Adapting a smartphone-based rehabilitation programme for older adults living with and beyond cancer: a development study using Intervention Mapping

Background & Aim Older adults living with and beyond cancer (LWBC) have greater risk of other cancers, other chronic diseases, and functional decline compared to those without cancer.

Around two-thirds of new cancer cases each year in the UK are among those aged 65 or older; a proportion expected to grow ~40% by 2040. This represents a large and growing burden on patients, informal carers, and the healthcare system.

Physical activity and wellbeing programmes improve cancer-related patient-reported outcomes, and cancer-specific and all-cause mortality. However, many older adults LWBC are not meeting minimum physical activity guidelines.

Digital health programmes (using information and communications technologies to support health) show promise in delivering and supporting healthy lifestyle behaviours.

Robust evidence is needed to test the efficacy of digital health programmes for implementation into standard care pathways.

The purpose of this mixed-methods intervention development study is to adapt an existing, feasible, smartphone-based cardiac rehabilitation programme (REMOTE-CR) for older adults LWBC.

We aim to 1) explore the needs and preferences of older adults living LWBC and exercise/healthcare professionals for a smartphone-based, tailored rehabilitation programme, 2) build a cancer-specific version of the programme based on step 1, and 3) test the usability and acceptability of the programme among this population.

Methods This study addresses the development, modelling, and formative testing phases of the MRC Framework for Complex Intervention Development. We will use Intervention Mapping and the Digital Inclusion Evaluation Toolkit to guide the process.

Qualitative interviews and focus groups: 30 older adults LWBC (10 each age group; 65-74, 75-84, 85+) and 20 healthcare professionals (HCPs) will be recruited to explore desired goals and outcomes, and necessary adaptations to the existing REMOTE-CR programme. All interviews will be conducted via video or telephone.

Interviews and focus groups will be recorded and transcribed verbatim. Data will be analysed using a thematic framework, using a deductive and inductive approach. Themes will guide the mapping of intervention components to desired outcomes.

Usability Testing: The existing REMOTE-CR software platform will be adapted for older adults LWBC to produce a functional cancer-specific prototype (REMOTE-C) ready for usability testing. Ten older adults LWBC will be recruited to participate in three rounds of formative user testing.

Participants will complete a series of tasks with the aim of identifying usability challenges and design problems, and solutions maximising overall user experience.

Primary outcomes will be perceived ease of use and perceived usefulness of the intervention components measured by the Technology Acceptance Model.

Route to Definitive Trial This study will deliver a co-adapted smartphone-based wellbeing programme with older adults LWBC ready for feasibility testing.

The next step will be a two-site, feasibility randomised controlled trial (RCT) to determine whether a definitive trial is feasible, perform summative usability testing, and explore the potential magnitude for a signal of benefit in patient reported outcomes (to be submitted to NIHR RfPB).

If the feasibility RCT meets pre-determined progression criteria, we will continue to a multi-site, definitive evaluation phase trial (to be submitted to NIHR HTA) commencing within the next five years.