Development and Evaluation of a Theory-Based Physical Activity Guidebook for Breast Cancer Survivors

Behaviour change techniques used in lifestyle interventions that aim to reduce cancer-related fatigue in cancer survivors: a systematic review

BACKGROUND

Lifestyle interventions that target dietary and/or physical activity behaviours may impact cancer-related fatigue in cancer survivors. Changing lifestyle may be especially difficult for cancer survivors suffering from cancer-related fatigue. To increase effectiveness of lifestyle interventions, behaviour change techniques (BCTs) can be applied. The aim of this review is to systematically describe which BCTs are applied in lifestyle interventions targeting cancer-related fatigue among cancer survivors who finished primary treatment.

METHODS

PubMed, Scopus, PsycINFO, Cochrane Library and Web of Science were searched to identify randomised controlled trials (RCTs) of dietary and/or physical activity interventions targeting cancer-related fatigue in cancer survivors. The BCT taxonomy was used to code the BCTs that were applied in those interventions. BCTs that were reported in at least 25% of effective interventions were indicated as 'promising BCT', but only retained this classification when these BCTs were present in less than 25% of ineffective interventions.

RESULTS

Twenty-nine RCTs were identified, of which 17 were effective in reducing cancer-related fatigue. The most frequently applied BCTs were Goal setting (behaviour), Instruction on how to perform the behaviour, Demonstration of the behaviour, Behavioural practice/rehearsal, and Credible Source. The BCT 'Generalisation of the target behaviour' was identified as promising. These results should be interpreted with caution as only three studies screened their participants on level of cancer-related fatigue and most studies focused only on physical activity. Furthermore, many studies did not include a measure for actual behaviour change and had no follow-up period after the intervention ended.

CONCLUSIONS

There is a need for studies that screen their participants on level of cancer-related fatigue and a need for studies that focus more on dietary behaviours as a possible intervention to reduce fatigue. Also, studies should include follow-up timepoints after the interventions ends to examine long-term behaviour change. Future lifestyle interventions should describe interventions in detail to allow for easier coding of BCTs, and report on actual behaviour change following the intervention. Interventions may apply the BCT 'Generalisation of the target behaviour' to incorporate lifestyle behaviours in daily life. This may increase the chance that interventions will effectively reduce cancer-related fatigue.

Considering depression as a secondary outcome in the optimization of physical activity interventions for breast cancer survivors in the PACES trial: a factorial randomized controlled trial

BACKGROUND

Depressive symptoms result in considerable burden for breast cancer survivors. Increased physical activity may reduce these burdens but existing evidence from physical activity interventions in equivocal. Furthermore, physical activity intervention strategies may differentially impact depressive symptoms, which should be considered in designing and optimizing behavioral interventions for breast cancer survivors.

METHODS

The Physical Activity for Cancer Survivors (PACES) trial enrolled 336 participants breast cancer survivors, who were 3 months to 10 years post-treatment, and insufficiently active (< 150 min of moderate-to-vigorous physical activity per week). Participants were randomly assigned to a combination of 4 intervention strategies in a full-factorial design: 1) supervised exercise sessions, 2) facility access, 3) Active Living Every Day, and 4) Fitbit self-monitoring. Depressive symptoms were assessed at baseline, mid-intervention (3 months), and post-intervention (6 months) using the Quick Inventory for Depressive Symptoms. Change in depressive symptoms were analyzed using a linear mixed-effects model.

RESULTS

Results from the linear mixed-effects model indicated that depressive symptoms decreased significantly across the entire study sample over the 6-month intervention (F = 4.09, p = 0.044). A significant ALED x time interaction indicated participants who received the ALED intervention experienced greater reductions in depressive symptoms (F = 5.29, p = 0.022). No other intervention strategy significantly impacted depressive symptoms.

CONCLUSIONS

The ALED intervention consists of strategies (i.e., goal setting, social support) that may have a beneficial impact on depressive symptoms above and beyond the effect of increased physical activity. Our findings highlight the need to consider secondary outcomes when designing and optimizing physical activity interventions.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03060941. Posted February 23, 2017.

