Peer Coaching for Digital Health Engagement Among Adolescent and Young Adult (AYA) Cancer Survivors

Abstract Adolescent and Young Adult (AYA) cancer survivors face heightened risks of medical and psychological challenges due to the long-term effects of their treatment and their unique emotional, social, and practical needs. Despite their increased vulnerability to psychological distress, only a small proportion of AYA survivors seek professional mental health care, indicating that traditional psychotherapy may be less accessible or appealing to this population. Evidence suggests that mindfulness meditation, a form of mind-body therapy, is effective in reducing psychological distress, sleep disturbances, fatigue, and other symptoms in cancer patients and survivors. While mobile app delivery of mindfulness interventions offers scalability and convenience, engagement and sustained use remain significant challenges, reducing their overall effectiveness. Guided by the Supportive Accountability model, this study seeks to address the critical issue of user engagement by testing and refining the “Mindful Peer Coach” intervention—a peer-supported coaching approach to enhance adherence to a mindfulness-based mobile app and improve health-related quality of life outcomes (e.g., well-being, stress management). During the first two years, the project will focus on 1) evaluating the initial impact of the Mindful Peer Coach intervention (e.g., virtual and text message-based coaching) through a multiple baseline time-series study and 2) refining the intervention using feedback collected through in-depth interviews with key stakeholders (AYA cancer survivors and peer coaches) to optimize training and implementation. In Years 3-5, a pilot Sequential, Multiple Assignment, Randomized Trial (SMART) design study will be conducted to evaluate the feasibility and preliminary outcomes of a sequential step-up approach, where AYA survivors will progress from text message coaching to virtual live coaching based on their engagement and needs. This innovative approach has the potential to optimize digital health engagement, address the psychosocial needs of AYA cancer survivors, and maximize the benefits of mindfulness-based mobile apps. This mentored research will enhance our understanding of strategies to improve user engagement with digital health interventions and equip Dr. Kwok with critical skills in intervention development, advanced trial designs, and cancer survivorship research, launching his independent research career in AYA cancer survivorship and in the field of digital health research.