UC Davis

Background & Significance Yoga, an age-old fusion of somatic movement, breathing, and meditation, is expanding in popularity in the United States as well as around the globe due to its positive influence on physical, psychological, social, and spiritual health (Andelkar et al., 2018). A recent secondary analysis of the National Health Interview Survey (NHIS) denoted an 8.6% steady increase in the number of yoga users within 15 years (the year 2002 to 2017) (Zhang et al., 2021). The global crisis due to COVID-19 has aggravated stress and anxiety in the general public (Husky et al., 2020; Shevlin et al., 2020) as well as in vulnerable populations such as breast cancer survivors (Seven et al., 2021). Yoga might be good stress and anxiety alleviation strategy during the global pandemic, as shown in different studies (Sahni et al., 2021; Sharma et al., 2020). Furthermore, social distancing practices to control infection spread have motivated virtual yoga support (Sharma et al., 2020; Trevino et al., 2021). Despite many commercial apps for self-management and wellness support, the validity and usability of these apps generally have not been well established (Scott et al., 2018). Studies have recommended the necessity of evaluating and testing apps with breast cancer patients and their caregivers in order to provide uninterrupted wellness and physical activity support while considering individualized challenges associated with breast cancer (Monteiro-Guerra et al., 2020). Besides providing insight into the range of commercially available mobile apps for yoga support with a validated tool, this dissertation research evaluates breast cancer survivors' acceptance and use of a specific mobile yoga tool. For that evaluation, I implemented a non-randomized small intervention with a convenience sample of breast cancer survivors. The findings of this study emphasize the usability of a mobile app for yoga support. Specific Aims Aim 1 To conduct a systematic evaluation of commercially available mobile health applications for yoga practice for the potential benefit of breast cancer survivors Method Aim 1 is achieved by selecting a group of yoga apps from the popular app stores (Google Play Store and Apple App Store) based on a pre-determined selection criterion and utilizing the well-tested Mobile Application Rating Scale (MARS) to assess the app quality. Aim 2 To explore the relationships between technology acceptance and use as measured by the Health Technology Acceptance and Use Scale (HTAU) and actual use of a mobile yoga application. Method Aim 2 is accomplished with a brief intervention study with breast cancer survivors. Following a seven-day intervention with a specific yoga app, a validated instrument was used to assess participants’ use of the app. Results Android and Apple yoga app review After the MARS evaluation, we noted that the majority of the apps from both app stores (Google Play store: 78%; Apple App Store: 50%) scored a minimum of 4 or above out of a maximum 5-rating score. The lowest mean score was observed in the information and engagement domain. Most of the apps performed well in the aesthetics and functionality domain. Yoga app intervention study Out of 92 participants, 48 participants were included in our final sample. The participants were self-reported, utilizing the yoga app for practicing yoga on average 64.48 minutes (SD=44.47) in the intervention week. Additionally, our study observes the highest HTAU score in the facilitating condition (Mean=4.30; SD=1.04) followed by effort expectancy (Mean=4.26; SD=1.45) and another six constructs. A statistically significant relationship is noted between the HTAU mean construct score and the future intention of continued app use. Conclusion Our findings of both app review studies highlighted the need for attention in the information section of the yoga apps on both Android and Apple platforms. 59% of the respondents of our post-study survey wished to continue using the yoga app after completing our study. This denotes that a commercial app that has yoga support content may attract some breast cancer survivors. The findings of this study will be helpful to identify the pros and cons of commercially available yoga tools and the usability of these apps to support breast cancer survivors. This study will be helpful in improving design-specific constraints in the future and providing survivors with a better yoga practice environment after evaluating their user-specific needs. However, the findings of our study should be interpreted with caution, considering our limitations. Our preliminary investigation sought further research in this area.