Thesis
Exploring the effect of a lifestyle survivorship program on psychosocial mechanisms of action and cancer-related health outcomes among adult cancer survivors
University of Iowa
Master of Science (MS), University of Iowa
Autumn 2023
DOI: 10.25820/etd.006856
Abstract
Introduction
The American Cancer Society (ACS) recommends cancer survivors follow the recommended guidelines for physical activity (PA), diet, and sleep to improve cancer-related health outcomes. The ACS recommends healthcare systems establish comprehensive survivorship programs supportive of engaging in healthy lifestyle behaviors following active treatment. However, few lifestyle-focused programs exist for addressing the unique needs of cancer survivors. The purpose of this project is to explore the effect of a lifestyle-based, health coaching program on cancer-related health outcomes and psychosocial mechanisms of action among young and middle-aged adult cancer survivors.
Methods
Young and middle-aged cancer survivors (<age 65) were recruited to participate in a phase IIa ‘proof of concept’ study which utilized a pre-post pre-experimental design conducted. The intervention period lasted eight-weeks, and baseline and post-testing occurred for a week before and after the intervention, meaning the programs’ duration was roughly ten-weeks. Participants were recruited through electronic medical records, mass emails, and provider referrals. Participants received up to five health coaching sessions with a trained student health coach, three health education videos focused on improving sleep, PA, and diet for cancer survivors, and a Fitbit wearable device to monitor PA and sleep. Cancer-related health outcomes were measured using the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale including physical function, pain, pain interference, fatigue, depression, sleep disturbance, and social roles. Psychosocial mechanisms of action were measured using a modified questionnaire based on the Multi-Process Action Control (M-PAC) Theory which included questions on attitudes, opportunity, capability, intentions, behavioral skills for health, habits, and health identity. Paired t-tests were used to assess changes from pre- to post-test. An effect size was calculated using Cohen’s d. Acceptability was assessed using surveys at post-test to understand participants’ enjoyment of the overall program and satisfaction of program features. Demographic data was collected via self-report entrance surveys.
Results
A total of 42 individuals consented to the study, and 36 participants completed baseline testing. A total of 30 participants (80% female; mean body mass index (BMI) =31.0+5.8 kg/m2; mean age=42.0+10.8 years) completed the entire study protocol. We observed significant improvements in the following psychosocial mechanisms of action: behavioral skills (d = 2.04, p < 0.01) habits (d = 0.52, p < 0.01) and identities (d = 0.72, p = 0.01). For cancer-related health outcomes, we observed significant improvements in fatigue (d = 0.86, p = 0.03), sleep disturbance (d = 0.95, p = 0.01), social roles (d = 0.68, p = 0.01), and global health (d = 0.99, p < 0.01). We observed significant worsening in pain interference (d = -1.01, p < 0.01). Participants found this program to be enjoyable and helpful for improving health. Health coaching and remote delivery were rated as the most satisfactory of all the program features.
Discussion
These findings suggest adult cancer survivors improved several targeted psychosocial constructs and reported improvements in important cancer-related health outcomes of fatigue, sleep disturbance, the ability to participate in social roles, and global health. Participants gained skills to maintain behavior change, as indicated by improvements in behavioral skills (goal setting, self-monitoring, action planning), health habits, and health identities. Decreased fatigue and sleep disturbance, and increased ability to participate in social roles and global health suggest important health improvements for participants. Participants found the program to be acceptable and satisfactory to participate. Further investigation is needed to improve the program before advancing to a phase IIb pilot test.
Details
- Title: Subtitle
- Exploring the effect of a lifestyle survivorship program on psychosocial mechanisms of action and cancer-related health outcomes among adult cancer survivors
- Creators
- Lauren Steinke
- Contributors
- Lucas J Carr (Advisor)Jessica S Gorzelitz (Committee Member)Mary C Schroeder (Committee Member)
- Resource Type
- Thesis
- Degree Awarded
- Master of Science (MS), University of Iowa
- Degree in
- Health and Human Physiology
- Date degree season
- Autumn 2023
- Publisher
- University of Iowa
- DOI
- 10.25820/etd.006856
- Number of pages
- xi. 57 pages
- Copyright
- Copyright 2023 Lauren Steinke
- Grant note
- Funding from Holden Comprehensive Cancer Center.
- Language
- English
- Date submitted
- 11/28/2023
- Description illustrations
- illustrations, tables
- Description bibliographic
- Includes bibliographical references (pages 32-36).
- Public Abstract (ETD)
- As cancer treatments improve and survival rates increase, it is estimated that there will be more cancer survivors than ever before. It is recommended survivors engage in proper physical activity, dietary, and sleeping behaviors to improve cancer-related outcomes. This study’s purpose was to explore the effect of a lifestyle-based program on cancer-related health outcomes, such as fatigue, anxiety, and global health, and psychosocial mechanisms of action, the indicators of behavior change, such as behavioral skill development and habit formation. Thirty adult cancer survivors, all 3-60 months post-treatment, were recruited. Participants completed pre-testing in week one and post-testing protocols in week ten, answering questions to self-report questionnaires. Participants were given a Fitbit monitor, access to three educational videos, and met with a trained student health coach to discuss wellness goals. The findings suggest participants improved several targeted psychosocial constructs including behavioral skills, habits, and identities. This suggests the intervention may have been effective at helping participants create sustainable behavior change. Participants also reported improvements in their ability to participate in social roles, global health, fatigue, and sleep disturbance which suggests the intervention may have been effective at improving health outcomes. Participants found this program to be enjoyable and helpful. Of all the program features, health coaching and remote delivery were rated most satisfactory. Future studies are needed to better understand the effect of a lifestyle behavior change program in this population. These findings should be interpreted with caution given the exploratory nature of the study design. Future pilot studies that include a control group are warranted to establish causality of the intervention.
- Academic Unit
- Health and Human Physiology
- Record Identifier
- 9984546849302771
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