Predictors of initial engagement with an asynchronous cognitive behavioral stress management website among older women with nonmetastatic breast cancer

Purpose Digital interventions, like websites, offer greater access to psychosocial treatments; however, engagement is often suboptimal. Initial use may be a target to “hook” participants. Few studies examine engagement with cognitive behavioral stress management (CBSM). We tested predictors of engagement in the first week of using a CBSM website among women with breast cancer (BC). Methods Older women (≥ 50 years) with nonmetastatic BC enrolled in an on-going trial (8/2016–4/2022, #NCT03955991) and were randomized to receive 10 synchronous, virtual CBSM group sessions immediately ( n = 41) or after a 6-month waitlist ( n = 34). All received simultaneous access to an asynchronous website, where supplemental videos and resources were released weekly. Engagement was tracked via breadth (features used) and depth (clicks within content). Multilevel modeling tested predictors of engagement (i.e., time, condition, age, daily stress, depression, race, ethnicity, disease stage). Results Breadth decreased over the first week of CBSM ( b = -0.93, p < .01), and women with more advanced stage disease engaged with more breadth ( b = 0.52, p < .01) and depth ( b = 14.06, p < .01) than women with earlier stage disease. Non-Hispanic ( b = -0.59, p = .03) and White ( b = -0.97, p < .01) women engaged with more features. Cancer stage and intervention timing interacted. Women with more advanced cancer stage who received CBSM later engaged with the most depth ( b = -11.73, p = .04). All other characteristics did not predict engagement. Conclusions Disease stage, race, ethnicity, and intervention timing predicted engagement with a CBSM website in older BC patients. Implications for cancer survivors Delivering CBSM later in cancer treatment may mitigate competing demands. Fostering greater engagement in racial/ethnic minorities is needed.