Diagnosis
Barriers and Facilitators of Healthy Diet and Exercise Among Adolescent and Young Adult Cancer Survivors: Implications for Behavioral Interventions
http://online.liebertpub.com/doi/full/10.1089/jayao.2015.0028
Purpose: This study uses qualitative methods to identify barriers to and facilitators of exercise and healthy eating among adolescent and young adult (AYA) cancer survivors (survivors currently aged 18–39 years and diagnosed with cancer anytime in their lives), as reported by survivors and their primary supporters.
Methods: Survivors (Mage = 27.6 years, SD = 6.6 years) had completed active cancer therapy. Survivors and supporters (i.e., nominated by survivors as someone who was a main source of support) attended separate focus group sessions (five survivor focus groups, five supporter focus groups) and were asked to complete a self-reported questionnaire assessing demographic and cancer history and engagement in exercise and healthy eating.
Results: In total, 25 survivors and 19 supporters participated. The three overarching themes identified were barriers to exercise and healthy eating (e.g., lack of resources, negative thoughts and feelings, negative social and environmental influences), facilitators of exercise and healthy eating (e.g., cognitive motivators, tools for health behavior implementation, social relationships), and intervention implications (e.g., informational needs, desire for social support).
Conclusion: AYA cancer survivors and their supporters identified barriers to and facilitators of healthy lifestyle behaviors, which should be considered when designing interventions to improve the long-term health of survivors.
Following cancer treatment, patients experience an acute shift from frequent medical appointments to a long-term focus on health promotion and surveillance aimed at decreasing risk and monitoring for cancer recurrence or secondary cancers. Recommended healthy lifestyle behaviors for survivors include healthy eating and engaging in physical activity.1 These health behaviors are expected to reduce risk for recurrence and new cancers,2–4 to improve quality of life, and to extend survival.5 Adolescent and young adult (AYA) survivors, a substantial and growing population,6 demonstrate poor adherence to these recommendations,7–10 which is alarming given their increased risk for cancer recurrence, long-term health problems, and poor quality of life.11–20
While AYA oncology guidelines stipulate that patients should receive nutrition and exercise guidance,21 there are limited evidence-based interventions tailored for this group and limited literature on how best to deliver health interventions to AYA survivors.22 Before designing such interventions, consistent with the Intervention Mapping framework,23,24 it is important first to identify the barriers to and facilitators of survivors' health behaviors. Drawing on the Socio-Ecological Framework and Social Cognitive Theory,25,26 these barriers and facilitators to health behaviors are expected to occur on several levels (i.e., individual, family, peer, healthcare) and to involve social influences (e.g., social support, others' health behaviors), outcome expectancies (e.g., the survivor's anticipated consequences of the health behaviors), and survivors' self-efficacy (i.e., the survivor's belief that he/she can implement the health behaviors). Consistent with these models, some studies have identified individual-level barriers such as fatigue, limited time, feelings of discouragement, as well as negative social influences.10,27 However, fewer studies have been qualitative10 or have focused on potential facilitators to healthy eating and exercise among AYA survivors, such as in-person or online peer support groups.28 It is essential to identify facilitators so that interventions can both decrease barriers and promote facilitators. In addition, prior studies have not included perspectives on healthy lifestyle behaviors from individuals who support survivors, such as family or close friends. Incorporating these perspectives is particularly important for AYA survivors because the AYA developmental period is marked by significant changes to the social support system.29
To address these gaps, the current study used qualitative methods to identify barriers to and facilitators of exercise and healthy eating among AYA cancer survivors (survivors currently aged 18–39 years and diagnosed with cancer anytime in their lives), as reported both by survivors and their primary supporters. Following the socio-ecological and social cognitive theories, it was hypothesized that survivors and their supporters would cite barriers and facilitators on multiple levels (e.g., individual, family, peer, healthcare), including social factors (e.g., social support), health behavior-specific outcome expectancies, and the need for increased self-efficacy for implementing health behaviors
http://online.liebertpub.com/doi/full/10.1089/jayao.2015.0028
Purpose: This study uses qualitative methods to identify barriers to and facilitators of exercise and healthy eating among adolescent and young adult (AYA) cancer survivors (survivors currently aged 18–39 years and diagnosed with cancer anytime in their lives), as reported by survivors and their primary supporters.
Methods: Survivors (Mage = 27.6 years, SD = 6.6 years) had completed active cancer therapy. Survivors and supporters (i.e., nominated by survivors as someone who was a main source of support) attended separate focus group sessions (five survivor focus groups, five supporter focus groups) and were asked to complete a self-reported questionnaire assessing demographic and cancer history and engagement in exercise and healthy eating.
Results: In total, 25 survivors and 19 supporters participated. The three overarching themes identified were barriers to exercise and healthy eating (e.g., lack of resources, negative thoughts and feelings, negative social and environmental influences), facilitators of exercise and healthy eating (e.g., cognitive motivators, tools for health behavior implementation, social relationships), and intervention implications (e.g., informational needs, desire for social support).
Conclusion: AYA cancer survivors and their supporters identified barriers to and facilitators of healthy lifestyle behaviors, which should be considered when designing interventions to improve the long-term health of survivors.
Following cancer treatment, patients experience an acute shift from frequent medical appointments to a long-term focus on health promotion and surveillance aimed at decreasing risk and monitoring for cancer recurrence or secondary cancers. Recommended healthy lifestyle behaviors for survivors include healthy eating and engaging in physical activity.1 These health behaviors are expected to reduce risk for recurrence and new cancers,2–4 to improve quality of life, and to extend survival.5 Adolescent and young adult (AYA) survivors, a substantial and growing population,6 demonstrate poor adherence to these recommendations,7–10 which is alarming given their increased risk for cancer recurrence, long-term health problems, and poor quality of life.11–20
While AYA oncology guidelines stipulate that patients should receive nutrition and exercise guidance,21 there are limited evidence-based interventions tailored for this group and limited literature on how best to deliver health interventions to AYA survivors.22 Before designing such interventions, consistent with the Intervention Mapping framework,23,24 it is important first to identify the barriers to and facilitators of survivors' health behaviors. Drawing on the Socio-Ecological Framework and Social Cognitive Theory,25,26 these barriers and facilitators to health behaviors are expected to occur on several levels (i.e., individual, family, peer, healthcare) and to involve social influences (e.g., social support, others' health behaviors), outcome expectancies (e.g., the survivor's anticipated consequences of the health behaviors), and survivors' self-efficacy (i.e., the survivor's belief that he/she can implement the health behaviors). Consistent with these models, some studies have identified individual-level barriers such as fatigue, limited time, feelings of discouragement, as well as negative social influences.10,27 However, fewer studies have been qualitative10 or have focused on potential facilitators to healthy eating and exercise among AYA survivors, such as in-person or online peer support groups.28 It is essential to identify facilitators so that interventions can both decrease barriers and promote facilitators. In addition, prior studies have not included perspectives on healthy lifestyle behaviors from individuals who support survivors, such as family or close friends. Incorporating these perspectives is particularly important for AYA survivors because the AYA developmental period is marked by significant changes to the social support system.29
To address these gaps, the current study used qualitative methods to identify barriers to and facilitators of exercise and healthy eating among AYA cancer survivors (survivors currently aged 18–39 years and diagnosed with cancer anytime in their lives), as reported both by survivors and their primary supporters. Following the socio-ecological and social cognitive theories, it was hypothesized that survivors and their supporters would cite barriers and facilitators on multiple levels (e.g., individual, family, peer, healthcare), including social factors (e.g., social support), health behavior-specific outcome expectancies, and the need for increased self-efficacy for implementing health behaviors