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Leveraging values to promote adherence to endocrine therapy among breast cancer survivors: A mixed-methods investigation (Pages 122-129)

Journal of Contextual Behavioral Science (JCBS)

Volume 25, July 2022, Pages 122-129


Joanna J.Arch, Elizabeth Slivjak, Emma E. Bright, Catherine M. Crespi, Michael E. Levin, Sarah R.Genung, Madeline Nealis, Karen Albright, Jill L.Mitchell, Ami D.Sheth, Jessica F.Magidson, Annette L.Stanton



Improving medication adherence represents one of the greatest behavioral challenges in medicine. Personal values are an under-examined source of motivation for adhering to medication. This secondary analysis leverages a mixed-method approach to understanding a novel, online, values-based intervention (‘REACH’) for promoting endocrine therapy (ET) adherence among breast cancer survivors, using data from a randomized trial.


Breast cancer survivors with challenges taking ET (n = 88) were randomized 1:1 to ET Education + Values (REACH) or Education-only online interventions. This report focuses on the three values strategies used in REACH to promote ET adherence: affirming health-related values, using values-based perspective-taking to motivate adherence, and creating a personalized cue-to-action values sticker for participants’ ET pillbox. Immediate responses to these values strategies were analyzed using Linguistic Inquiry and Word Count (LIWC) and in both conditions, using repeated assessment of positive and negative affective states. Long-term responses to these strategies were evaluated using structured study exit interviews.


Compared to Education, REACH led to less tense and sad and more loving states in the immediate term. Convergently, during REACH values exercises, LIWC identified greater use of positive emotion words than negative emotion words. Thematic coding of exit interviews identified generally positive responses to values content in the longer-term with a small minority of negative responses.


Distinct approaches to linking domain-relevant values directly to ET adherence were associated with generally positive affective responses, informing theory and practice.

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