Appl Clin Inform 2022; 13(05): 935-948
DOI: 10.1055/s-0042-1757295
Research Article

Development of a Mobile-Based Self-care Application for Patients with Breast Cancer-Related Lymphedema in Iran

Maryam Ahmadi
1   Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
,
Seyedeh Nafiseh Shahrokhi
1   Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
,
Morteza Khavaninzadeh
2   Department of General Surgery, School of Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
,
Jahanpour Alipour
3   Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
4   Department of Health Information Technology, School of Paramedical, Zahedan University of Medical Sciences, Zahedan, Iran
› Author Affiliations
Funding None.

Abstract

Background Due to the chronic, progressive, and debilitating nature of breast cancer-related lymphedema (BCRL), it is necessary to observe and maintain self-care management accordingly. This study was conducted to develop a mobile application based on the Android operating system for self-care management of Iranian patients with BCRL.

Methods An applied developmental study was conducted in 2020. The users' information needs assessment as well as design, development, implementation, and evaluation of the mobile app for self-care management of patients with BCRL was done by searching the literature, reviewing the existing mobile applications, and surveying the users' needs. The mobile app was designed using the Android Studio environment and Java programming language in the Android operating system. The usability of the app was evaluated by 30 patients with BCRL using the questionnaire for user interface satisfaction-seventh version (QUIS 7).

Results The mobile app for BCRL included demographic information, clinical information, lifestyle and system functions (drug use, nutrition, exercise, smoking cessation, communication, and test time reminder). User usability evaluation of the app content and functions confirmed that it was appropriate and satisfactory for the self-management of women with BCRL.

Conclusion The mobile app was appropriate in terms of the content, function, and quality for improving the patients' lifestyle and education and self-management of BCRL symptoms according to its usability evaluation from the end-users' (patients) perspective. It is suggested that studies should be performed to confirm the effectiveness and identify the clinical significance of the app.

Protection of Human and Animal Subjects

The present study was reviewed and approved by Ethics Committee of Iran University of Medical Sciences (ethical code: IR.IUMS.REC.1399.046). All participants provided written informed consent for this study. Research Ethics Committees Certificate available from:

https://ethics.research.ac.ir/ProposalCertificateEn.php?id=124445&Print=true&NoPrintHeader=true&NoPrintFooter=true&NoPrintPageBorder=true&LetterPrint=true


Author Contributions

M.A. and S.N.Sh. conceived the study. J.A. and S.N.Sh. wrote the first and final draft of the manuscript. M.A. and M.Kh. contributed substantially to the manuscript. All authors participated in the design of the study, revised the manuscript critically for intellectual content, and have read and approved the final manuscript.


Availability of Data and Materials

The data used and analyzed during the current study are not publicly available due to Iran University of Medical Sciences policy but are available from the corresponding author on reasonable request.




