=Paper=
{{Paper
|id=Vol-2885/paper1.pdf
|storemode=property
|title=mHealth Applications for Childhood Cancer Support and Self-management: Persuasive Systems Design Features
|pdfUrl=https://ceur-ws.org/Vol-2885/paper1.pdf
|volume=Vol-2885
|authors=Elena Vlahu-Gjorgievska,Connor Hart,Suliman Basahal,Kamana Pokharel,Khin Than Win
|dblpUrl=https://dblp.org/rec/conf/persuasive/Vlahu-Gjorgievska21
}}
==mHealth Applications for Childhood Cancer Support and Self-management: Persuasive Systems Design Features==
https://ceur-ws.org/Vol-2885/paper1.pdf
mHealth Applications for Childhood Cancer Support and
Self-management: Persuasive Systems Design features
Elena Vlahu-Gjorgievska[0000-0001-6160-5343], Connor Hart, Suliman Basahal, Kamana
Pokharel and Khin Than Win1[0000-0002-7810-6388]
University of Wollongong, Wollongong NSW 2522, AU
elenavg@uow.edu.au
Abstract. The wide accessibility of mobile devices and the potential for self-
management and informational support through mHealth applications provides
an opportunity to address unmet informational needs, achieve patient self-man-
agement, and provide long-term care for young cancer patients and their par-
ents/caregivers. The aim of this paper is to examine the functionalities and fea-
tures offered by mHealth applications for the support and self-management of
childhood and adolescent cancer patients. In order to evaluate the influence of
these apps on the user’s motivation for behaviour change, an extensive review
was conducted and the features of the selected applications are further analysed
using the Persuasive Systems Design. The review provided in this paper found a
number of mobile health applications fulfilling a variety of functions and needs
for childhood and young adult cancer patients and their families. Most of the
analysed applications provide one or few features from the Persuasive Systems
Design primary task support, dialogue, or social support category.
Keywords: mHealth, Cancer Patients, Self-management, Persuasive Systems
Design.
1 Introduction
mHealth is defined by the Global Observatory for eHealth (GOe) as medical and public
health practice supported by mobile devices, such as mobile phones, patient monitoring
devices, personal digital assistants (PDAs), and other wireless devices [1]. Common
application areas for mHealth include improving data collection, raising awareness and
education, remote telemonitoring in real-time, or delivering healthcare services more
effectively [2,3].
In 2018, over 10590 children were expected to be diagnosed with cancer in the
United States, along with 1180 estimated deaths, which makes it the second-largest
cause of death for children aged 0-14 years [4]. Leukaemia, brain and nervous system
tumours, and lymphoma are the most common types in children and adolescents; while
the overall survival rate has been increasing over the decades, the incidence rate has not
declined [5]. Cancer and its treatments have significant impacts on the quality of life of
the patients, causing side effects and symptoms such as intense pain, nausea, weight
Copyright © 2021 for this paper by its authors.
Use permitted under Creative Commons License Attribution 4.0 International (CC BY 4.0).
6 Ninth International Workshop on Behavior Change Support Systems (BCSS 2021):
mHealth Applications for Childhood Cancer Support and Self-management
loss, and infertility. In addition, children and adolescents can suffer psychosocial side
effects such as post-traumatic stress, anxiety and depression, learning disabilities, rela-
tionship or sexual dysfunction, and employment and education discrimination [6].
These disruptions affect their self-esteem, social and family life, and future life plans,
requiring a life-long survivorship plan [6,7].
Despite these recognised needs, many cancer survivors still report having unmet in-
formation needs regarding clinical areas such as cancer recurrence and fertility con-
cerns, and in areas such as healthy lifestyle behaviours, interaction with others at their
age, and financial impacts [8]. These areas of unmet needs also apply to parent/care-
givers, and both the patient and their family as a result experience distress, highlighting
a need for providing centred care for young cancer patients [8].
The wide accessibility of mobile devices and the potential for self-management and
informational support through mHealth applications provides an opportunity to address
unmet informational needs, achieve patient self-management, and provide long-term
care for young cancer patients and their parents/caregivers. The aim of this paper is to
examine the functionalities and features offered by mHealth applications for the support
and self-management of childhood and adolescent cancer patients. In order to evaluate
the influence of these apps on the user’s motivation for behaviour change, the features
of the selected applications will be further analysed using the Persuasive Systems De-
sign (PSD).
