Exploring Breast Cancer Survivors' Preferences for Text Messaging-Based Mobile Health Interventions Targeting Sleep and Physical Activity: Qualitative Study
Clinical Snapshot
PICO Framework
| P — Population | Breast cancer survivors (n=16, mean age 59.3 years) currently experiencing sleep disturbances, recruited in Seattle, WA, USA (May 2020 – March 2021) |
| I — Intervention | SMS text messaging-based mobile health interventions targeting sleep hygiene and physical activity promotion |
| C — Comparator | No formal comparator — qualitative preference elicitation study; participant attitudes toward text messaging compared implicitly with other modalities (apps, voice interaction) |
| O — Outcomes | Participant perspectives, preferences, and attitudes toward SMS-based mHealth interventions for sleep and physical activity; desired features, timing, and frequency of messaging |
Bottom Line
This small formative qualitative study (n=16) provides useful preliminary insights into how breast cancer survivors with sleep disturbances perceive SMS-based mobile health interventions. Three themes emerged: broadly positive attitudes toward text messaging as a health delivery channel, preference for reminder and accountability features (particularly bedtime and relaxation prompts), and high acceptance of SMS and apps but not voice interaction. A daily reminder one hour before bedtime was identified as an acceptable format. These findings are clinically actionable in guiding the design of future mHealth interventions for this population. However, the study's small, geographically homogeneous sample, absence of saturation reporting, lack of reflexivity disclosure, and limited analytic transparency constrain the strength of conclusions. The pandemic-era data collection context may have inflated technology acceptance. Clinicians and intervention developers should treat these findings as hypothesis-generating rather than definitive. Replication in larger, more diverse samples — including culturally and linguistically diverse Australian BC survivors — is needed before broad implementation. The study is appropriately positioned as formative groundwork for a subsequent randomised evaluation.
Key Findings
Effect Size: Not applicable — qualitative study; no quantitative effect sizes reported
Primary Outcome: Three qualitative themes identified: (1) positive attitudes toward text messaging-based health interventions; (2) specific user needs including reminders, accountability features, and relaxation/bedtime exercise prompts; (3) technology usage habits with high acceptance of SMS and apps but low acceptance of voice interaction
Nnt Or Sensitivity: Not applicable — formative qualitative preference study; no diagnostic, therapeutic, or prognostic metrics reported. Key actionable finding: daily SMS reminder scheduled 1 hour before bedtime was the most acceptable format for sleep hygiene support
Clinical Application
SMS-based interventions are low-cost, scalable, and do not require smartphone ownership or internet access, making them feasible across a range of healthcare settings. The identified preferences (daily reminders, accountability features, bedtime prompts) are technically straightforward to implement. Voice-based interactions were not preferred, suggesting this modality should be avoided in this population. Findings are formative and require validation in a larger, more diverse sample before clinical implementation. Sleep disturbance and physical inactivity are recognised survivorship concerns in Australian breast cancer care, consistent with Cancer Australia and RACGP survivorship guidelines. SMS-based mHealth tools are not currently listed on the PBS, but align with the Australian Digital Health Agency's national digital health strategy and My Health Record infrastructure. The TGA classifies most SMS reminder tools as low-risk Software as a Medical Device (SaMD), though regulatory classification depends on specific clinical claims. RACGP guidelines on cancer survivorship care support non-pharmacological approaches to sleep and physical activity promotion. Australian oncology nurses and GPs managing survivorship care could consider SMS-based tools as adjuncts to existing care plans, particularly for patients in regional or remote areas with limited access to face-to-face behavioural interventions. Cultural and linguistic diversity in the Australian BC survivor population — not represented in this US sample — would require separate formative work before local implementation. Female breast cancer survivors (mean age ~59 years) with current sleep disturbances; findings most directly applicable to post-treatment survivors in community or outpatient oncology settings who have access to SMS-capable mobile devices
Abstract
BACKGROUND: Sleep disturbances and low physical activity are common among breast cancer (BC) survivors and are associated with increased morbidity and mortality. Given the increased access to technological devices and the growing popularity of SMS text messaging-based mobile health interventions, these tools have the potential to both address sleep disturbances and promote physical activity in a scalable and cost-effective way. To understand and make effective use of these tools, it is important to consider the preferences of BC survivors with sleep disturbances, including how SMS text messaging-based mobile health interventions could deliver interventions involving physical activity and sleep hygiene. OBJECTIVE: The objective of this study was to explore the perspectives and preferences of BC survivors regarding text messaging-based mobile interventions targeting sleep and physical activity. METHODS: Three focus groups (n=13 participants) and 3 individual interviews (n=3) were conducted from May 2020 to March 2021 with 16 BC survivors (mean age=59.3, SD 8.9 y) currently experiencing sleep disturbances. The interview questions focused on their experiences with poor sleep and preferences for text messaging-based mobile health interventions. Thematic analysis was applied to the deidentified transcriptions of audio recordings. RESULTS: Three themes were identified: (1) attitudes toward health interventions delivered through text messaging, (2) specific user needs, and (3) technology usage habits and preferences. Most participants reported a positive attitude toward the possibility of using technology to help improve their sleep and increase their physical activity. Most expressed a high level of acceptance toward some technologies, such as text messaging and mobile apps, but not others, such as voice interactions. In terms of desired features, reminders and accountability features, such as meeting physical activity goals, were mentioned most frequently. In addition, incorporating bedtime and relaxation exercise reminders was thought to be helpful. Regarding time and frequency, a daily reminder scheduled for 1 hour before bedtime was found to be acceptable. CONCLUSIONS: The insights have been used to guide the development of a messaging-based mobile health intervention for improving sleep and physical activity in BC survivors. Future research will focus on delivering an intervention addressing these health behaviors and assessing its acceptability and effectiveness.
References
- 1.Tsai, C.-S., Szewczyk, W., Lee, H., Drerup, M., Blakeney, E. A.-R., Greenlee, H., Heffner, J. L., Vasbinder, A., & Reding, K. W. (2026). Exploring breast cancer survivors' preferences for text messaging-based mobile health interventions targeting sleep and physical activity: Qualitative study. JMIR Formative Research. https://doi.org/10.2196/85386
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