Publication History

Received: 06 June 2022

Accepted: 20 August 2022

Article published online:
05 October 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Carranza-Rosales P, Guzmán-Delgado NE, Carranza-Torres IE, Viveros-Valdez E, Morán-Martínez J. Breast organotypic cancer models. Curr Top Microbiol Immunol 2018; DOI: 10.1007/82_2018_86.
  • 2 Farshbafnadi M, Pastaki Khoshbin A, Rezaei N. Immune checkpoint inhibitors for triple-negative breast cancer: from immunological mechanisms to clinical evidence. Int Immunopharmacol 2021; 98: 107876
  • 3 Karadeniz Küçük A, Şener B. eds. Design for Positive Breast Self-Exam Experience Using Mobile Apps; 2021
  • 4 Norfjord van Zyl M, Tillgren P, Asp M. The politicians' perspectives on participation in mammographic screening: an interview-based study from a region in Sweden. Arch Public Health 2021; 79 (01) 52
  • 5 Yap KM, Sekar M, Seow LJ. et al. Mangifera indica (Mango): a promising medicinal plant for breast cancer therapy and understanding its potential mechanisms of action. Breast Cancer (Dove Med Press) 2021; 13: 471-503
  • 6 Wanchai A, Armer JM. A systematic review association of reflexology in managing symptoms and side effects of breast cancer treatment. Complement Ther Clin Pract 2020; 38: 101074
  • 7 Fapohunda A, Fakolade A, Omiye J. et al. Cancer presentation patterns in Lagos, Nigeria: experience from a private cancer center. J Public Health Africa 2020; 11 (02) 1138
  • 8 Shamshirian A, Heydari K, Shams Z. et al. Breast cancer risk factors in Iran: a systematic review & meta-analysis. Horm Mol Biol Clin Investig 2020;41(04):
  • 9 Nelson NL. Breast cancer-related lymphedema and resistance exercise: a systematic review. J Strength Cond Res 2016; 30 (09) 2656-2665
  • 10 Sung H, Ferlay J, Siegel RL. et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71 (03) 209-249
  • 11 International Agency for Research on Cancer. Number of new cases of cancers in Islamic Republic of Iran in 2020. WHO; 2021 . Accessed November 12, 2021 at: https://gco.iarc.fr/today/data/factsheets/populations/364-iran-islamic-republic-of-fact-sheets.pdf
  • 12 Kostanoglu A, Tarakcı E. Physical therapy enhances functions and quality of life in older patients with breast cancer-related lymphedema: A prospective experimental study. Niger J Clin Pract 2021; 24 (03) 387-392
  • 13 Fu MR, Axelrod D, Guth A. et al. The effects of obesity on lymphatic pain and swelling in breast cancer patients. Biomedicines 2021; 9 (07) 818
  • 14 Pappalardo M, Starnoni M, Franceschini G, Baccarani A, De Santis G. Breast cancer-related lymphedema: recent updates on diagnosis, severity and available treatments. J Pers Med 2021; 11 (05) 402
  • 15 Fu MR, Axelrod D, Guth AA. et al. Usability and feasibility of health IT interventions to enhance self-care for lymphedema symptom management in breast cancer survivors. Internet Interv 2016; 5: 56-64
  • 16 Mobarakeh ZS, Mokhtari-Hesari P, Lotfi-Tokaldany M, Montazeri A, Heidari M, Zekri F. Combined decongestive therapy and reduction of pain and heaviness in patients with breast cancer-related lymphedema. Support Care Cancer 2019; 27 (10) 3805-3811
  • 17 Baumann FT, Reike A, Reimer V. et al. Effects of physical exercise on breast cancer-related secondary lymphedema: a systematic review. Breast Cancer Res Treat 2018; 170 (01) 1-13
  • 18 Jaarsma T, Cameron J, Riegel B, Stromberg A. Factors related to self-care in heart failure patients according to the middle-range theory of self-care of chronic illness: a literature update. Curr Heart Fail Rep 2017; 14 (02) 71-77
  • 19 Farzandipour M, Nabovati E, Heidarzadeh Arani M, Akbari H, Sharif R, Anvari S. Enhancing asthma patients' self-management through smartphone-based application: design, usability evaluation, and educational intervention. Appl Clin Inform 2019; 10 (05) 870-878
  • 20 Kim SH, Park S, Kim SJ, Hur MH, Lee BG, Han MS. Self-management needs of breast cancer survivors after treatment: results from a focus group interview. Cancer Nurs 2020; 43 (01) 78-85
  • 21 Hou IC, Lan MF, Shen SH. et al. The development of a mobile health app for breast cancer self-management support in Taiwan: design thinking approach. JMIR Mhealth Uhealth 2020; 8 (04) e15780
  • 22 Berry DL, Blonquist TM, Nayak MM, Grenon N, Momani TG, McCleary NJ. Self-care support for patients with gastrointestinal cancer: iCancerHealth. Appl Clin Inform 2018; 9 (04) 833-840