Development of Educational Print Materials for Physical Activity in Cancer: Evaluation of Readability and Suitability

Educational health materials may be important tools to increase physical activity in cancer patients. Nevertheless, most of the available resources regarding physical activity for cancer patients were found not suitable, had a low grade of readability, and thus, represent a significant barrier to behavior change. To date, little data about development criteria and evaluation of physical activity resources for cancer before their spread exist. The purposes of this study were (i) to describe the development of a physical activity guidebook designed for cancer patients and (ii) to test its readability and suitability. The guidebook was developed through multi-step passages, including group discussions, a literature review, identification of a motivational theory, and using previous research on exercise preferences, barriers, and facilitators to target the information. Two validated formulae were used to assess the readability, whereas thirty-four judges completed the Suitability of Assessment Materials questionnaire to evaluate the suitability of the guidebook. The guidebook was found readable for patients having at least a primary education, and the judges scored it as "superior" material. Our guidebook, following a rigorous method in the development phase, was considered to be suitable and readable. Further evaluations through clinical trials could investigate its effectiveness for behavior change and its impact on cancer patients.

Pilot Studies to Evaluate Feasibility of a Physical Activity Intervention for Persons With Depression

Exercise reduces depressive symptoms and improves physical health in persons with depression. However, the interventions implemented in research studies require significant resources, limiting adoption into clinical practice and suggesting the need for more efficient interventions. In two nonrandomized pilot studies, the authors evaluated the feasibility of a multicomponent intervention (group educational sessions, Fitbit, and access to exercise facility) in adult persons with depression and breast cancer survivors with depression. The participants in both pilot studies completed 12 weeks of group educational sessions to increase physical activity levels, were provided with self-monitoring devices, and were provided access to on-site exercise facilities. Depressive symptoms significantly decreased postintervention, and over 90% of the participants reported that they had benefited from the intervention. These results indicate that implementing a multicomponent intervention is feasible and may reduce depressive symptoms and improve other psychosocial outcomes.

Behavior change techniques for increasing physical activity in cancer survivors: a systematic review and meta-analysis of randomized controlled trials

Purpose

The purpose of this systematic review and meta-analysis is to investigate how physical activity (PA) can be effectively promoted in cancer survivors. The effect of PA-promoting interventions in general, behavior change techniques (BCTs), and further variables as moderators in particular are evaluated.

Methods

This study included randomized controlled trials of lifestyle interventions aiming at an increase in PA that can be carried out independently at home, published by December 2016, for adults diagnosed with cancer after completion of the main treatment. Primary outcomes were subjective and objective measures of PA prior to and immediately after the intervention. Meta-analysis and meta-regression were used to estimate effect sizes (ES) in terms of standardized mean differences, variation between ES in terms of heterogeneity indices (I²), and moderator effects in terms of regression coefficients.

Results

This study included 30 studies containing 45 ES with an overall significant small positive effect size of 0.28 (95% confidence interval=0.18–0.37) on PA, and I²=54.29%. The BCTs Prompts, Reduce prompts, Graded tasks, Non-specific reward, and Social reward were significantly related to larger effects, while Information about health consequences and Information about emotional consequences, as well as Social comparison were related to smaller ES. The number of BCTs per intervention did not predict PA effects. Interventions based on the Theory of Planned Behavior were associated with smaller ES, and interventions with a home-based setting component were associated with larger ES. Neither the duration of the intervention nor the methodological quality explained differences in ES.

Conclusion

Certain BCTs were associated with an increase of PA in cancer survivors. Interventions relying on BCTs congruent with (social) learning theory such as using prompts and rewards could be especially successful in this target group. However, large parts of between-study heterogeneity in ES remained unexplained. Further primary studies should directly compare specific BCTs and their combinations.

Patient facing decision support system for interpretation of laboratory test results

Background

In some healthcare systems, it is common that patients address laboratory test centers directly without a physician’s recommendation. This practice is widely spread in Russia with about 28% of patients who visiting laboratory test centers for diagnostics. This causes an issue when patients get no help from the physician in understanding the results.

Computer decision support systems proved to efficiently solve a resource consuming task of interpretation of the test results. So, a decision support system can be implemented to rise motivation and empower the patients who visit a laboratory service without a doctor’s referral.

Methods

We have developed a clinical decision support system for patients that solves a classification task and finds a set of diagnoses for the provided laboratory tests results.

The Wilson and Lankton’s assessment model was applied to measure patients’ acceptance of the solution.

Results

A first order predicates-based decision support system has been implemented to analyze laboratory test results and deliver reports in natural language to patients. The evaluation of the system showed a high acceptance of the decision support system and of the reports that it generates.

