Co-designing and evaluating the feasibility of an online physical activity, nutrition, and psychosocial intervention for post-treatment cancer survivors

Author: Morgan Leske

Leske, Morgan, 2024 Co-designing and evaluating the feasibility of an online physical activity, nutrition, and psychosocial intervention for post-treatment cancer survivors, Flinders University, College of Education, Psychology and Social Work

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Abstract

Regular physical activity and a nutritious diet following anti-cancer treatment can improve cancer survivors’ Quality of Life (QoL), but many are not meeting healthy lifestyle recommendations. Qualitative research suggests cancer survivors desire holistic programs that target physical health, mental health and adjustment following treatment. Online-platforms offer an accessible delivery modality for such multicomponent interventions. This thesis aimed to evaluate evidence for effectiveness of multicomponent interventions and co-design an online physical activity, nutrition, and psychosocial support intervention for cancer survivors.

The first study comprised a systematic review and meta-analysis of healthy living interventions effect on post-treatment cancer survivors’ QoL, and the moderating effect of including a mental health component. Ninety-two articles were included, and 53 effect sizes were extracted. The pooled effect size demonstrated a small positive effect of healthy living interventions in comparison to control (d = 0.30). Subgroup analyses revealed no differences between interventions which did versus did not include mental health, however, this finding was based on a small number of interventions that included mental health.

The second study co-designed Healthy Living after Cancer Online (HLaC Online). A basic outline of the program was presented in focus groups and interviews to cancer survivors, oncology healthcare professionals, and cancer support representatives. Thematic analysis of the transcripts identified five themes relating to website design, promoting and maintaining long term engagement, relatability and relevance, navigating professional support, and family and peer support. Recommended changes, such as simple activities and guidance videos, were integrated into HLaC Online.

A mixed-methods study, including pre/post questionnaires and an interview, was then used to evaluate the feasibility and usability of HLaC Online. Eleven cancer survivors participated in the 12-week program. Five participants did not interact with HLaC Online. The remaining participants on average accessed 3.33 modules. Perceived usability varied. Qualitative feedback indicated that topics were relevant and helpful, but motivation challenges emerged relating to cancer-related symptoms and the program’s perceived time burden. One suggestion was to provide human guidance for website orientation and accountability.

The final study evaluated whether adding brief telephone support improved the feasibility of HLaC Online. Fifty-two cancer survivors were randomised (n=47 commenced allocated intervention) to receive HLaC Online as self-directed (n=25) or with two telephone coaching calls (HLaC Online+coaching n=22). Participants completed questionnaires at baseline, post-intervention, and one-month follow-up. HLaC Online+coaching participants rated usability and satisfaction higher. A higher proportion of HLaC Online participants did not engage with the intervention. Preliminary efficacy signals found small to moderate improvements for symptom distress, fibre intake behaviours, and sitting time in both conditions. HLaC Online yielded small improvements in QoL, while HLaC Online+coaching demonstrated moderate improvements in fear of cancer recurrence.

Overall, findings indicated that HLaC Online is feasible and holds promise for supporting cancer survivors achieving a healthy lifestyle. However, lack of intrinsic motivation can be a barrier to intervention engagement. Adding two telephone coaching calls can reduce non-engagement. Developing a standardised assessment to identify participants at risk of non-engagement could be used to appropriately stratify telephone coaching calls in future.

Keywords: cancer survivorship, digital health, co-design, lifestyle intervention, complex interventions

Subject: Psychology thesis

Thesis type: Doctor of Philosophy
Completed: 2024
School: College of Education, Psychology and Social Work
Supervisor: Lisa Beatty