Effects of a Multiple Health Behavior Change Intervention for Colorectal Cancer Survivors on Psychosocial Outcomes and Quality of Life: a Randomized Controlled Trial

Background

Multiple health behavior change can ameliorate adverse effects of cancer.

Purpose

The purpose of this study was to determine the effects of a multiple health behavior change intervention (CanChange) for colorectal cancer survivors on psychosocial outcomes and quality of life.

Methods

A total of 410 colorectal cancer survivors were randomized to a 6-month telephone-based health coaching intervention (11 sessions using acceptance and commitment therapy strategies focusing on physical activity, weight management, diet, alcohol, and smoking) or usual care. Posttraumatic growth, spirituality, acceptance, mindfulness, distress, and quality of life were assessed at baseline, 6 and 12 months.

Results

Significant intervention effects were observed for posttraumatic growth at 6 (7.5, p?p?=?0.033), spirituality at 6 months (1.8, p?=?0.011), acceptance at 6 months (0.2, p?=?0.005), and quality of life at 6 (0.8, p?=?0.049) and 12 months (0.9, p?=?0.037).

Conclusions

The intervention improved psychosocial outcomes and quality of life (physical well-being) at 6 months with most effects still present at 12 months. (Trial Registration Number: ACTRN12608000399392).     

MobileMums: A Randomized Controlled Trial of an SMS-Based Physical Activity Intervention

Background  

Postnatal women (<12 months postpartum) are at increased risk of physical inactivity.     

Development and Initial Evaluation of a Multifaceted Intervention to Improve Mental Health and Quality of Life Among Prostate Cancer Survivors

Mental health issues affect a third of prostate cancer (PCa) survivors. Here, we describe the development and preliminary evaluation of a unique multifaceted intervention, the Prostate Cancer–Patient Empowerment Program (PC-PEP), designed to improve mental health and quality of life among survivors. The 28-day pilot PC-PEP Intervention was developed following the engagement of patients, survivors, caregivers and health care professionals In identifying survivorship needs and well-being resources for improved mental health. The pilot intervention was implemented with a group of 30 PCa survivors in Halifax, Canada. Measures collected over the 28-day program included psychological distress and physical health indicators, as well as program compliance. Participation in PC-PEP resulted in significant improvement in measures of mental and physical health over the 28-day program. Very good to excellent compliance with all five components of PC-PEP was observed. This evaluation provides strong initial support for a multifaceted program to improve mental health outcomes in prostate cancer survivors.

     

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.     

Intervention Mediators in a Randomized Controlled Trial to Increase Colonoscopy Uptake Among Individuals at Increased Risk of Familial Colorectal Cancer

Background

Understanding the pathways by which interventions achieve behavioral change is important for optimizing intervention strategies.

Purpose

We examined mediators of behavior change in a tailored-risk communication intervention that increased guideline-based colorectal cancer screening among individuals at increased familial risk.

Methods

Participants at increased familial risk for colorectal cancer (N = 481) were randomized to one of two arms: (1) a remote, tailored-risk communication intervention (Tele-Cancer Risk Assessment and Evaluation (TeleCARE)) or (2) a mailed educational brochure intervention.

Results

Structural equation modeling showed that participants in TeleCARE were more likely to get a colonoscopy. The effect was partially mediated through perceived threat (β = 0.12, p < 0.05), efficacy beliefs (β = 0.12, p < 0.05), emotions (β = 0.22, p < 0.001), and behavioral intentions (β = 0.24, p < 0.001). Model fit was very good: comparative fit index = 0.95, root-mean-square error of approximation = 0.05, and standardized root-mean-square residual = 0.08.

Conclusion

Evaluating mediating variables between an intervention (TeleCARE) and a primary outcome (colonoscopy) contributes to our understanding of underlying mechanisms that lead to health behavior change, thus leading to better informed and designed future interventions.

Trial Registration Number

ClinicalTrials.gov, NCT01274143.