Conclusions

Detailed notification of the laboratory service patients with elements of the decision support is significant for the laboratory data management, and for patients’ empowerment and safety.

Electronic supplementary material

The online version of this article (10.1186/s12911-018-0648-0) contains supplementary material, which is available to authorized users.

The Promoting Activity in Cancer Survivors (PACES) trial: a multiphase optimization of strategy approach to increasing physical activity in breast cancer survivors

BACKGROUND

Despite the significant, empirically supported benefits of physical activity, the majority of breast cancer survivors do not meet recommended guidelines for physical activity. A variety of effective strategies to increase physical activity in breast cancer survivors have been identified. However, it is unknown which of these strategies is most effective or how these strategies might be combined to optimize intervention effectiveness.

METHODS

The proposed trial uses multiphase optimization strategy (MOST) to evaluate four evidence-based intervention strategies for increasing physical activity in breast cancer survivors. We will enroll 500 breast cancer survivors, age 18 and older, who are 3-months to 5 years post-treatment. Using a full-factorial design, participants will be randomized to receive a combination: 1) supervised exercise, 2) facility access, 3) self-monitoring, and 4) group-based active living counseling. The primary outcome, moderate-to-vigorous physical activity (MVPA) will be measured at baseline, 3 months, and 6 months using an Actigraph GT3X+. To evaluate intervention effects, a linear mixed-effects model will be conducted with MVPA as the outcome and with time (3 months and 6 months) as the within-subjects factor and intervention (i.e., supervised exercise, facility access, self-monitoring, and active living counseling) as the between subjects factor, along with all two-way interactions.

DISCUSSION

The purpose of the PACES study is to evaluate multiple strategies for increasing physical activity in breast cancer survivors. Results of this study will provide in an optimized intervention for increasing physical activity in breast cancer survivors.

TRIAL REGISTRATION

Clinicaltrials.gov Identifier: NCT03060941 . Registered February 23, 2017.

The Effect of the Move More Pack on the Physical Activity of Cancer Survivors: Protocol for a Randomized Waiting List Control Trial with Process Evaluation

Background

Physical activity can improve many common side effects of cancer treatment as well as improve physical function and quality of life (QOL). In addition, physical activity can improve survival rate and reduce cancer recurrence. Despite these benefits, only 23% of cancer survivors in England are active to recommended levels. Cancer survivors are interested in lifestyle behavior change. Home-based interventions offer a promising means for changing physical activity behavior. Prediagnosis levels of physical activity and self-efficacy have been reported to be predictors of physical activity behavior change. The Move More Pack, which has undergone revision, is a printed resource with supporting Internet-based tools that aims to increase the physical activity of cancer survivors in the United Kingdom. The revised Move More Pack is underpinned by the theory of planned behavior and the social cognitive theory.

Objective

The aim of this proposed study was to investigate the effect of the revised Move More Pack, supported by Internet-based tools, on physical activity, self-efficacy, and health-related QOL (HRQOL) of cancer survivors in the United Kingdom.

Methods

This study is a two-arm waiting list randomized control trial with embedded process evaluation. A sample of 99 participants per arm will be recruited by invitation through an email database of cancer survivors held by UK charity Macmillan Cancer Support and an advert placed on the Macmillan Cancer Support Facebook page. Each participant is randomized to receive brief physical activity information and the UK guidelines for physical activity, or brief physical activity information and the revised Move More Pack with supporting Internet-based tools. The intervention and control arm will be followed up at 12 weeks to identify changes in self-reported physical activity, self-efficacy, and HRQOL based on Web-based questionnaires. The control arm will receive the revised Move More Pack at 12 weeks with follow-up at 24 weeks. The intervention arm is followed up at 24 weeks to determine maintenance of reported changes. Subgroup analyses will be completed based on participants’ prediagnosis level of physical activity and baseline self-efficacy as possible predictors of positive changes. Use of each component of the revised Move More Pack will be assessed using a 4-point Likert scale. Semistructured phone interviews will evaluate the use and perceived usefulness of the revised Move More Pack.

Results

Participant recruitment started in March 2017. Projected completion of this study is October 2018.