2 Background
Self-management empowers the patients to make decisions and engage in behaviours
that affect their health. It can be a good strategy for treatment allowing patients to iden-
tify challenges associated with their condition [9,10]. Self-managing includes learning
about the condition, participating in making health decisions, understanding and know-
ing how to deal with specific health emergencies.
The pervasiveness of information and communication technologies in everyday life
provides great opportunities for managing health conditions. Fogg [11] identified that
computers can play roles as a tool, media, and social actor. However, in order to have
full effect digital tools need to be based on reliable and tailored information that will
allow patients to better understand the content and adopt changes in their every-day
routines. From this perspective technology-assisted health behaviour change support
systems would need to provide goal setting and behaviour change techniques such as
self-monitoring, feedback, reinforcement, and social support. Furthermore, Michie et
al. [12] introduced a behaviour change taxonomy with 93 behaviour change techniques
clustered into 16 groups including feedback and monitoring, goals and planning, social
support, shaping knowledge and regulation. In this context, Persuasive Technology
(PT) are interactive systems effective at promoting various health and wellness related
behaviour by shaping and reinforcing behaviour and/or attitude [13].
Oinas-Kukkonen and Harjumaa [14] developed a Persuasive Systems Design (PSD)
model presenting behaviour change support features divided into four categories: Pri-
Ninth International Workshop on Behavior Change Support Systems (BCSS 2021): 7
mHealth Applications for Childhood Cancer Support and Self-management
mary Task Support, Dialogue Support, Credibility Support, and Social Support fea-
tures. PSD features influence behaviour change by assisting the user in achieving the
primary task (goal); supporting human-computer interactions with feedback prompts,
suggestions or reminders; indicating system’s credibility; and motivating users by lev-
eraging social influence.
The PSD model can assist in designing and evaluating systems that influence atti-
tudes or behaviours. Multiple studies have used the PSD for the validations of different
systems [15-18]. According to Win et al. [18], besides the behavioural influence of
individual PSD features, the categories of features can also contribute to positive out-
comes enhancing health behavioural changes.
To be effective in patients’ healthcare management, the applications need to consider
appropriate software design features that will guide the user towards the desired attitude
or behaviour change. By implementing Persuasive Systems Design features, the appli-
cations can be seen as an effective self-management tool that elicits users’ motivation
for undertaking activities that are important for successful management of their health
condition.
3 Methodology
For the purpose of the paper, a search of two databases SCOPUS and PubMed (that
include a large number of health journals) was conducted. The search terms were com-
binations of [“teen”, “adolescent”, “child-hood”, “child”, “young”, “youth”, “paediat-
ric”] AND [“mHealth”, “mobile”, “eHealth”, “mobile health”, “mobile application”,
“smartphone”, “mobile device”, “mobile app”] AND [“cancer”, “oncology”, “oncolo-
gist”, “tumour”, “chemotherapy”, “malignant”, “carcinoma”, “melanoma”, “blastoma”,
“sarcoma”, “leukemia”, and “lymphoma”].
The query returned 531 results from SCOPUS and 1218 results from PubMed. Of
the 1749 results, 40 articles were selected for full-text review.
In order for the article to be included in the review it was required: 1) to be focused
on a specific mobile application, 2) the testing sample or target demographic to include
childhood and/or adolescent cancer patients (0-19 years of age) or the caregivers of
these patients, and 3) the application is intended to provide support and/or self-man-
agement, including post-treatment care for cancer patients. Articles that were excluded:
1) did not contain the mobile application, 2) study population was not oncology pa-
tients, 3) study was not focused on childhood or young adolescent demographic, or 4)
the applications were focused outside of ongoing and post-treatment support and self-
management of cancer patients (e.g. cancer prevention, public awareness).
The 40 selected articles were reviewed and discussed by all researchers leading to a
selection of 14 articles covering 13 unique mobile applications. Of the included articles,
two contained patients within and outside the specified age range, while the rest were
within the specified range.
