Supporting breast cancer survivors via text messages: reach, acceptability, and utility of EMPOWER-SMS

Anna C. Singleton*, Rebecca Raeside, Stephanie R. Partridge, Justin Tat-Ko, Stephanie Che Mun Sum, Karice K. Hyun, Molly Hayes, Clara K. Chow, Aravinda Thiagalingam, Katherine Maka, Kerry A. Sherman, Elisabeth Elder, Julie Redfern

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    9 Citations (Scopus)


    Purpose: This study aims to evaluate the reach, usefulness, acceptability, and factors influencing engagement with a lifestyle-focused text message intervention to support women’s mental and physical health after breast cancer treatment. 

    Methods: This study uses a mixed-methods process evaluation nested in the EMPOWER-SMS randomised controlled trial (n = 160; intervention n = 80, wait-list control n = 80). Data sources included screening logs, text message delivery software analytics, intervention feedback survey, and focus groups (n = 16), which were summarised thematically based on the framework approach. 

    Results: A total of 387 women met the inclusion criteria (meanage ± SD = 59.3 ± 11.6 years). Participants who declined (n = 227) were significantly older than those who enrolled (n = 160; 62.2 ± 11.1 vs 55.1 ± 11.1 years, respectively, p < 0.001). Most intervention participants (64/80; 80%) completed the end-of-study survey, reporting the messages were easy to understand (64/64; 100%), useful (58/64; 91%), and motivating (43/64; 67%). The focus groups (n = 16) revealed five factors influencing engagement: (i) feelings of support/continued care, (ii) convenience/flexibility of message delivery, (iii) weblinks, (iv) information from a credible source, and (v) options to save or share messages. 

    Conclusion: A lifestyle-focused text message program was acceptable and useful for women after breast cancer treatment. However, text messaging may be a barrier for women aged over 68 years. Suggestions for program improvements included delivering the program to patients with other cancers, during all stages of treatment, and including more weblinks in text messages. 

    Implications for Cancer Survivors 

    Text message programs offer a low-cost way to deliver post-treatment health support to breast cancer survivors in a non-invasive way. Text messages can improve patient–health professional communication and were found to be acceptable and useful.

    Original languageEnglish
    Pages (from-to)1165–1175
    Number of pages11
    JournalJournal of Cancer Survivorship
    Issue number6
    Early online date9 Sept 2021
    Publication statusPublished - Dec 2022


    • breast cancer survivor
    • mobile health
    • mHealth
    • supportive care
    • text messaging
    • process evaluation


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