Conclusions

This study’s findings will identify if the proposed low-cost broad reach intervention improves physical activity, self-efficacy, and the HRQOL of cancer survivors. The process evaluation is designed to contextualize the use and perceived usefulness of the revised Move More Pack, help augment its efficient distribution, and identify potential improvements to its design.

The feasibility of a pragmatic distance-based intervention to increase physical activity in lung cancer survivors

The purpose of this study was to investigate the feasibility and preliminary efficacy of a pragmatic distance-based intervention designed to increase physical activity (PA) participation in lung cancer survivors. Fourteen lung cancer survivors were recruited via invitation from the State Cancer Registry to join a 12-week PA intervention of print materials paired with brief telephone follow-up. Outcome measures of feasibility, PA participation and quality of life (QoL) were assessed at baseline, post-intervention and follow-up via telephone interview. Eligibility, recruitment and attrition rates were 16%, 58% and 29% respectively. No adverse events were reported; however, pain scores worsened following the intervention (median change -3.6, IQR -8.0, 0.0). Average intervention adherence was 91% with low median ratings of participation burden (i.e., all items 1/7) and high trial evaluation (i.e., all items 7/7). Post-intervention, median change in self-reported moderate and vigorous PA was 84 min (IQR -22, 188), and several domains of QoL improved. However, for both of these outcomes, improvements were not maintained at follow-up. Our findings suggest that this pragmatic distance-based intervention was safe, had good adherence rates, and indicate potential for improving short-term PA and QoL in lung cancer survivors. Additional strategies are needed to improve other indicators of feasibility, particularly recruitment, retention and long-term maintenance of improvements. Australian New Zealand Clinical Trials Registration: ACTRN12612000085875.

Applying Psychological Theories to Promote Long-Term Maintenance of Health Behaviors

Behavioral health theory provides a framework for researchers to design, implement, and evaluate the effects of health promotion programs. However, limited research has examined theories used in interventions to promote long-term maintenance of health behaviors. The purpose of this review was to evaluate the available literature and identify prominent behavioral health theories used in intervention research to promote maintenance of health behaviors. We reviewed theories used in intervention research assessing long-term maintenance (≥ 6 months post-intervention) of physical activity, weight loss, and smoking cessation. Five prominent behavioral theories were referenced by the 34 studies included in the review: Self-Determination Theory, Theory of Planned Behavior, Social Cognitive Theory, Transtheoretical Model, and Social Ecological Model. Descriptions and examples of applications of these theories are provided. Implications for future research are discussed.

Feasibility and preliminary efficacy of adding behavioral counseling to supervised physical activity in kidney cancer survivors: a randomized controlled trial

BACKGROUND

Supervised physical activity (PA) improves short-term health outcomes in cancer survivors, but longer-term adherence is rarely achieved.

OBJECTIVE

The aim of this study was to evaluate the feasibility and preliminary efficacy of adding behavioral counseling to supervised PA in kidney cancer survivors (KCSs).

METHODS

Thirty-two KCSs were randomized to a 4-week supervised PA program plus standard exercise counseling (SPA + EC group; n = 16) or a 4-week supervised PA plus behavioral counseling based on the Theory of Planned Behavior (SPA + BC group; n = 16). The primary outcome was self-reported PA at 12 weeks. Secondary outcomes were quality of life, anthropometric measures, cardiorespiratory fitness, and physical function.

RESULTS

Follow-up rates for outcomes at 12 weeks were 88% and 94% for fitness testing and questionnaires, respectively. Adherence to the interventions was 94% in both groups with a 6% attrition rate. Analyses of covariance revealed that PA minutes at 12 weeks favored the SPA + BC group by +34 minutes (95% confidence interval, -62 to 129), which was a small effect size (d = 0.21) not reaching statistical significance (P = .47). Moreover, the SPA + BC group increased their 6-minute walk by 48 m more than the SPA + EC group (95% confidence interval, 1-95; d = +0.64; P = .046). There were no significant changes in quality of life measures.

CONCLUSIONS

This pilot study provides preliminary evidence that adding behavioral counseling to supervised PA in KCSs is feasible and may improve PA and fitness in the short-term. Larger and longer-term trials are needed.

IMPLICATIONS FOR PRACTICE

Oncology nurses may consider adopting behavioral counseling strategies in addition to supervised PA to motivate KCSs to maintain PA.