8 Ninth International Workshop on Behavior Change Support Systems (BCSS 2021):
mHealth Applications for Childhood Cancer Support and Self-management
4 Results
Based on the provided functions and features the applications can be categorised as: (1)
Applications that primarily provide broad informative support to the user (such as
knowledge banks, contact information, monitoring and management tools, and diaries);
(2) Applications with a focus on symptom management (allowing patients to report,
assess, receive feedback on, and receive self-management strategies for their disease
and treatment symptoms); (3) Pain assessment or patient-reported outcome applica-
tions; and (4) Medication management applications.
For most applications, the evaluation is done with a pilot study, ranging the trial
period from 10 days to 6 months. The sample size also varies from 4 to 59 users includ-
ing young and adolescent patients and their parents or caregivers (Table 1). Need to be
noted that the evaluation of the Oncology Family App [19], EAT! [20], Dosecast [21]
and FitBit & Facebook [22] showed that adherence rates remained high early on but
became far less consistent over time.
Five of the reviewed applications provide informative support for users.
The Oncology Family App [19] aims to provide remote support for the parent/care-
givers of children with cancer. The application has four modules: a state-wide hospital
contacts module sorted by distance to the user, “When to call” module that describes
general oncology and bone marrow transplant symptoms, a blood results table that al-
lows the parent/caregiver to record and examine the child’s blood test results, and mod-
ule containing recommended websites, contacts, appointments, and a personal note-
taking feature. According to the app evaluation, modules “When to call” and “Blood
Results Table” were the most popular. However, the overall review of the app was very
positive for both ease of use and usefulness for the families [19].
Mendoza et al. [22] conduct a pilot randomised control study using a Fitbit
smartphone application associated with a wearable Fitbit flex wristband for physical
activity monitoring. Additionally, the study made use of a Facebook group for peer
support. The participants had a goal (number of daily steps), received affective text
messages and a Facebook discussion forum with awarding badges for weekly achieve-
ments. The study found that passive engagement with the peer group was more common
than actively commenting and discussing posts. Also, only 1-hour non-significant daily
increase in physical activity was found among users who did engage actively with the
group [22].
Care Assistant [23] is an Android smartphone application for supporting par-
ents/caregivers of children with Acute Lymphoblastic Leukaemia (ALL). The applica-
tion consists of 8 modules: user information (age, education level, child’s diagnosis,
treatment, and other demographic data); treatment tracking module (multiple relevant
treatment data); family care module (information and solutions for common problems
and symptoms); financial and social assistance module (financial assistance organisa-
tions and suggestions on transitioning children back to normal life); knowledge centre
(credible and systematic information related to leukaemia); self-assessment question-
naires (evaluating the parent/caregiver’s own well-being); an interactive platform for
parent/caregivers (discussion forum supported by healthcare providers); and reminders
Ninth International Workshop on Behavior Change Support Systems (BCSS 2021): 9
mHealth Applications for Childhood Cancer Support and Self-management
module (allowing users to set customised reminders) [23]. The results from the evalu-
ation study showed that the users found the app easy to use and accessible. They also
gained knowledge about leukaemia, found confidence in caregiving, received social
support, and had reduced stress while using the app [24].
The Tue Aftercare App [25] is an Android application aiming to enhance post-treat-
ment care and raise awareness of follow-up examinations for former patients diagnosed
with childhood cancer and their families. The application uses patient information (age,
gender, demographic information, disease type, and other relevant data) to provide tai-
lored information about potential late effects of their disease and the need for follow-
up appointments. The app also features an optional calendar and appointment remind-
ers. The application was evaluated very positively, noting the impression of the pa-
tients’ relatives with the ability to manage and coordinate their child’s care [25].
The purpose of the Cherry [26] app is to benefit the patient’s care by using an elec-
tronic diary for recording thoughts and experiences, including information about cancer
and its treatment. It also uses social functions to allow sharing with healthcare provid-
ers, friends, and parents/caregivers and feedback from healthcare providers. App pre-
liminary evaluations have shown that users have a positive and enthusiastic view of the
app and find it easy to use [26].
Four of the reviewed applications provided symptom management reporting and
feedback or management strategies for the users of the app.