  • 23 Alcorso J, Sherman KA, Koelmeyer L, Mackie H, Boyages J. Psychosocial factors associated with adherence for self-management behaviors in women with breast cancer-related lymphedema. Support Care Cancer 2016; 24 (01) 139-146
  • 24 Temur K, Kapucu S. The effectiveness of lymphedema self-management in the prevention of breast cancer-related lymphedema and quality of life: a randomized controlled trial. Eur J Oncol Nurs 2019; 40: 22-35
  • 25 Harder H, Holroyd P, Burkinshaw L. et al. A user-centred approach to developing bWell, a mobile app for arm and shoulder exercises after breast cancer treatment. J Cancer Surviv 2017; 11 (06) 732-742
  • 26 Carter J, Sandall J, Shennan AH, Tribe RM. Mobile phone apps for clinical decision support in pregnancy: a scoping review. BMC Med Inform Decis Mak 2019; 19 (01) 219
  • 27 Islam MN, Karim MM, Inan TT, Islam AKMN. Investigating usability of mobile health applications in Bangladesh. BMC Med Inform Decis Mak 2020; 20 (01) 19
  • 28 Hendriks JML, Gallagher C, Astley C, Linz D, Gallagher RW. Heart and vasculature. Int J Cardiol 2019; 24: 100410
  • 29 Xie Z, Nacioglu A, Or C. Prevalence, demographic correlates, and perceived impacts of mobile health app use amongst Chinese adults: cross-sectional survey study. JMIR Mhealth Uhealth 2018; 6 (04) e103
  • 30 Lupton D. The digitally engaged patient: self-monitoring and self-care in the digital health era. Soc Theory Health 2013; 11 (03) 256-270
  • 31 Wang W, Chan S, He HG. Developing and testing a mobile application programme to support self-management in patients with stable angina: a feasibility study protocol. Stud Health Technol Inform 2014; 201: 241-248
  • 32 Karimpour M, Parsaei H, Rojhani-Shirazi Z, Sharifian R, Yazdani F. An android application for estimating muscle onset latency using surface EMG signal. J Biomed Phys Eng 2019; 9 (02) 243-250
  • 33 Smarr KL, Musser DR, Shigaki CL, Johnson R, Hanson KD, Siva C. Online self-management in rheumatoid arthritis: a patient-centered model application. Telemed J E Health 2011; 17 (02) 104-110
  • 34 Ravn Jakobsen P, Hermann AP, Søndergaard J, Wiil UK, Clemensen J. Development of an mHealth application for women newly diagnosed with osteoporosis without preceding fractures: a participatory design approach. Int J Environ Res Public Health 2018; 15 (02) E330
  • 35 Wong RSM, Yu EYT, Wong TW. et al. Development and pilot evaluation of a mobile app on parent-child exercises to improve physical activity and psychosocial outcomes of Hong Kong Chinese children. BMC Public Health 2020; 20 (01) 1544
  • 36 Parmanto B, Pramana G, Yu DX, Fairman AD, Dicianno BE, McCue MP. iMHere: a novel mHealth system for supporting self-care in management of complex and chronic conditions. JMIR Mhealth Uhealth 2013; 1 (02) e10
  • 37 Fu MR, Axelrod D, Guth AA. et al. Proactive approach to lymphedema risk reduction: a prospective study. Ann Surg Oncol 2014; 21 (11) 3481-3489
  • 38 Fu MR, Chen CM, Haber J, Guth AA, Axelrod D. The effect of providing information about lymphedema on the cognitive and symptom outcomes of breast cancer survivors. Ann Surg Oncol 2010; 17 (07) 1847-1853
  • 39 Ridner SH, Dietrich MS, Kidd N. Breast cancer treatment-related lymphedema self-care: education, practices, symptoms, and quality of life. Support Care Cancer 2011; 19 (05) 631-637
  • 40 Cheung DST, Or CKL, So MKP, Tiwari A. Usability testing of a smartphone application for delivering qigong training. J Med Syst 2018; 42 (10) 191
  • 41 Militello LG, Diiulio JB, Borders MR. et al. Evaluating a modular decision support application for colorectal cancer screening. Appl Clin Inform 2017; 8 (01) 162-179
  • 42 Salimian N, Ehteshami A, Ashouri-Talouki M. Developing Ghasedak: a mobile application to improve the quality of cancer palliative care. Acta Inform Med 2019; 27 (01) 19-22
  • 43 Ghanbari E, Yektatalab S, Mehrabi M. Effects of psychoeducational interventions using mobile apps and mobile-based online group discussions on anxiety and self-esteem in women with breast cancer: randomized controlled trial. JMIR Mhealth Uhealth 2021; 9 (05) e19262
  • 44 Ali EE, Chan SSL, Poh HY. et al. Design considerations in the development of app-based oral anticancer medication management systems: a qualitative evaluation of pharmacists' and patients' perspectives. J Med Syst 2019; 43 (03) 63
  • 45 Armstrong KA, Semple JL, Coyte PC. Replacing ambulatory surgical follow-up visits with mobile app home monitoring: modeling cost-effective scenarios. J Med Internet Res 2014; 16 (09) e213