Exploring the Feasibility of a Broad-Reach Physical Activity Behavior Change Intervention for Women Receiving Chemotherapy for Breast Cancer: A Randomized Trial

Background: Facilitating healthy levels of physical activity (PA) during chemotherapy is important for the psychosocial and physical health of breast cancer survivors. The primary objective of this feasibility study was to examine the effects of a broad-reach PA behavior change intervention among women with breast cancer receiving adjuvant chemotherapy.

Methods: Breast cancer patients receiving adjuvant chemotherapy (N = 95) were randomly assigned to receive a PA resource kit consisting of tailored print materials and a step pedometer (intervention) or a standard public health PA recommendation (standard recommendation). The primary outcome was daily pedometer steps. Secondary outcomes were self-reported light, moderate, and vigorous intensity PA, total moderate-to-vigorous PA, and sedentary time. Assessments were conducted before and after adjuvant chemotherapy.

Results: Attrition was 19% (17 of 95). Intervention patients wore their step pedometer for 85 days (range, 35–144 days; SD = 26.4) for a 95% adherence rate. Analyses of covariance suggested that the intervention was not statistically superior to standard recommendation for daily average pedometer steps (−771; 95% CI = −2024 to 482; P = 0.22), total MVPA minutes (−4; 95% CI = −62 to 570; P = 0.90), or sedentary time (+160; 95% CI = −186 to 506; P = 0.42).

Conclusion: This broach-reach and low intensive intervention was not more effective for promoting PA in breast cancer patients receiving chemotherapy than providing the standard public health guidelines for PA.

Impact: Achieving physical activity behavior change during adjuvant breast cancer chemotherapy may require some level of supervised physical activity or more intensive (e.g., face-to-face, supervised) interventions. Cancer Epidemiol Biomarkers Prev; 25(2); 391–8. ©2015 AACR.

Main outcomes of the Move More for Life Trial: a randomised controlled trial examining the effects of tailored-print and targeted-print materials for promoting physical activity among post-treatment breast cancer survivors

BACKGROUND

Participation in physical activity can improve the health outcomes of breast cancer survivors. To impact public health, broad-reaching sustainable interventions that promote physical activity are needed.

PURPOSE

To evaluate the efficacy of two distance-based interventions for promoting physical activity among breast cancer survivors compared with a standard recommendation control.

METHODS

Breast cancer survivors who had finished 'active' cancer treatment were eligible to participate. Participants (n = 330) were randomly assigned to receive one of the following mail-delivered interventions: three computer-tailored newsletters, a previously developed breast cancer-specific physical activity booklet or a pamphlet detailing the public health recommendations for physical activity (control). Primary outcomes were self-reported moderate to vigorous aerobic activity and participant's self-reported resistance training activity at 4 months post-baseline. Secondary outcomes were pedometer step counts, whether or not participants were meeting the physical activity guidelines, time spent in sedentary behaviour, fatigue and health-related quality of life.

RESULTS

Participants randomised into the tailored-print intervention group were three times more likely to commence resistance training and meet the resistance-training guidelines immediately after the intervention than participants allocated to the control group. There were no other significant intervention effects.

CONCLUSION

Computer-tailored newsletters may be an effective strategy for enhancing resistance-based physical activity among breast cancer survivors. The null findings relating to other outcomes may be due to ceiling effects (in the case of aerobic activity, fatigue and health-related quality of life) or the sensitivity of the measure used (in the case of sitting time). These issues require further exploration.

Theory-and evidence-based development and process evaluation of the Move More for Life program: a tailored-print intervention designed to promote physical activity among post-treatment breast cancer survivors

Objective

Several physical activity interventions have been effective in improving the health outcomes of breast cancer survivors. However, few interventions have provided detailed descriptions regarding how such interventions work. To develop evidence-based practice in this field, detailed descriptions of intervention development and delivery is needed. This paper aims to (1) describe the theory-and evidence-based development of the Move More for Life program, a physical activity program for breast cancer survivors; and (2) serve as an exemplar for theory-based applied research.

Method

The program-planning model outlined by Kreuter and colleagues was used to develop the computer-tailored intervention.

Results

The tailoring guide developed by Kreuter and colleagues served as a useful program planning tool in terms of integrating theory and evidence-based best practice into intervention strategies. Overall, participants rated the intervention positively, with the majority reporting that the tailored materials caught their attention, were personally relevant to them, and were useful for helping them to change their behaviour. However, there was considerable room for improvement.

