Usability and Implementation Considerations of Fitbit and App Intervention for Diverse Cancer Survivors: Mixed Methods Study

Background: Despite the known benefits of physical activity, cancer survivors remain insufficiently active. Prior trials have adopted digital health methods, although 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 records, 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 1 and 3 months. Interviews were conducted at the end of the 3-month intervention with participants and cancer care clinicians to assess the acceptability of the intervention and the 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 screened for eligibility, 31 were enrolled in the trial (mean age 64.8, SD 11.1 years; female patients=17/31, 55%; Hispanic or Latino=7/31, 23%; non-White=11/31, 35%; less than a bachelor's degree=14/31, 45%; and household income 75,000=11/31, 35%). The mean (SD) years since diagnosis was 7.1 (8.2), and the two most frequent cancer diagnoses were prostate (9/31, 29%) and breast (4/31, 13%) 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 5-point Likert scale (1=worst, 5=best). Interviews with 10 patients yielded four themes: (1) Fitbit and app setup was easy but the research team provided assistance, when needed, which was helpful, (2) motivational messages within the app were not memorable, (3) step counts and Fitbit notifications were motivating, and (4) medical professionals viewing their data were acceptable. Interviews with 5 cancer care clinicians yielded four themes: (1) some patients used wearables but rarely discussed data with clinicians; (2) activity trackers can be helpful to motivate patients and keep them accountable; (3) objective activity measures-similar to BMI, weight, and blood pressure- that they can track over time and refer to afterward were preferred; and (4) training and systematic processes to view these data as part of active workflow were desired. Conclusions: Implementing a remotely delivered, light-intensity physical activity program was feasible and acceptable in a sample 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.