EAT! (Eating After Transplant) [20] is a mobile app that supports adolescents (pa-
tients recovering from Hematopoietic Stem Cell Transplantation - HSCT) with self-
management of issues related to eating. The app provides descriptive information and
self-management strategies (“what to do”) to help patients and caregivers understand
and minimize the effects of their eating issues. According to the evaluation results, the
users reported high acceptability and moderate usability of the EAT!, however even
though the initial usage of the app was high it declined over time [20].
eChIMES (Electronic Children's International Mucositis Evaluation Scale) [27] is
an electronic symptom reporting diary for children suffering from oral mucositis (a
common effect of chemotherapy and hematopoietic stem cell transplantation). The ap-
plication consists of a symptom and pain assessment, instructions on use, and a diary
for assessment dates. The app was considered easy to use, understandable, and suitable
for measuring mucositis [27].
mOST (Mobile Oncology Symptom Tracker) [28] is an eDiary for cancer patients
performing an assessment of treatment-related symptoms. Besides symptoms tracking,
the app also supports reminders with an audible alert and customizable text and time.
The results of the evaluation trial show that patients see the app as easy to use and
would recommend it to others [28].
Advanced Symptom Management System for Young people (ASyMS-YG) [29] is
an extended version of ASyMS for young people. By using mobile phones, ASyMS-
YG allows patients to record and send symptom reports to the hospital, and receive
back tailored (based on the severity of symptoms) self-care advice from healthcare pro-
viders. The evaluation results indicated that the application is feasible and acceptable
to young people and healthcare professionals [29].
10 Ninth International Workshop on Behavior Change Support Systems (BCSS 2021):
mHealth Applications for Childhood Cancer Support and Self-management
Two of the reviewed applications provided pain assessment, reporting and feedback
or strategies for the users of the app.
Pain Squad+ [30] provides pain self-management for adolescents suffering from
cancer. The app generates real-time algorithm-based feedback in form of self-manage-
ment recommendations. It also features automatic alerts to a trained nurse if the pain is
repeatedly rated above the limit. Pain Squad+ is gamified and gives rewards to the users
for adherence to pain assessment and treatment recommendation completion. The users
found the app understandable, easy to use and helpful in describing or treatment of the
pain [30].
Pain Buddy [31] application aims to provide children with real-time pain manage-
ment strategies and feedback. The app includes daily pain and symptom diaries, remote
monitoring of symptoms (with the alert for health care providers), cognitive and behav-
ioural skills training, interactive guidance through the program, and motivating incen-
tive system. The cognitive and behavioural skill training sessions use an animated av-
atar that educates children on strategies for self-managing their pain and symptoms.
The application trial revealed that the app and the support provided were highly satis-
fying and useful in improving pain management [31].
One of the reviewed applications provided assessment and reporting of broader pa-
tient-reported outcomes, one app provided customisable medication management and
reminder functions for increasing medication adherence. Paediatric PROMIS App [32]
is a smartphone app that tracks Patient-Reported Outcomes (PROs) of children with
chronic disease. The app, designed in cartoon styles, uses audio and on-screen text to
guide the user to report its symptoms and receive feedback regarding its status and care
suggestions. All usability test participants (children diagnosed with a kind of cancer
currently under treatment and its parents) found the app easy to use with a child-friendly
interface [32].
Dosecast [21] is a smartphone app for medication adherence. The application in-
cludes visual and audible medication reminders and a log of responses to those re-
minders. The evaluation study (with adolescents and young adults with cancer) found
that most users tended to take their medication immediately upon receiving the re-
minder. The application was found to be easy to use and perceived as useful in terms
of taking oral medications as prescribed and increasing the user’s independence in tak-
ing medications [21].
Table 1. The aim and Persuasive Systems Design features included in the reviewed applica-
tions.