Conclusion

The Move More for Life program is an example of a theory-based, low-cost and potentially sustainable strategy to physical activity promotion and may stand as an exemplar for Social Cognitive Theory-based applied research. By providing a detailed description of the development of the Move More for Life program, a critical evaluation of the working mechanisms of the intervention is possible, and will guide researchers in the replication or adaption and re-application of the specified techniques. This has potential implications for researchers examining physical activity promotion among cancer survivors and for researchers exploring distance-based physical activity promotion techniques among other populations.

Trial registrations

Australian New Zealand Clinical Trials Registry (ANZCTR) identifier: ACTRN12611001061921.

A qualitative synthesis of trials promoting physical activity behaviour change among post-treatment breast cancer survivors

BACKGROUND

Health outcome trials have provided strong evidence that participating in regular physical activity can improve the quality of life and health of post-treatment breast cancer survivors. Focus is now needed on how to promote changes in physical activity behaviour among this group.

PURPOSE

This systematic review examines the efficacy of behavioural interventions for promoting physical activity among post-treatment breast cancer survivors.

METHODS

Behavioural intervention studies published up until July 2012 were identified through a systematic search of two databases: MEDLINE and CINAHL, and by searching reference lists of relevant publications and scanning citation libraries of project staff.

RESULTS

Eight out of the ten identified studies reported positive intervention effects on aerobic physical activity behaviour, ranging from during the intervention period to 6 months post-intervention. Only two studies reported intervention effect sizes. The identification of factors related to efficacy was not possible because of the limited number and heterogeneity of studies included, as well as the lack of effect sizes reported. Nonetheless, an examination of the eight studies that did yield significant intervention effects suggests that 12-week interventions employing behaviour change techniques (e.g., self-monitoring and goal setting) derived from a variety of theories and delivered in a variety of settings (i.e., one-on-one, group or home) can be effective at changing the aerobic physical activity behaviour of breast cancer survivors in the mid- to long terms.

CONCLUSIONS

Behavioural interventions do hold promise for effectively changing physical activity behaviour among breast cancer survivors. However, future research is needed to address the lack of studies exploring long-term intervention effects, mediators of intervention effects and interventions promoting resistance-training activity, and to address issues impacting on validity, such as the limited use of objective physical activity measures and the use of convenience samples.

IMPLICATIONS FOR CANCER SURVIVORS

Identifying effective ways of assisting breast cancer survivors to adopt and maintain physical activity is important for enhancing the well-being and health outcomes of this group.

Development of a questionnaire to assess the determinants of exercise among breast cancer survivors in Puerto Rico

The Theory of Planned Behavior (TPB) serves to understand determinants that predict the intention to exercise. According to this theory, attitudes, subjective norms, and perceptions of behavioral control determine intention. This is the first theory-based tool designed to measure the determinants of exercise among women in Puerto Rico who are breast cancer survivors. Understanding the determinants will assist in planning theory based interventions. The purpose of this study was to develop a TPB-based questionnaire to assess the determinants of exercise of breast cancer survivors in Puerto Rico and to evaluate its psychometric properties. Quantitative and qualitative methods were used for questionnaire development and psychometric testing. Three independent samples were recruited for the phases of item generation, pilot testing, and evaluation of psychometric properties. An initial 97-item questionnaire was constructed. Test-retest reliability was assessed for the indirect subscales; six items were found unreliable and removed. For the direct subscales, seven items with item-to-total correlations <0.30 were removed. The final version consisted of 84 items, with Cronbach's α ranging from 0.65 to 0.89. Construct validity was demonstrated by significant, fair-to-moderate correlations of all but one of the direct subscales and the multiplied scores of the indirect subscales of similar constructs.

Physical activity and/or dietary interventions in breast cancer survivors: a systematic review of the maintenance of outcomes

PURPOSE

Maintaining physical activity and dietary improvements achieved during an intervention is important for the long-term health outcomes of breast cancer survivors. This review aimed to determine: (a) the proportion of physical activity and/or dietary intervention trials in breast cancer survivors that assessed post-intervention maintenance of outcomes, (b) the proportion of trials that achieved successful post-intervention maintenance of outcomes, and (c) the sample, intervention, and methodological characteristics common among trials that achieved successful post-intervention maintenance of outcomes.