     

Translating Physical Activity Interventions for Breast Cancer Survivors into Practice: An Evaluation of Randomized Controlled Trials

Background  Although physical activity (PA) interventions have been effective for improving health outcomes in breast cancer survivors, little is known relative to their potential for translation into practice. Purpose  This review was designed to provide a quantitative estimate of the reporting of both internal and external validity in recent studies of PA in breast cancer survivors (BCS). Methods  The Reach, Efficacy/Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was utilized to assess the reporting of internal and external validity in 25 randomized controlled trials (RCTs) of PA and BCS published between 1998 and 2008. Each trial was evaluated relative to the degree it met criteria for each of the above dimensions. Results  The majority of studies in this review reported dimensions reflecting internal validity. The overall level of detail relative to external validity of PA interventions was rarely reported, limiting the generalizability of study findings. Conclusions  As with many RCTs of health behavior change, detail relative to contextual elements of published PA interventions in BCS is limited. It is recommended that future physical activity interventions in BCS be designed to facilitate scalable and sustainable interventions for improving health outcomes in this population.     

Efficacy and Mediation of a Theory-Based Physical Activity Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial

Background

Few trials have tested physical-activity interventions among sexual minorities, including African American men who have sex with men (MSM).

Purpose

We examined the efficacy and mediation of the Being Responsible for Ourselves (BRO) physical-activity intervention among African American MSM.

Method

African American MSM were randomized to the physical-activity intervention consisting of three 90-min one-on-one sessions or an attention-matched control intervention and completed pre-intervention, immediately post-intervention, and 6- and 12-month post-intervention audio computer-based surveys.

Results

Of the 595 participants, 503 completed the 12-month follow-up. Generalized estimating equation models revealed that the intervention increased self-reported physical activity compared with the control intervention, adjusted for pre-intervention physical activity. Mediation analyses suggested that the intervention increased reasoned action approach variables, subjective norm and self-efficacy, increasing intention immediately post-intervention, which increased physical activity during the follow-up period.

Conclusions

Interventions targeting reasoned action approach variables may contribute to efforts to increase African American MSM’s physical activity.

Clinical trial registration

The trial was registered with the ClinicalTrials.gov Identifier NCT02561286.

     

Targeted Messages Increase Dairy Consumption in Adults: a Randomized Controlled Trial

Background

Dairy consumption amongst North Americans aged 30–50 has been declining. Targeted messages have been identified as a cost-efficient method through which to increase health-enhancing behavior, such as dairy intake.

Purpose

The aim of this study is to assess the utility of targeted, framed, efficacy-enhancing messages on calcium consumption from dairy in adults aged 30–50 in a randomized controlled trial.

Method

Seven hundred and thirty-two individuals (463 women, 269 men; M _age?=?40.57 years) were randomly assigned to one of five message conditions: (1) gain-framed (GF), (2) loss-framed (LF), (3) self-regulatory efficacy-enhancing (SRE), (4) GF plus SRE (GF?+?SRE), or (5) LF plus SRE (LF?+?SRE). Conditions were separate for men and women. Each condition received an emailed message on four consecutive days. Calcium intake from dairy, self-regulatory efficacy, outcome expectations, and outcome value were measured at baseline, 1 and 4 weeks following the intervention.

Results

Calcium intake from dairy significantly increased from baseline to week 1 post-intervention in all conditions (p?<?.001). A significant message condition x time interaction (p?=?.04) revealed that increases seen in the LF?+?SRE condition were maintained at week 4. All social cognitive constructs increased following the intervention (ps?<?.01). Self-regulatory efficacy (β?=?.28, p?<?.01) and outcome expectations (β?=?.19, p?<?.01) were significant predictors of subsequent calcium intake (week 4) from dairy.

Conclusion

Taken together, it appears as though ensuring message content is targeted to the specific population’s beliefs and motives is of importance when developing behavioral change intervention material.

     

mHealth Technologies to Influence Physical Activity and Sedentary Behaviors: Behavior Change Techniques,Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background

mHealth programs offer potential for practical and cost-effective delivery of interventions capable of reaching many individuals.

