Nutrition Self-Efficacy, Digital Engagement and Psychological Well-Being Among Women with Breast Cancer Using a Digital Nutrition-Education Programme: An Exploratory Cross-Sectional Study

Abstract Purpose Women receiving treatment for breast cancer are at risk of malnutrition and psychological distress. Digital nutrition education may help, but it only works if patients engage with it, and little is known about which patient factors go with engagement and psychological well-being. The objective was to describe engagement with a hospital-based digital nutrition-education programme and to explore associations among dietary behaviour change, nutrition self-efficacy, digital engagement, nutritional status, quality of life and psychological well-being. Methods This exploratory cross-sectional study included 50 women aged 20–50 years receiving active treatment for breast cancer at three tertiary-care hospitals in Visakhapatnam, India, who had used a six-module, blog-based programme. Self-report scales, platform analytics and anthropometry were collected at a single visit. Associations were examined with Pearson correlation and multiple linear regression adjusted for age and baseline health. The indirect association of self-efficacy with well-being through engagement was estimated as a secondary, hypothesis-generating analysis, with Monte Carlo confidence intervals. Results Self-efficacy was strongly correlated with digital engagement (r = 0.80, 95% CI 0.67 to 0.88) and with psychological well-being (r = 0.70, 95% CI 0.52 to 0.82). In the adjusted model (R² = 0.50), self-efficacy was independently associated with well-being (B = 4.21, 95% CI 1.84 to 6.57, p < .001), whereas digital engagement was not (B = 0.01, 95% CI − 0.11 to 0.13, p = .875). The indirect association through engagement was not different from zero (0.15, 95% CI − 1.67 to 2.01). Dietary behaviour change was associated with nutritional status (B = 5.67, 95% CI 3.71 to 7.63) and quality of life (B = 4.93, 95% CI 2.14 to 7.71). Conclusion Among women using a digital nutrition-education programme, nutrition self-efficacy, rather than the amount of platform use, was the variable most closely associated with psychological well-being. The design was cross-sectional, uncontrolled and small, so these findings do not show that the programme is effective. They identify self-efficacy as a candidate target to test in an adequately powered, controlled, longitudinal trial.