METHODS

A structured search of PubMed, CINAHL, Medline via Ovid, Web of Science, CENTRAL, and PsycInfo was conducted for articles published until March 2012. Included trials had to evaluate a randomized controlled trial of a physical activity and/or dietary behavior change intervention that targeted breast cancer survivors and report on between-group differences of behavioral outcomes at end-of-intervention and at least 3 months post-intervention follow-up. Methodological quality of included trials was also assessed.

RESULTS

The search resulted in 1,298 publications. Of 63 identified trials that assessed end-of-intervention outcomes, 10 (16 %) assessed post-intervention maintenance of outcomes; four of these 10 trials achieved successful maintenance. Due to the limited number and heterogeneity of the four trials, few commonalities in sample, intervention, and methodological characteristics were identified.

CONCLUSION

Assessing post-intervention maintenance of physical activity and dietary outcomes in breast cancer survivors is rare. There is a pressing need to direct more attention to this issue to inform the development of interventions to improve the long-term health outcomes for the growing number of breast cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

For breast cancer survivors, maintaining regular physical activity and a healthy diet are important to enhancing health and well-being over the long-term. More research is needed to identify the best ways of supporting survivors to make and maintain these lifestyle changes.

Move more for life: the protocol for a randomised efficacy trial of a tailored-print physical activity intervention for post-treatment breast cancer survivors

BACKGROUND

Due to early detection and advances in treatment, the number of women surviving breast cancer is increasing. Whilst there are many positive aspects of improved survival, breast cancer survival is associated with many long-term health and psychosocial sequelae. Engaging in regular physical activity post-diagnosis can reduce this burden. Despite this evidence, the majority of breast cancer survivors do not engage in regular physical activity. The challenge is to provide breast cancer survivors with appealing and effective physical activity support in a sustainable and cost-effective way. This article describes the protocol for the Move More for Life Study, which aims to assess the relative efficacy of two promising theory-based, print interventions designed to promote regular physical activity amongst breast cancer survivors.

METHOD AND DESIGN

Breast cancer survivors were recruited from across Australia. Participants will be randomised into one of three groups: (1) A tailored-print intervention group, (2) a targeted-print intervention group, or (3) a standard recommendation control group. Participants in the tailored-print intervention group will receive 3 tailored newsletters in the mail over a three month period. Participants in the targeted-print group will receive a previously developed physical activity guidebook designed specifically for breast cancer survivors immediately after baseline. Participants in the standard recommendation control will receive a brochure detailing the physical activity guidelines for Australian adults. All participants will be assessed at baseline, and at 4 and 10 months post-baseline. Intervention efficacy for changing the primary outcomes (mins/wk aerobic physical activity; sessions/exercises per week resistance physical activity) and secondary outcomes (steps per day, health-related quality life, compliance with physical activity guidelines, fatigue) will be assessed. Mediation and moderation analyses will also be conducted.

DISCUSSION

Given the growing number of cancer survivors, distance-based behaviour change programs addressing physical activity have the potential to make a significant public health impact.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR) identifier: ACTRN12611001061921.

Move more for life: the protocol for a randomised efficacy trial of a tailored-print physical activity intervention for post-treatment breast cancer survivors

BACKGROUND

Due to early detection and advances in treatment, the number of women surviving breast cancer is increasing. Whilst there are many positive aspects of improved survival, breast cancer survival is associated with many long-term health and psychosocial sequelae. Engaging in regular physical activity post-diagnosis can reduce this burden. Despite this evidence, the majority of breast cancer survivors do not engage in regular physical activity. The challenge is to provide breast cancer survivors with appealing and effective physical activity support in a sustainable and cost-effective way. This article describes the protocol for the Move More for Life Study, which aims to assess the relative efficacy of two promising theory-based, print interventions designed to promote regular physical activity amongst breast cancer survivors.

METHOD AND DESIGN

Breast cancer survivors were recruited from across Australia. Participants will be randomised into one of three groups: (1) A tailored-print intervention group, (2) a targeted-print intervention group, or (3) a standard recommendation control group. Participants in the tailored-print intervention group will receive 3 tailored newsletters in the mail over a three month period. Participants in the targeted-print group will receive a previously developed physical activity guidebook designed specifically for breast cancer survivors immediately after baseline. Participants in the standard recommendation control will receive a brochure detailing the physical activity guidelines for Australian adults. All participants will be assessed at baseline, and at 4 and 10 months post-baseline. Intervention efficacy for changing the primary outcomes (mins/wk aerobic physical activity; sessions/exercises per week resistance physical activity) and secondary outcomes (steps per day, health-related quality life, compliance with physical activity guidelines, fatigue) will be assessed. Mediation and moderation analyses will also be conducted.