Application/ Study type
App’s aim Sample size PSD features
Article / length
Informative support Post release
The Oncol- Tailoring,
for parents/caregiv- evaluation 24 families (38
ogy Family Tunneling,
ers in remote loca- / 6 months parents /caregivers)
App [19] Self-monitoring
tions. after release
Ninth International Workshop on Behavior Change Support Systems (BCSS 2021): 11
mHealth Applications for Childhood Cancer Support and Self-management
59 patients Self-monitoring,
Promote physical Pilot ran-
(29-intervention, Reward badges,
Fitbit and Fa- activity using domised con-
30-control group) Social support
cebook [22] monitoring and trol study
14-18 years (discussion fo-
social support / 10 weeks
(mean 16.6) rums)
Pilot Tunneling,
Assist parents/
(quantitative 15 parents/ Social support
Care Assis- caregivers with
and qualita- caregivers (WeChat discus-
tant [23,24] information and
tive) study 23-42 years sion forum),
management tools
/ 2 weeks Reminders
Follow-up care Personalisation
Tue After- Usability 13 patients (15
information and (recommenda-
care App study years)
reminders for former tion),
[25] / N/A 9 relatives
patients Reminders
Self-monitoring,
Provide information Personalization
Cherry [26] N/A
and sharable eDiary N/A (feedback),
Social support
Provide symptom 16 patients
Pilot study
EAT! [20] management 11-18 years Tunneling
/ 60 days
strategies (mean 14)
Pilot (cross- 10 patients
eChIMES Symptom reporting sectional) (mean 15.3 years)
Self-monitoring
[27] eDiary study 40 patients
/ N/A (mean 12.4 years)
10 patients
Symptom assessment Pilot study Self-monitoring,
mOST [28] 13-21 years
eDiary / 3 weeks Reminders
(mean 18.2)
Pilot 4 patients Self-monitoring,
ASyMS-YG Symptom assessment randomised (2-intervention, Personalisation
[29] and feedback control study 2-control group) (advice and sup-
/ 14 days 13-15 years port)
Self-monitoring,
Personalisation
38 patients
Pain Squad+ Pain assessment and Pilot study (self-manage-
12-18 years
[30] management / 28 days ment, recommen-
(mean 14.2)
dations),
Rewards
Self-monitoring,
Pain and symptom
Tunneling,
Pain Buddy reporting with Pilot study 12 patients
Personalisation
[31] feedback and / 10 days 8-18 years
(alerts),
management
Rewards
Paediatric Usability 10 patients
Reporting and Self-monitoring,
PROMIS study (8-13 years)
feedback Personalisation
App [32] / N/A 5 parents/
12 Ninth International Workshop on Behavior Change Support Systems (BCSS 2021):
mHealth Applications for Childhood Cancer Support and Self-management
caregivers (feedback and
(21-33 years) suggestions)
Feasibility
23 patients
Dosecast Medication and accepta-
15-29 years Reminders
[21] reminders bility study
(mean 19.7)
/ 12 weeks
5 Discussion
Applications for support and self-management of cancer patients and their families
found in the literature cover a variety of areas and functions. The most frequent area
deals with the management and reporting of patient-reported outcomes. This can be
focused on specific aspects of the patient experience such as the management of pain
and symptoms using tools such as eDiaries, electronic quizzes, or electronic forms for
patients to record their pain and symptom experiences [27,28]. These applications not
only support the patient in their treatment, but often provide the means for sharing that
information with caregivers, healthcare providers, and support networks [23,26,29].
As shown in Table 1, some applications perform real-time or remote monitoring of
health data, allowing transmission of the data to a healthcare provider and immediate
response with appropriate supportive information or actions [30-32]. Other applications
take a more informative role providing the patients or their parents/caregivers with sup-
port, such as contact information, emergency indicators, diet and fitness strategies, to
promote healthy recovery [19,20,22,23]. Finally, some applications provide organisa-
tional tools to help patients manage their treatment including reminders for medication
adherence and follow-up appointments [21,25].
Different applications introduce specific features allowing users to set a goal [22],
receive feedback in form of advice, recommendation or suggestion [25,26,29,32], pro-
vide reinforcement like reminders or rewards [21-25,28,30,31], or offer social support
thru discussion forums [22,23]. Healthy lifestyle behaviour information with symptom
and pain management strategies are being common in patients reporting apps, with
some apps specifically focusing on physical activity and mitigating treatment effects
that interrupted patient diets [20,22]. However, despite the importance of meeting par-
ents/caregivers' needs for more specific condition related information and to reduce
their distress, only two applications, The Oncology Family App [19] and Care Assistant
[23] focus on parents/caregivers. Both applications were information banks that support
users’ role as caregivers, but only Care Assistant [23,24] took the parent/caregiver own
healthcare into account by providing a module with self-assessment questionnaires for
evaluation of their well-being.
