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Cited by 16Digital Mental Health InterventionsCancer survivorship and careTelemedicine and Telehealth Implementation

User Experiences of an Internet-Based Stepped-Care Intervention for Individuals With Cancer and Concurrent Symptoms of Anxiety or Depression (the U-CARE AdultCan Trial): Qualitative Study

Open access
Igelström, Helena, Hauffman, Anna, Alfonsson, Sven, Sjöström, Jonas, Cajander, Åsa, Johansson, Birgitta·2020·Journal of Medical Internet Research
DOI 10.2196/16604PMC PMC7268002

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Abstract

Background: The internet-based stepped-care intervention iCAN-DO, used in the multicenter randomized controlled trial AdultCan, was developed for adult patients undergoing treatment for cancer and concurrently experiencing anxiety or depressive symptoms. iCAN-DO aimed to decrease symptoms of anxiety or depression. Step 1 comprises access to a library with psychoeducational material and a peer-support section, as well as the possibility to pose questions to a nurse. Step 2 of the intervention offers treatment consisting of internet-based cognitive behavioral therapy (iCBT) to participants still experiencing anxiety or depression at 1, 4, or 7 months after inclusion. Objective: The study aimed to explore user experiences of delivery, design, and structure of iCAN-DO from the perspective of people with cancer. Methods: We studied user experiences by interviewing 15 informants individually: 10 women with breast cancer (67%), 4 men with prostate cancer (27%), and 1 man with colorectal cancer (7%) with a mean age 58.9 years (SD 8.9). The interviews focused on informants' perceptions of ease of use and of system design and structure. Informants had been included in iCAN-DO for at least 7 months. They were purposefully selected based on activity in Step 1, participation in iCBT (ie, Step 2), gender, and diagnosis. Results: Of the 15 informants, 6 had been offered iCBT (40%). All informants used the internet on a daily basis, but 2 (13%) described themselves as very inexperienced computer users. The analysis revealed three subthemes, concerning how user experiences were affected by disease-specific factors and side effects (User experience in the context of cancer), technical problems (Technical struggles require patience and troubleshooting), and the structure and design of iCAN-DO (Appealing and usable, but rather simple). Conclusions: The results indicate that user experiences were affected by informants’ life situations, the technical aspects and the design of iCAN-DO, and informants’ preferences. The results have generated some developments feasible to launch during the ongoing study, but if iCAN-DO is to be used beyond research interest, a greater level of tailoring of information, features, and design may be needed to improve user experiences. The use of recurrent questionnaires during the treatment period may highlight an individual’s health, but also function as a motivator showing improvements over time.

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  • Previous research suggests that single-page websites or apps with properly labeled interactions and different color depths, familiar icons, and images are more usable and acceptable to cancer survivors.

    “Previous research has yielded comparable results [64,65,69-71], suggesting that single-page websites or apps that enable properly labeled interactions and make use of different color depths, familiar icons, and images are more usable and acceptable to cancer survivors.”

    From Development and Evaluation of the Usefulness, Usability, and Feasibility of iNNOV Breast Cancer: Mixed Methods Study (2022) · cites this paper as [71]

    The Results section ('Appealing and Usable, but Rather Simple'; page not specified) reports that some participants found the cancer-support portal intuitive and easy to navigate, and that its simple design appealed to some users. It does not link greater usability or acceptability to a single-page layout, labeled interactions, color depths, familiar icons, or images. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • In previous studies, survivors emphasized delivering content in different formats and adding graphical displays of self-reports, and BCSs stressed developing a my progress page to display completed content and chart anxiety scores to facilitate tracking progress.

    “In a previous study by Igelström et al [71], the importance of delivering content in different formats and adding a graphical display of self-reports was emphasized by participant survivors. In another study by Wagner et al [72], BCSs stressed the importance of developing a my progress page to display didactic content and tools that had been completed and chart anxiety scores to facilitate”

    From Development and Evaluation of the Usefulness, Usability, and Feasibility of iNNOV Breast Cancer: Mixed Methods Study (2022) · cites this paper as [71]

  • These findings echo many limitations and development requirements gathered in previous research aimed at developing digital programs for supporting cancer survivors.

    “These findings echo many of the limitations and development requirements gathered in previous research aimed at developing digital programs for supporting cancer survivors [64,65,68-73].”

    From Development and Evaluation of the Usefulness, Usability, and Feasibility of iNNOV Breast Cancer: Mixed Methods Study (2022) · cites this paper as [71]

  • Previous research corroborates these findings.

    “Previous research corroborate these findings [71-73].”

    From Development and Evaluation of the Usefulness, Usability, and Feasibility of iNNOV Breast Cancer: Mixed Methods Study (2022) · cites this paper as [71]

    The cited paper reports findings about users’ experiences of iCAN-DO (Abstract, Conclusions; page unavailable). The citing sentence does not identify what “these findings” are, so a search for corroborating findings cannot establish whether this paper supports the intended comparison. (LLM, conf=0.74)

    Experimental — accuracy not yet measured

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Research works printed but not linked: 1

  1. [14]Orem DE Nursing: Concepts of Practice. 6th edition 2001 St. Louis, MO Mosby

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Authors
Igelström, H., Hauffman, A., Alfonsson, S., Sjöström, J., Cajander, Å., & Johansson, B.
Affiliations
Uppsala University (SE)
Corresponding author
Igelström, Helena
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2020-05-19
Volume
22
Issue
5
Pages
e16604
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/16604
PMC
PMC7268002
OpenAlex
W3022811274
Cited by
16
References
31
Citations by year
2024: 1 · 2023: 4 · 2022: 6 · 2021: 4 · 2019: 1
FWCI
3.16
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Diva portal (Dalarna University Library) (submittedVersion, other-oa)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Cancerfonden
Topics
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Keywords
internet-based cognitive behavioral therapy, cancer-related anxiety, cancer-related depression, user experience, usability, system design, breast cancer, prostate cancer, colorectal cancer, psychoeducation, peer support, technical challenges
MeSH terms
Internet-Based Intervention, Adult, Aged, Anxiety, Depression, Female, Humans, Male, Middle Aged, Neoplasms, Internet, Qualitative Research

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