Feasibility of a Smartphone-Based Health Coaching Intervention for Patient Self-Management of Nutrition in the Post-Chemotherapy Setting

Introduction. While quality of life (QoL) has become an increasingly important outcome measure following hematopoietic stem cell transplant (HSCT), ongoing support services available to patients post-HSCT patients are limited due to high cost and limited reimbursement. Smartphone devices offer a novel means by which to offer low cost, longitudinal support through the use of virtual health coaches. However there is little existing research on the acceptability and effectiveness of using smartphones to deliver health coaching for patients with malignant diseases after HSCT.

Methods. Patients were recruited in the outpatient setting in the stem cell transplant clinic at MD Anderson Cancer Center to enroll in digital health coaching. Upon enrollment, patients were asked to download a smartphone application (Vida Health), which allowed participants to communicate in real time with a health coach through live video, phone, or text messages. Coaches provided health education, offered ongoing encouragement, and helped patients set small weekly goals to enhance nutrition, physical activity, stress management, and medication adherence. Patients completed the Functional Assessment of Cancer Therapy - Bone Marrow Transplant (FACT-BMT) survey at baseline and 3-month follow up.

Results. A total of 62 patients completed at least 3 months of Vida health coaching. The median age was 56 years (45-72 years) and 41% were women. Time elapsed since HSCT ranged from 3 months to 9 months with primary diagnoses being: Myeloma 50%, Lymphoma 20%, Other Hematologic Malignancy 30%. Primary goals as stated by patients were: 72% optimizing nutrition, 60% stress management and emotional support, 60% remembering to take medications, 45% improving sleep, 20% staying physically active. 68% of patients sent at least one message to coach with an average 29 messages sent from patient to coach during the 3 month coaching period. FACT-BMT scores improved significantly after coaching with a 27% improvement in physical wellbeing (pre-coaching mean 6.1, post-coaching 4.7) and a 53% improvement in functional wellbeing (pre-coaching mean 13.8, post-coaching 21.1). Emotional wellbeing also increased 40% (from mean of 10.3 to 6.2).

Conclusion. These preliminary findings suggest digital health coaching may help post-HSCT patients improve QoL, particularly among physical, functional, and emotional domains. We believe that utilizing novel tools such as smartphone-enabled health coaching may offer an important means by which to continue to support patients' wellbeing outside of the clinic.