Specific Persuasive Systems Design elements can be seen in different functionalities
provided by the reviewed applications, such as an automatic alert to trained nurse or
care provider [30,31], gamification with cartoon characters or animated avatars [31,32],
audio and on-screen text guides, or customisable visual and audio medication reminders
[21,32].
Ninth International Workshop on Behavior Change Support Systems (BCSS 2021): 13
mHealth Applications for Childhood Cancer Support and Self-management
Also, all applications have features designed in accordance with one or few PSD
features of Primary Task, Dialog or Social Support category (Table 1). Most of the
applications support self-management through self-monitoring or providing reminders.
From the Primary Task Support Category, Tailoring can be identified in one appli-
cation, while Tunneling is present in four applications. Even though the Tailoring of
the information is used only in one application, we can see that the Personalisation (in
the form of personalised feedback, advice or suggestions) is implemented in six appli-
cations. The Reminder is one of the features implemented from the Dialogue Category,
and it is implemented in four applications. Another feature is Reward, implemented in
the other three apps.
Further observation is related to the social elements present in the applications. Three
applications have implemented social support for sharing the information with caregiv-
ers, health providers or friends. The specific social peer support function is the solution
proposed by Mendoza et al. [22] that uses a Facebook group where patients could talk,
share progress, and win badges for milestones. Even in this case, the authors found that
active participation in the support group was low, so these social interactions need to
be further addressed. Even though implemented social elements can be seen as PSD
features of Social Learning, Comparison or Facilitation, it should be further refined and
enhanced.
Based on the analyses, reviewed applications for support and self-management of
childhood and young adult cancer patients can further support behaviour changes of
patients and their caregivers. This can be done by extending the apps’ and introducing
PSD features that will provide customised information, interactivity and reinforce so-
cial influence, guiding the user towards targeted behaviour.
A significant limitation of the provided literature review is the overall lack of evi-
dence as the studies tended to have small sample sizes and short trial periods (only one
application had a trial length of 6 months). Most of the applications were found to be
acceptable, feasible and easy to use. But even though the users were satisfied with the
applications, the evaluation of some applications [19-22] showed that adherence rates
remained high early on but became far less consistent over time. Potential reasons for
these cases can be the technological novelty wearing off, patients becoming more fa-
miliarized with their disease and treatment habits, usability issues, or users finding a
better application with similar functions [20,33]. Additionally, some studies were only
single-use trials, others only performed a usability study that did not measure effective-
ness. This long-term adherence drop is something the short or one-off trials may fail to
examine, leading to higher adherence rates and usability impressions than in actual use.
However, implementation of PSD features can assist in continued support for users by
providing incremental motivation, thus retain high adherence rates for the apps.
6 Conclusion
The review provided in this paper found a number of mobile health applications ful-
filling a variety of functions and needs for childhood and young adult cancer patients
and their families. Most of the analysed applications provide one or few features from
14 Ninth International Workshop on Behavior Change Support Systems (BCSS 2021):
mHealth Applications for Childhood Cancer Support and Self-management
the Persuasive Systems Design primary task support, dialogue or social support cate-
gory.
Even though the applications have provided a range of information as well as tools
to achieve self-management, such as eDiaries, reporting and monitoring mechanisms,
data management tools, feedback, reminders or rewards, there are still areas of unmet
needs and a lack of evidence on how significantly the apps will impact self-manage-
ment behaviours. These open needs and areas must continue to be explored, and there
is a distinct need for more large-scale studies to ensure the applications are successfully
realised. Despite this, the applications have been seen as usable, acceptable, and feasi-
ble or effective in the trials presented in the reviewed articles, which provides a positive
outlook for the future of the field.
To address the comprehensive support for the users, future research directions
should explore the potential for mobile health to provide long-term care to current and
former patients of childhood and adolescent cancer through informative support about
follow-up treatment processes and potential late effects and how they can be managed.
Another area is to focus on the unmet social interaction and peer support needs of pa-
tients. These issues can be addressed in the designing phase by the established princi-
ples of Persuasive Systems Design used in the context of the patient’s parent/caregiver
and family perspective.
References
1. Kay, M., Santos, J., Takane, M.: mHealth: New horizons for health through mobile
technologies. World Health Organization 64(7), 66-71 (2011).
