4. Discussion
obesity, abdominal obesity, breast cancer
OBESITY, SDH, BREAST CANCER
As breast cancer is a significant health issue, and obesity increases the risk for breast cancer, especially for women with children, we developed a smartphone-based intervention using a popular communication app tailored to Chinese mothers. Our intervention aimed at reducing obesity, increasing knowledge and attitude, and reducing barriers to breast cancer. In our pilot study, less than 50% of participants who have abdominal obesity reported eating five servings of fruit and vegetables and exercising daily at baseline. We observed a significant reduction in WC and BMI in the intervention group compared to the control group and small to large effect sizes of the intervention on improving PA steps, breast cancer knowledge, and breast cancer attitude at three months follow-up. Smaller effects on behavior and psychosocial outcomes were found at the six-month follow-up. Our pilot study revealed good feasibility and high satisfaction in accessing the modules.The lower level of engagement in healthy eating and active lifestyle found in women with abdominal obesity in China is problematic and even worse during the COVID pandemic. The results of our study are consistent with other studies. Previous work examining the effects of the COVID pandemic in China found that more than half of people gained weight, with 16.3% of women gaining more than 2.5 kg [The results of our study revealed great potential in reducing obesity and the risk of breast cancer. Although studies focusing on Chinese women are limited, current evidence demonstrates that premenopausal Asian women with abdominal obesity have a higher risk of breast cancer compared to non-Hispanic white women [Our study also revealed small to large effects on the behaviors and psychosocial factors, such as increasing fruit/vegetable intake, PA steps, and social support regarding diet and PA. As studies have supported the impact of a poorer health lifestyle, including a sedentary lifestyle and inadequate fruit and vegetable intake, on an increased risk for abdominal obesity, it is important to build a healthy lifestyle and a supportive environment for maintaining a healthy lifestyle to ensure the sustainability of health behavior changes [In addition, this intervention also improved women’s knowledge and attitudes regarding breast cancer. Our study is consistent with other studies suggesting that adequate educational programs can increase women’s knowledge and attitudes about breast cancer [Our pilot study revealed good feasibility and high satisfaction in accessing the modules. Traditional in-person weight management and breast cancer prevention programs are time-consuming and costly, especially during a pandemic. The promising effect of our intervention can contribute to the use of communication apps and theoretical-based intervention. Our intervention integrates the SCT and SDH, the use of everyday technology (WeChat), and an adaptation of an evidence-based program tailored to the behavior patterns, preferences, and cultures of women in China. WeChat is a popular multifunctional social media mobile app, and connectivity is widely available without restrictions [There are several limitations in this pilot study. The study’s results need to be interpreted with caution. Because this pilot study was conducted with a small sample size and a homogeneous population, we have limited power to detect small differences. The results may also only be generalized to similar populations. Moreover, this study did not include other potential risk factors such as alcohol drinking and smoking. Other limitations included convenience sampling, self-reported measures, and only 6 months of follow-up. Future studies would also need to investigate whether specific subgroups of women can benefit more from this program and include other potential risk factors (such as alcohol consumption and smoking) in the study.