Meditation, Education, Navigation, & Training Using eHealth: Cancer Adaptation Through Learning Mindful Awareness

This indicator of implementation feasibility for the intervention delivered is defined by the overall enrollment rate being >/= 70% (e.g., total number of individuals enrolled/total number approached). Enrollment rate will be tracked continuously during the 9-week study.

This indicator of implementation feasibility for the intervention delivered is defined by the retention rate being >/= 70% (e.g., total number of participants who drop out/ total number enrolled). Retention rate will be tracked continuously during the 9-week study.

This indicator of implementation feasibility for the intervention delivered is defined by the overall completion rate being >/= 70% (e.g., total number of individuals completed/total number enrolled). Completion rate will be tracked continuously during the 9-week study.

Acceptability will be measured using a Likert-type survey assessing participant enjoyment, satisfaction, perceived benefit, and ease of use. Acceptability is defined as >/= 70% of survey responses in affirmation of this.

Acceptability of the Wakeful program as measured by mindfulness reflections written by participants in the Wakeful app will be collected continuously during the 9-week study. Written mindfulness reflections downloaded, de-identified, and coded using Dedoose, a collaborative, web-based application that facilitates all types of research data management and analysis. The study team will identify common themes, create definitions, and develop coding rules regarding specific group comments. The comments will then be compiled and summarized in frequency tables denoting the number of times responses were made. Results will be summarized according to thematic area.

Adherence to the Wakeful program will be monitored and usage tracked continuously during the 9-week study. Data include the following:

• Number of times a user: logs into the Wakeful app; opens the educational videos; opens the audio files; opens the audio files; acknowledges or comments on other users' reflections
• Number of minutes a user spends: logged into the Wakeful app; on the educational videos; on the audio files; writing into the reflection text boxes; acknowledging or commenting on other users' reflections

Mindful self-compassion will be measured using the Self-Compassion Scale-12.

This short form is a 12-item scale measuring items related to self-kindness, self-judgment, and common humanity. Statements on the Self-Compassion Scale are scored on a Likert scale of 1 (almost never) to 5(almost always). To calculate an overall compassion score - Items representing uncompassionate responses to inadequacy or suffering (the self-judgment, isolation, and over-identification subscales) are reverse-coded only when calculating the overall compassion score. In this way, higher scores represent a lower frequency of these responses.

Symptom burden of anxiety will be measured at baseline and week 9 using the PROMIS 4-Item Short Forms of Anxiety. This 4-item scale measures uses a 5-point Likert scale (1=never to 5=always). The minimum value one can score is 4, and the maximum is 20. The lower scores represent better outcome.

Symptom burden of anxiety will be measured at baseline and week 9 using the PROMIS 4-Item Short Forms of Depression. This 4-item scale measures uses a 5-point Likert scale (1=never to 5=always). The minimum value one can score is 4, and the maximum is 20. The lower scores represent better outcome.

Change in perceived stress will be measured using the Perceived Stress Scale-10.

This short form is a 10-item scale measuring items related to perceived stress. Items are scored on a Likert scale of 0 (never) to 4(very often). Items representing unperceived stress responses are reverse-coded when calculating the overall score. In this way, lower scores indicate better outcome.

Change in health behaviors will be assessed using the Enacted Health Behaviors Questionnaire-10, a local questionnaire developed by the study researchers.

Participants will report on the following: consumption frequency of red meat, grains, fruits and vegetables; use of cigarettes, tobacco products, and alcohol, preventive medications, vitamins, supplements, and medical screening tests; and engagement in regular physical exercise, meditation, and yoga. Unhealthy behaviors will be reverse scored. Higher scores represent better outcome. Significant change will be indicated by p<.05 on reported health behaviors between pre- and post-intervention.

Change in leisure time physical activity will be measured using the Godin Leisure Time Exercise Questionnaire Physical Activity.

This is a measure of self-reported physical activity participation. Participants report "times per week" they participate in strenuous (e.g., jogging), moderate (e.g., fast walking), and mild (e.g., easy walking) exercise over the past 7 days and the "average duration each time you exercised (in minutes)" for each of the three activity categories. Weekly minutes of total, light, moderate, and vigorous activity are calculated by multiplying the frequency and time of each activity. This value is divided by 7 to obtain daily averages. The minimum value one can score is 0, and the maximum depends on the number of self-reported minutes of physical activity. Higher scores indicate better outcome.

Meditation experience in young adult cancer survivors will be assessed using the Meditation Experience Questionnaire, a local questionnaire developed by the study researchers.

Participants will report on their experience and familiarity with meditation concepts and practices. The measure uses Yes-No response options (1=Yes; 0=No). The minimum value one can score is 0, and the maximum is 5. The higher scores represent better outcome.

Treatment expectancy in young adult cancer survivors will be assessed using the HEAL 6-Item Treatment Expectancy Subscale, a local questionnaire developed by the study researchers.

Participants will report on the expectations they have about the outcomes of the study treatment. Each scale measure uses a 5-point Likert scale (1=not at all to 5=very much). The higher scores represent better outcome.

Socio-demographic and clinical factors in mindfulness program participation in young adult cancer survivors will be assessed using the Socio-Demographic and Clinical Information Questionnaire., a local questionnaire developed by the study researchers.

Participants will report on the following: age; sex; gender identity; relationship status; living status; education; employment; income; current/past health history; current/past cancer history and treatment.