2. Almathami, H.K.Y., Win, K.T., Vlahu-Gjorgievska, E.: Barriers and facilitators that
influence telemedicine-based, real-time, online consultation at patients’ homes: systematic
literature review. Journal of medical Internet research 22(2), e16407 (2020).
3. 3. Roess, A.: The promise, growth, and reality of mobile health-another data-free zone. N
Engl J Med 377(21), 2010-2011 (2017).
4. National Cancer Institute: Cancer in Children and Adolescents.
www.cancer.gov/types/childhood-cancers/child-adolescent-cancers-fact-sheet (2018).
Accessed 03/03/2021
5. Siegel, R.L., Miller, K.D., Jemal, A.: Cancer statistics, 2018. CA: A Cancer Journal for
Clinicians 68(1), 7-30 (2018). doi:https://doi.org/10.3322/caac.21442
6. Nass, S.J., Beaupin, L.K., Demark-Wahnefried, W., Fasciano, K., Ganz, P.A., Hayes-Lattin,
B., Hudson, M.M., Nevidjon, B., Oeffinger, K.C., Rechis, R.: Identifying and addressing the
needs of adolescents and young adults with cancer: summary of an Institute of Medicine
workshop. The oncologist 20(2), 186 (2015).
7. Kimberly, D.M., Rebecca, L.S., Chun, C.L., Angela, B.M., Joan, L.K., Julia, H.R., Kevin,
D.S., Rick, A., Ahmedin, J.: Cancer treatment and survivorship statistics, 2016. CA: a cancer
journal for clinicians 66(4), 271-289 (2016).
8. McCarthy, M.C., McNeil, R., Drew, S., Orme, L., Sawyer, S.M.: Information needs of
adolescent and young adult cancer patients and their parent-carers. Supportive Care in
Cancer 26(5), 1655-1664 (2018).
9. Grady, P.A., Gough, L.L.: Self-management: a comprehensive approach to management of
chronic conditions. American journal of public health 104(8), e25-e31 (2014).
Ninth International Workshop on Behavior Change Support Systems (BCSS 2021): 15
mHealth Applications for Childhood Cancer Support and Self-management
10. Almutairi, N., Vlahu-Gjorgievska, E., Win, K.T.: Asthma management application for
consumers: Nudging as a feature. In: CEUR Workshop Proceedings 2019, 2340.
11. Fogg, B.J.: Persuasive technology: using computers to change what we think and do.
Ubiquity 2002(December), 2 (2002).
12. Michie, S., Richardson, M., Johnston, M., Abraham, C., Francis, J., Hardeman, W., Eccles,
M.P., Cane, J., Wood, C.E.: The behavior change technique taxonomy (v1) of 93
hierarchically clustered techniques: building an international consensus for the reporting of
behavior change interventions. Annals of behavioral medicine 46(1), 81-95 (2013).
13. Orji, R., Moffatt, K.: Persuasive technology for health and wellness: State-of-the-art and
emerging trends. Health informatics journal 24(1), 66-91 (2018).
14. Oinas-Kukkonen, H., Harjumaa, M.: Persuasive systems design: Key issues, process model,
and system features. Communications of the Association for Information Systems 24(1), 28
(2009).
15. Lehto, T., Oinas-Kukkonen, H.: Persuasive features in six weight loss websites: A
qualitative evaluation. In: International Conference on Persuasive Technology 2010, pp.
162-173. Springer
16. Matthews, J., Win, K.T., Oinas-Kukkonen, H., Freeman, M.: Persuasive technology in
mobile applications promoting physical activity: a systematic review. Journal of medical
systems 40(3), 72 (2016).
17. Vlahu-Gjorgievska, E., Alkorbi, A.S., Nushayli, M.M., Win, K.T.: Persuasive Social
Support Features in Diabetes Self-Management mHealth Applications. In: 30th Australasian
Conference on Information Systems 2019, p.103.
18. Win, K.T., Roberts, M.R., Oinas-Kukkonen, H.: Persuasive system features in computer-
mediated lifestyle modification interventions for physical activity. Informatics for Health
and Social Care 44(4), 376-404 (2019).
19. Slater, P.J., Fielden, P.E., Bradford, N.K.: The oncology family app: providing information
and support for families caring for their child with cancer. Journal of Pediatric Oncology
Nursing 35(2), 94-102 (2018).