DISCUSSION

Given the growing number of cancer survivors, distance-based behaviour change programs addressing physical activity have the potential to make a significant public health impact.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR) identifier: ACTRN12611001061921.

Participatory design of mass health communication in three languages for seniors and people with disabilities on Medicaid

OBJECTIVES

We used participatory design methods to develop and test guidebooks about health care choices intended for 600 000 English-, Spanish-, and Chinese-speaking seniors and people with disabilities receiving Medicaid in California.

METHODS

Design and testing processes were conducted with consumers and professionals; they included 24 advisory group interviews, 36 usability tests, 18 focus groups (105 participants), 51 key informant interviews, guidebook readability and suitability testing, linguistic adaptation, and iterative revisions of 4 prototypes.

RESULTS

Participatory design processes identified preferences of intended audiences for guidebook content, linguistic adaptation, and format; guidebook readability was scored at the sixth- to eighth-grade level and suitability at 95%. These findings informed the design of a separate efficacy study that showed high guidebook usage and satisfaction, and better gains in knowledge, confidence, and intended behaviors among intervention participants than among control participants.

CONCLUSIONS

Participatory design can be used effectively in mass communication to inform vulnerable audiences of health care choices. The techniques described can be adapted for a broad range of health communication interventions.

Suitability and readability assessment of educational print resources related to physical activity: implications and recommendations for practice

OBJECTIVE

The primary objective of this study was to assess the suitability and readability level of publicly available educational print resources related to physical activity (PA).

METHODS

Educational print resources related to PA (n=66) were requested from organizations (e.g., professional, commercial, government, and educational). The suitability assessment of materials (SAM) and the simple measure of gobbledygook (SMOG) readability measure were used to evaluate the suitability and readability of the PA resources.

RESULTS

Of the 66 PA resources, suitability scores were superior in only 10 resources (15%), adequate in 36 resources (55%), and inadequate/not suitable in 20 resources (30%). The average reading grade level for the PA resources was a 10th grade level (S.D.=1.82; Rg=5th grade to 15th grade). Only 56.5% (n=35) of PA resources depicted a primary PA recommendation that was consistent with the public health recommendation for PA.

CONCLUSION

Results indicate that the majority of educational print resources related to PA have poor readability indices and inadequate to adequate suitability.

PRACTICE IMPLICATIONS

Health educators developing educational print resources related to PA must ensure these resources conform to the highest suitability standards. This includes developing resources that a) contain information consistent with current public health recommendations, and b) can be utilized by all individuals regardless of health literacy status.

Analyzing theoretical mechanisms of physical activity behavior change in breast cancer survivors: results from the activity promotion (ACTION) trial

BACKGROUND

We previously reported that a physical activity (PA) behavior change intervention based on the theory of planned behavior (TPB) increased PA and quality of life in breast cancer survivors.

PURPOSE

To examine the effects of our interventions on TPB variables and to determine if PA at 12 weeks follow-up was mediated by TPB variables at 4 weeks.

METHODS

Breast cancer survivors (N = 377) were randomly assigned to receive either a standard public health recommendation for PA (SR group), a step pedometer alone, or one of two TPB-based behavior change interventions consisting of print materials (alone or combined with a step pedometer). For the purpose of this study, we compared the two TPB-based intervention groups (INT group) to the SR group.

RESULTS

Compared to the SR group, the INT group reported more favorable changes in instrumental attitude (mean difference = 0.13; 95% CI = -0.01 to 0.23; d = 0.19; p = 0.077), intention (mean difference = 0.33; 95% CI = 0.10 to 0.56; d = 0.33; p = 0.006), and planning (mean difference = 0.39; 95% CI = 0.04 to 0.73; d = 0.26; p = 0.027). Mediation analyses indicated that both planning and intention partially mediated the effects of the intervention on PA at 12 weeks.

CONCLUSIONS

Our TPB-based behavior change intervention resulted in small improvements in the TPB constructs that partially mediated the effects of our intervention on PA behavior. Additional research with the TPB is warranted.