Procedure and Measurements
Stages followed within the process of data collection are as follows:
Structuring the Mobile Application: Support has been received from Technopark Office for the mobile app. An appropriate human-computer interface design has been incorporated into the mobile app. The mobile app, which was sent to the patients of the treatment group as a short message (SMS), was installed by directly downloading the file with an extension “.apk” to their smartphones. The participants can sign into the app with their given username and password. The main page of the app consists of six segments; ”my training, my questions, symptom diary, my opinions, my reminds, my profile”. Mobile app allows patients to record daily symptoms with an indication of severity.
Mobile Application Usability: Font type, size, style and color selection was selected carefully for the readability and the visibility of the app on the screen. Especially, pink color was selected as the font and heading color in the mobile application since it is the symbol of breast cancer reflecting hope and happiness.
Mobile Application User Training: A training on the how to download and use of mobile app was organized face-to-face for the treatment group before the intervention.
Data Collection Instruments: Data collection instruments were introduced to the participants their consent was taken by informing them about the purpose of the research. Data were collected from the treatment and control group simultaneously at baseline (T0) then 12 weeks (T1) post-intervention. Data was collected with the method of face to face interview by using the following measurement instruments: Participants Introductory Information Form, Functional Assessment for the Cancer Treatment – Endocrine Symptoms Quality of Life Scale (FACT-ES QLS) and NCCN Distress Thermometer. Data collection time varied between 20 to 50 minutes. A flow diagram of the research is shown in Figure 2.
Figure 2.
Participants Information Form: The form was prepared by the researcher by analyzing the relevant studies [9, 19- 23].related to the QOL of women with breast cancer. There are 20 questions related to sociodemographic characteristics such as age, marital status, education status, number of children and medical history and clinical features related to the treatment. One question concerned with the opinions of the the participants about the installation and the use of the app after the intervention.
FACT-ES Quality of Life Scale (FACT-ES QLS): The scale is designed to measure the side effects and the potential benefits of the treatment for women with breast cancer using EHT. Validity and reliability of the scale were verified by Fallowfieldet et al.and translated into different languages other than English24. The scale includes five sub dimensions and total of 46 items measuring the well-being of patients within the course of the last 7 days. There are sub dimensions for each of the following: physical well-being (7 items, 0-28 points), social/family well-being (7 items, 0- 28 points), emotional well-being (6 items, 0-24 points), functional well-being (7 items, 0-28 points) and endocrine symptoms (19 items, 0-76 points). Endocrine symptoms’ subdimension contains symptoms related to the side effects of EHT. Total Cronbach alpha value was found as 0.92. Scale subdimensions’ Cronbach alpha values range from 0.65 and 0.91 24. Turkish translation and permissions were received from the administrator of the web site. The range of total points of the scale is 0-184. It shows that QOL increases as total points of the scale increase.
NCCN Distress Thermometer: This is a measurement instrument improved in 1998 by Roth et. al., to determine the distress level of cancer patients 25. Distress level is graded in between 0 and 10 on a ‘thermometer’. Patients may specify the severity of the distress level they experienced related to their problems, with these numbers, within the course of the last 7 days. No distress is specified with “0” point, a severe amount of distress is specified with “10” points. 5 and more points of NCCN scale shows that there is distress and follow up and assessment of the individuals should be made.