-positive breast cancer is adherence to long-term https://formative.jmir.org/2021/6/e23884 XSLFO RenderX. African-American women have low long-term adherence rates to endocrine therapy [6,7]. The incidence of breast cancer is lower in African-American women than in White women, African-American women have a decreased survival rate. The difference in survival rate may stem from poor endocrine therapy adherence, which increases breast cancer recurrence. Accessible and culturally sensitive interventions to increase endocrine therapy adherence are necessary
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