Purpose

To (1) compare the effectiveness of mHealth interventions to promote physical activity (PA) and reduce sedentary behavior (SB) in free-living young people and adults with a comparator exposed to usual care/minimal intervention; (2) determine whether, and to what extent, such interventions affect PA and SB levels and (3) use the taxonomy of behavior change techniques (BCTs) to describe intervention characteristics.

Methods

A systematic review and meta-analysis following PRISMA guidelines was undertaken to identify randomized controlled trials (RCTs) comparing mHealth interventions with usual or minimal care among individuals free from conditions that could limit PA. Total PA, moderate-to-vigorous intensity physical activity (MVPA), walking and SB outcomes were extracted. Intervention content was independently coded following the 93-item taxonomy of BCTs.

Results

Twenty-one RCTs (1701 participants—700 with objectively measured PA) met eligibility criteria. SB decreased more following mHealth interventions than after usual care (standardised mean difference (SMD) ?0.26, 95 % confidence interval (CI) ?0.53 to ?0.00). Summary effects across studies were small to moderate and non-significant for total PA (SMD 0.14, 95 % CI ?0.12 to 0.41); MVPA (SMD 0.37, 95 % CI ?0.03 to 0.77); and walking (SMD 0.14, 95 % CI ?0.01 to 0.29). BCTs were employed more frequently in intervention (mean = 6.9, range 2 to 12) than in comparator conditions (mean = 3.1, range 0 to 10). Of all BCTs, only 31 were employed in intervention conditions.

Conclusions

Current mHealth interventions have small effects on PA/SB. Technological advancements will enable more comprehensive, interactive and responsive intervention delivery. Future mHealth PA studies should ensure that all the active ingredients of the intervention are reported in sufficient detail.

     

A Reminiscence Program Intervention to Improve the Quality of Life of Long-term Care Residents with Alzheimer's Disease. A Randomized Controlled Trial

Objective: A single-blinded, parallel-groups (intervention, active and passive control groups) randomized controlled trial (RCT) was chosen to investigate whether a specific reminiscence program is associated with higher levels of quality of life in nursing home residents with dementia. Methods: The intervention used a life-story approach, while the control groups participated in casual discussions. The Social Engagement Scale (SES) and Self Reported Quality of Life Scale (SRQoL) were used as the outcome measures, which were examined at baseline (T0), 12 weeks (T1), and six months (T2) after the intervention. The final sample had 135 subjects (active control group = 45; passive control group = 45; intervention group = 45). Results: The Wilcoxon test showed significant differences in the intervention group between T2 and T0, and between T1 and T0 in the SES, and there were significant differences between T0 and T1 (intervention effect size = 0.267) and T1 and T2 (intervention effect size = 0.450) in the SRQoL. The univariate logistic regression scores showed that predictors of change in the SRQoL were associated with fewer baseline anxiety symptoms and lower depression scores. Conclusions: The intervention led to significant differences between the three groups over time, showing a significant improvement in the quality of life and engagement of the residents in the intervention group.     

Increasing Physical Activity Through Principles of Habit Formation in New Gym Members: a Randomized Controlled Trial

Background

The promotion of physical activity (PA) is paramount to public health, yet interventions in the social cognitive tradition have yielded negligible improvements. The limited progression may be due to an overreliance on intention as the proximal determinant of behavior and a lack of consideration of implicit/automatic processes. The purpose of this study was to examine the impact of a habit formation intervention on PA over 8 weeks in a two-arm parallel design, randomized controlled trial.

Methods

Participants (n = 94) were new gym members with the intention to engage in PA but below international PA guidelines at baseline, who were randomized into a control or habit experimental group. The experimental group attended a workshop (at baseline) and received a follow-up booster phone call at week 4. The primary outcome of the study was minutes of moderate-vigorous intensity PA (MVPA) at week 8. The secondary outcome was a manipulation check to determine if the experimental group effectively incorporated habit-building constructs (cues and practice consistency).

