Women breast cancer survivors are at increased risk for several negative health outcomes. Physical activity
can reduce these risks, but activity levels in this population are low. Standard interventions that use self-
regulation techniques (goal setting, self-monitoring, and feedback) are successful in the short term but do not
produce the long-term activity maintenance needed for optimal health benefits. Their effectiveness might be
improved by better connecting activity feedback to individuals' real-life experiences and values. Integrated
regulation is a form of motivation related to personal values and identity and is strongly related to physical
activity over time. Increasing this form of motivation could improve upon current intervention strategies,
particularly in this population. Narrative visualization uses photographic, visual, and text annotation to tell a
meaningful story with a data chart. This form of visualization can increase reflection, which in turn can predict
integrated regulation and physical activity. We hypothesize that an intervention that encourages participants to
create narrative visualizations from their step self-monitoring data will produce greater increases in physical
activity than a self-regulation intervention. To test this hypothesis, we must first investigate the feasibility and
acceptability of the narrative visualization intervention in a pilot randomized controlled trial. We will recruit 60
women breast cancer survivors (aged 55 – 79, < 150 minutes of physical activity per week) in two phases. In
Phase I, 20 women will use prototype materials for one week and undergo cognitive interviewing to investigate
feasibily and acceptability. Materials will be revised based on responses for use in the subsequent trial. In
Phase II, we will randomize 40 participants to receive either the narrative visualization intervention or a
standard self-regulation intervention for 12 weeks (with 12 weeks of no-intervention follow-up). Both groups will
receive a wearable activity monitor and feedback app for use during the intervention period as well as an initial
orientation/goal setting meeting and workbook. In the self-regulation group, participants will receive a workbook
in which they will write and log their weekly goals. The narrative visualization group will also receive extended
workbook content, a photo printer, and art supplies. The expanded workbooks will include spaces for posting
daily photos and drawing explanations of step charts as well as reflection prompts relating the photos and
charts to personal values and identity. Participants will be assessed at baseline, 12 weeks, and 24 weeks on
changes to their activity, reflection, and integrated regulation. Feasibility indicators will include wear of the
monitor and usage of the workbooks. Results from this study will be used to refine the intervention and to
develop a follow-up study powered to investigate the relationships between reflection, motivation, and activity.
Our overarching goal is to reduce the burden of cancer and improve quality of life among breast cancer
survivors. This project represents a critical step towards this goal. Insights from the study will impact research
and practice by testing a highly novel, scalable, and motivating intervention in a population at unique risk.
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