20. Rodgers, C.C., Krance, R., Street Jr, R.L., Hockenberry, M.J.: Feasibility of a symptom
management intervention for adolescents recovering from a hematopoietic stem cell
transplant. Cancer nursing 36(5), 394 (2013).
21. Wu, Y.P., Linder, L.A., Kanokvimankul, P., Fowler, B., Parsons, B.G., Macpherson, C.F.,
Johnson, R.H.: Use of a smartphone application for prompting oral medication adherence
among adolescents and young adults with cancer. In: Oncology nursing forum 2018, vol. 1,
p. 69. NIH Public Access
22. Mendoza, J.A., Baker, K.S., Moreno, M.A., Whitlock, K., Abbey‐Lambertz, M., Waite, A.,
Colburn, T., Chow, E.J.: A Fitbit and Facebook mHealth intervention for promoting physical
activity among adolescent and young adult childhood cancer survivors: a pilot study.
Pediatric blood & cancer 64(12), e26660 (2017).
23. Wang, J., Yao, N., Shen, M., Zhang, X., Wang, Y., Liu, Y., Geng, Z., Yuan, C.: Supporting
caregivers of children with acute lymphoblastic leukemia via a smartphone app: a pilot study
of usability and effectiveness. CIN: Computers, Informatics, Nursing 34(11), 520-527
(2016).
24. Wang, J., Yao, N., Wang, Y., Zhou, F., Liu, Y., Geng, Z., Yuan, C.: Developing “Care
Assistant”: A smartphone application to support caregivers of children with acute
lymphoblastic leukaemia. Journal of telemedicine and telecare 22(3), 163-171 (2016).
25. Kock, A.-K., Kaya, R., Müller, C., Andersen, B., Langer, T., Ingenerf, J.: A mobile
application to manage and minimise the risk of late effects caused by childhood cancer. In:
MIE 2015, pp. 798-802.
16 Ninth International Workshop on Behavior Change Support Systems (BCSS 2021):
mHealth Applications for Childhood Cancer Support and Self-management
26. Berntsen, E., Babic, A.: Cherry: mobile application for children with cancer. Studies in
health technology and informatics 192, 1168-1168 (2013).
27. Tomlinson, D., Hesser, T., Maloney, A.-M., Ross, S., Naqvi, A., Sung, L.: Development and
initial evaluation of electronic Children's International Mucositis Evaluation Scale
(eChIMES) for children with cancer. Supportive Care in Cancer 22(1), 115-119 (2014).
28. Baggott, C., Gibson, F., Coll, B., Kletter, R., Zeltzer, P., Miaskowski, C.: Initial evaluation
of an electronic symptom diary for adolescents with cancer. JMIR research protocols 1(2),
e2175 (2012).
29. Aldiss, S., Taylor, R., Soanes, L., Maguire, R., Sage, M., Kearney, N., Gibson, F.: Working
in collaboration with young people and health professionals. A staged approach to the
implementation of a randomised controlled trial. Journal of Research in Nursing 16(6), 561-
576 (2011).
30. Jibb, L.A., Stevens, B.J., Nathan, P.C., Seto, E., Cafazzo, J.A., Johnston, D.L., Hum, V.,
Stinson, J.N.: Implementation and preliminary effectiveness of a real‐time pain management
smartphone app for adolescents with cancer: A multicenter pilot clinical study. Pediatric
blood & cancer 64(10), e26554 (2017).
31. Fortier, M.A., Chung, W.W., Martinez, A., Gago-Masague, S., Sender, L.: Pain buddy: A
novel use of m-health in the management of children's cancer pain. Computers in biology
and medicine 76, 202-214 (2016).
32. Wang, J., Yao, N.A., Liu, Y., Geng, Z., Wang, Y., Shen, N., Zhang, X., Shen, M., Yuan, C.:
Development of a smartphone application to monitor pediatric patient-reported outcomes.
CIN: Computers, Informatics, Nursing 35(11), 590-598 (2017).
33. Becker, S., Kribben, A., Meister, S., Diamantidis, C.J., Unger, N., Mitchell, A.: User profiles
of a smartphone application to support drug adherence—experiences from the iNephro
project. PloS one 8(10), e78547 (2013).