Results

The experimental group showed a significant increase in MVPA after 8 weeks in both accelerometry (d = 0.39, p = .04) and self-report (d = 0.53, p = .01) compared with the control group. The experimental group also showed an increase in use of cues (d = 0.56, p < .001) and practice consistency (d = 0.40, p = .01) at week 8.

Conclusion

The results contribute to the initial validity of increasing PA through a focus on preparation cues and practice consistency. Future research should replicate these findings and extend the duration of assessment to evaluate whether PA changes are sustained. Registered Trial Number NCT02785107

     

Impact of a Combined Resistance and Aerobic Exercise Program on Motivational Variables in Breast Cancer Survivors: A Randomized Controlled Trial

Background  Short term exercise interventions have been shown to be beneficial for breast cancer survivors soon after treatments but longer term adherence is needed. Purpose  To examine the effects of a supervised exercise program on motivational variables in breast cancer survivors using Self-Determination Theory (SDT). Method  Sixty breast cancer survivors were randomized in a cross-over design to either an immediate exercise group (IEG; n = 30) that exercised from baseline to week 12 or a delayed exercise group (DEG; n = 30) that exercised from week 12 to 24. SDT variables were assessed at baseline, 6, 12, 18 and 24 weeks using the Behavioral Regulation for Exercise Questionniare-2 and the Basic Psychological Needs Satisfaction Scale. Results  Fifty-eight participants completed the follow-up assessments and achieved a 61.3% adherence rate. Analyses of variance revealed significant time by group interactions for almost all psychological needs and motivations that favored the exercise intervention time periods. For example, autonomy increased in the IEG from baseline to 12 weeks by 2.0 points compared to the DEG where scores decreased by 0.1 points (mean group difference = 2.0, p < 0.001). The cross-over results further supported the main findings. Conclusion  Supervised exercise soon after breast cancer treatments may help to develop a positive exercise motivational profile among breast cancer survivors that could portend longer term adherence. Authors’ Notes: Kerry S. Courneya is supported by the Canada Research Chairs Program and a Research Team Grant from the National Cancer Institute of Canada with funds from the Canadian Cancer Society and the NCIC/CCS Sociobehavioral Cancer Research Network.     

Healthy for Life: A Randomized Trial Examining Physical Activity Outcomes and Psychosocial Mediators

Background

Researchers theorize that interventions increase physical activity by influencing key theory-based mediators (e.g., behavioral processes). However, few studies have been adequately powered to examine the importance of mediators.

Purpose

This study examined both physical activity behavior and psychosocial mediators in a randomized trial specifically powered to detect mediation.

Methods

Healthy, sedentary adults (n?=?448; 70 % Caucasian, 87 % women, mean age was 43) were randomly assigned to either a 6-month print-based theory tailored physical activity intervention (n?=?224) or a 6-month health/wellness contact control arm (n?=?224).

Results

The print intervention arm exhibited greater increases in physical activity than the control arm at 6 and 12 months (p?<?.05). Additionally, behavioral processes were found to be an important mediator of physical activity behavior.

Conclusions

It is important for researchers and practitioners to focus on increasing behavioral strategies for physical activity adoption. Future studies should examine other potential mediators of physical activity.     

Informed Decision Making About Prostate Cancer Testing in Predominantly Immigrant Black Men: A Randomized Controlled Trial

Background

Decision support interventions have been developed to help men clarify their values and make informed decisions about prostate cancer testing, but they seldom target high-risk black and immigrant men.

Purpose

This study evaluated the efficacy of a decision support intervention focused on prostate cancer testing in a sample of predominantly immigrant black men.

Methods

Black men (N?=?490) were randomized to tailored telephone education about prostate cancer testing or a control condition.

Results

Post-intervention, the intervention group had significantly greater knowledge, lower decision conflict, and greater likelihood of talking with their physician about prostate cancer testing than the control group. There were no significant intervention effects on prostate specific antigen testing, congruence between testing intention and behavior, or anxiety.

Conclusions

A tailored telephone decision support intervention can promote informed decision making about prostate cancer testing in black and predominantly immigrant men without increasing testing or anxiety.     