  • 46 Choi J, Baker E, Nalawade S, Lee H. Steps to develop a mobile app for pain assessment of cancer patients: a usability study. Comput Inform Nurs 2020; 38 (02) 80-87
  • 47 Chung IY, Jung M, Lee SB. et al. An assessment of physical activity data collected via a smartphone app and a smart band in breast cancer survivors: observational study. J Med Internet Res 2019; 21 (09) 13463
  • 48 Economou D, Dwek M, Roberston C. et al , eds. PhytoCloud: A Gamified Mobile Web Application to Modulate Diet and Physical Activity of Women with Breast Cancer. Proceedings – IEEE Symposium on Computer-Based Medical Systems; 2017
  • 49 Greer JA, Jacobs JM, Pensak N. et al. Randomized trial of a smartphone mobile app to improve symptoms and adherence to oral therapy for cancer. J Natl Compr Canc Netw 2020; 18 (02) 133-141
  • 50 Lozano-Lozano M, Moral-Munoz JA, Galiano-Castillo N. et al. Designing beneca m-Health APP, a Mobile Health Application to Monitor Diet and Physical Activity in Cancer Survivors. Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics); 2017: 63-70
  • 51 Xu CS, Anderson B, Armer J, Shyu CR. eds. Improving disease management through a mobile application for lymphedema patients. Paper presented at: 2012 IEEE 14th International Conference on e-Health Networking, Applications and Services, Healthcom 2012; 2012
  • 52 Dorri S, Olfatbakhsh A, Asadi F. Informational needs in patients with breast cancer with lymphedema: is it important?. Breast Cancer (Auckl) 2020; 14: 1178223420911033
  • 53 Nahum JL, Fu MR, Scagliola J. et al. Real-time electronic patient evaluation of lymphedema symptoms, referral, and satisfaction: a cross-sectional study. mHealth 2021; 7: 20
  • 54 Sheikh Taheri A, Norouzi E, Sadoughi F. Developing a mobile-based self-care application for patients with breast cancer undergoing chemotherapy. J Health Administration 2019; 22 (04) 35-49
  • 55 Shahsavari H, Matory P, Zare Z, Taleghani F, Kaji MA. Effect of self-care education on the quality of life in patients with breast cancer. J Educ Health Promot 2015; 4 (01) 70
  • 56 Deveci Z, Karayurt Ö, Eyigör S. Self-care practices, patient education in women with breast cancer-related lymphedema. Turk J Phys Med Rehabil 2021; 67 (02) 187-195
  • 57 Nassif TM, Brunelle CL, Gillespie TC. et al. Breast cancer-related lymphedema: a review of risk factors, radiation therapy contribution, and management strategies. Curr Breast Cancer Rep 2020; 12 (04) 305-316
  • 58 Eaton LH, Narkthong N, Hulett JM. Psychosocial issues associated with breast cancer-related lymphedema: a literature review. Curr Breast Cancer Rep 2020; 12 (04) 216-224
  • 59 Ostby PL, Armer JM. Complexities of adherence and post-cancer lymphedema management. J Pers Med 2015; 5 (04) 370-388
  • 60 Luz RPC, Simao Haddad CA, Rizzi SKLA, Elias S, Nazario ACP, Facina G. Complex therapy physical alone or associated with strengthening exercises in patients with lymphedema after breast cancer treatment: a controlled clinical trial. Asian Pacific journal of cancer prevention. Asian Pac J Cancer Prev 2018; 19 (05) 1405-1410
  • 61 Shaw C, Mortimer P, Judd PA. Randomized controlled trial comparing a low-fat diet with a weight-reduction diet in breast cancer-related lymphedema. Cancer 2007; 109 (10) 1949-1956
  • 62 Rezaee R, Asadi S, Yazdani A, Rezvani A, Kazeroon AM. Development, usability and quality evaluation of the resilient mobile application for women with breast cancer. Health Sci Rep 2022; 5 (04) e708
  • 63 Karsh B, Holden RJ, Or CK. Human Factors and Ergonomics of Health Information Technology Implementation. Handbook of Human Factors and Ergonomics in Health Care and Patient Safety, 2nd ed. Boca Raton: CRC Press; 2011: 249-264
  • 64 Carayon P, Hoonakker P. Human factors and usability for health information technology: old and new challenges. Yearb Med Inform 2019; 28 (01) 71-77
  • 65 Alipour J, Mehdipour Y, Karimi A. Factors affecting acceptance of hospital information systems in public hospitals of Zahedan University of Medical Sciences: a cross-sectional study. J Med Life 2019; 12 (04) 403-410
  • 66 Hosseini Teshnizi S, Hayavi Haghighi MH, Alipour J. Evaluation of health information systems with ISO 9241–10 standard: a systematic review and meta-analysis. Inform Med Unlocked 2021; 25: 100639
  • 67 Aromatario O, Van Hoye A, Vuillemin A. et al. How do mobile health applications support behaviour changes? A scoping review of mobile health applications relating to physical activity and eating behaviours. Public Health 2019; 175: 8-18