Comparison With Prior Work
anxiety, breast cancer, cancer, psychiatric, depression
CANCER, DISORDERS, BREAST CANCER
The results from our self-enrollment data suggest that EMPOWER-SMS COVID-19 had a broad reach, with participants registering from diverse ages, socioeconomic backgrounds, urban and rural communities, and times since finishing treatment. Similar results were seen in the Text4Hope program, which was launched in Canada in March 2020 to support people’s mental health during COVID-19 lockdowns. Within 1 week, 32,805 people subscribed; the majority were White, females, and aged 26-60 years [Interestingly, 35.8% (301/841) of participants had finished treatment more than 3 years ago, suggesting an ongoing desire for support for health management after breast cancer. Although not statistically significant, a large proportion of participants who opted out of the study were in this long-term survivorship phase. Qualitative results revealed that these participants wanted to move on from their breast cancer experience and no longer wanted breast cancer–specific support, but instead wanted to receive general health and wellness support. This result mirrors findings from a cohort study of 1083 long-term cancer survivors (N=1083; mean 47 months following diagnosis) who reported ongoing symptoms of anxiety and depression and that being insufficiently informed about health support options was a major unmet need [Our current study also found that EMPOWER-SMS COVID-19 was delivered as planned with minimal cost (Aus $15.34/participant for 3 months, including staff time). The opt-out rate was low (62/838, 7.4%) and 97.43% (41,257/42,344) of SMS text messages were delivered successfully, indicating that the remaining participants received the entire EMPOWER-SMS COVID-19 program (49 SMS text messages/person). The low opt-out rates may have been due to participants’ perceptions that EMPOWER-SMS COVID-19 was highly acceptable, supportive, engaging, and useful for health management. SMS text message interventions have also been found highly acceptable among patients with psychiatric or mental health disorders [It is also important to remember that program improvement is an iterative process and adaptations may be needed to improve and maintain participant engagement and satisfaction over time. Although no adaptations were made to the EMPOWER-SMS COVID-19 SMS text messages during the study, these findings and results from the original EMPOWER-SMS program [