Efficacy and Use of an Internet-delivered Computer-tailored Lifestyle Intervention, Targeting Saturated Fat Intake, Physical Activity and Smoking Cessation: A Randomized Controlled Trial

Background Although experts claim that computer-tailored interventions provided over the Internet have great potential to promote health behavior change, few studies have tested the efficacy of computer-tailored lifestyle interventions online-delivered over the Internet. Purpose To evaluate the short-term (1 month) efficacy of an Internet-delivered, computer-tailored lifestyle intervention targeting saturated fat intake, physical activity (PA), and smoking cessation, and to evaluate exposure to the intervention. Methods A pretest–posttest randomized controlled trial with an intervention group and a no intervention waiting list control group was conducted. Self-reported behavior and determinants were assessed at baseline and 1 month follow-up. Exposure to the intervention was monitored through server registrations. The data were analyzed using multiple linear and logistic regression analysis. Results The intervention resulted in a significantly lower self-reported saturated fat intake (b = −0.76, p < 0.01) and a higher likelihood of meeting the PA guidelines among respondents who were insufficiently active at baseline (OR = 1.34, 95%CI = 1.001–1.80). No significant intervention effects were found for self-reported smoking status. Of the participants, 81% actually visited the website. Conclusions The Internet-delivered, computer-tailored lifestyle intervention was effective in reducing self-reported saturated fat intake and in increasing self-reported PA among participants who completed the study.     

A Randomized Controlled Trial of a Tailored Interactive Computer-Delivered Intervention to Promote Colorectal Cancer Screening: Sometimes More is Just the Same

Background

There have been few studies of tailored interventions to promote colorectal cancer (CRC) screening.

Purpose

We conducted a randomized trial of a tailored, interactive intervention to increase CRC screening.

Methods

Patients 50–70 years completed a baseline survey, were randomized to one of three groups, and attended a wellness exam after being exposed to a tailored intervention about CRC screening (tailored group), a public web site about CRC screening (web site group), or no intervention (survey-only group). The primary outcome was completion of any recommended CRC screening by 6 months.

Results

There was no statistically significant difference in screening by 6 months: 30%, 31%, and 28% of the survey-only, web site, and tailored groups were screened. Exposure to the tailored intervention was associated with increased knowledge and CRC screening self-efficacy at 2 weeks and 6 months. Family history, prior screening, stage of change, and physician recommendation moderated the intervention effects.

Conclusions

A tailored intervention was not more effective at increasing screening than a public web site or only being surveyed.     

Barriers to Supervised Exercise Training in a Randomized Controlled Trial of Breast Cancer Patients Receiving Chemotherapy

Background Exercise adherence is a challenge for breast cancer patients receiving chemotherapy but few studies have identified the key barriers. Purpose In this paper, we report the barriers to supervised exercise in breast cancer patients participating in a randomized controlled trial. Methods Breast cancer patients initiating adjuvant chemotherapy (N = 242) were randomly assigned to usual care (n = 82) or supervised resistance (n = 82) or aerobic (n = 78) exercise. Participants randomized to the two exercise groups (n = 160) were asked to provide a reason for each missed exercise session. Results The two exercise groups attended 70.2% (5,495/7,829) of their supervised exercise sessions and provided a reason for missing 89.5% (2,090/2,334) of their unattended sessions. The 2,090 reasons represented 36 different barriers. Feeling sick (12%), fatigue (11%), loss of interest (9%), vacation (7%), and nausea/vomiting (5%) accounted for the most missed exercise sessions. Disease/treatment-related barriers (19 of the 36 barriers) accounted for 53% (1,102/2,090) of all missed exercise sessions. Demographic and medical variables did not predict the types of exercise barriers reported. Conclusions Barriers to supervised exercise in breast cancer patients receiving chemotherapy are varied but over half can be directly attributed to the disease and its treatments. Behavioral support programs need to focus on strategies to maintain exercise in the face of difficult treatment side effects. Rapid Communication Accepted by Annals of Behavioral Medicine (October 8, 2007).