EmpowerHer: Hybrid Digital Intervention for Breast Cancer Survivors

Evaluated using the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30) and its breast cancer-specific module (EORTC QLQ-BR23). The EORTC QLQ-C30 incorporates a Global Health Status/QoL scale, functional scales, and symptom scales. The QLQ-BR23 incorporates functional scales (body image, sexual functioning, sexual enjoyment, future perspective) and symptom scales (systemic therapy side effects, breast symptoms, arm symptoms, upset by hair loss). All scores are linearly transformed to a 0-100 scale. For the Global Health Status and functional scales, a higher score represents a higher/better level of functioning and quality of life. For the symptom scales, a higher score represents a higher/worse level of symptomatology or problems.

Measured using the International Physical Activity Questionnaire (IPAQ). The primary metric will be weekly minutes of moderate-to-vigorous physical activity (MVPA). Total MET-minutes/week will also be calculated. Higher values indicate greater physical activity engagement.

Assessed using the 30-second Sit-to-Stand test. This test measures the number of times a participant can fully stand up from a seated position on a standard chair (44 cm seat height) and sit down again within a 30-second time limit, keeping their arms folded across their chest. Higher repetitions indicate greater lower-body muscular strength and functional mobility.

Assessed using the 30-second Arm Curl test. Participants are required to perform as many biceps curls as possible in 30 seconds while sitting on a chair, using a 2 kg dumbbell in their dominant hand (with the arm moving through a full range of motion from complete extension to complete flexion). Higher repetitions indicate greater upper-body muscular strength and muscular endurance.

Assessed using the 30-second Lie-to-Sit test, a functional assessment task designed to evaluate transitional mobility. The test measures the maximum number of repetitions a participant can complete within 30 seconds moving from a fully supine position (lying on a flat treatment table or mat) to a fully upright seated position. Higher repetitions reflect better transitional mobility, trunk control, and core strength.

Measures the feasibility of the intervention, defined as the percentage of prescribed exercise sessions completed by the participants over the 12-week intervention period. This will be calculated as the number of completed sessions divided by the total number of prescribed sessions (24 sessions in total, 2 sessions per week), multiplied by 100. Higher percentages indicate greater feasibility and adherence.

Measures the feasibility of the face-to-face component of the intervention, defined as the percentage of weekly facilitator-led, in-person motivational and educational sessions attended by the participants in community settings over the 12-week intervention period. This will be calculated as the number of attended in-person sessions divided by the total number of scheduled sessions (12 sessions in total, 1 session per week), multiplied by 100. Higher percentages indicate greater feasibility and adherence to the face-to-face community component.

Adoption will be operationalized as active engagement with the intervention through the mobile application. This will include participant-reported interaction with key app features, such as completion of daily wellbeing check-ins (e.g., sleep, energy). Additional indicators such as session-rated perceived exertion (sRPE) and self-reported enjoyment of activities will also be recorded as complementary measures of engagement.

Assesses the acceptability of the digital health platform using the System Usability Scale (SUS). The SUS is a 10-item questionnaire with five response options ranging from "strongly disagree" (0) to "strongly agree" (4). The overall score is calculated, normalized, and converted to a final scale ranging from 0 to 100. Higher scores indicate greater usability, friendliness, and acceptability of the mobile application (with scores above 68 considered acceptable).