Use of intervention mapping to adapt a health behavior change intervention for endometrial cancer survivors: the shape-up following cancer treatment program

Abstract

BackgroundAbout 80% of endometrial cancer survivors (ECS) are overweight or obese and have sedentary behaviors. Lifestyle behavior interventions are promising for improving dietary and physical activity behaviors, but the constructs associated with their effectiveness are often inadequately reported. The aim of this study was to systematically adapt an evidence-based behavior change program to improve healthy lifestyle behaviors in ECS.MethodsFollowing a review of the literature, focus groups and interviews were conducted with ECS (n = 16). An intervention mapping protocol was used for the program adaptation, which consisted of six steps: a needs assessment, formulation of matrices of change objectives, selection of theoretical methods and practical applications, program production, adoption and implementation planning, and evaluation planning. Social Cognitive Theory and Control Theory guided the adaptation of the intervention.ResultsThe process consisted of eight 90-min group sessions focusing on shaping outcome expectations, knowledge, self-efficacy, and goals about healthy eating and physical activity. The adapted performance objectives included establishment of regular eating, balanced diet, and portion sizes, reduction in sedentary behaviors, increase in lifestyle and organized activities, formulation of a discrepancy-reducing feedback loop for all above behaviors, and trigger management. Information on managing fatigue and bowel issues unique to ECS were added.ConclusionsSystematic intervention mapping provided a framework to design a cancer survivor-centered lifestyle intervention. ECS welcomed the intervention and provided essential feedback for its adaptation. The program has been evaluated through a randomized controlled trial.Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5329-5) contains supplementary material, which is available to authorized users.

Awareness of Health Outcomes Associated with Insufficient Physical Activity and Associations with Physical Activity Intentions and Behavior

“…The importance of awareness of the role of physical activity in health is recognized by many researchers and practitioners, who often include educational material about the topic in individual-level interventions and mass media campaigns (for a meta-analysis and systematic review, see (Howlett, Trivedi, Troop, & Chater, 2018); see also (Casey, Coote, & Byrne, 2018; Faulkner, Yun, Tremblay, & Spence, 2018; Howlett et al, 2018; Koutoukidis et al, 2018; Sylvester, Zammit, Fong, & Sabiston, 2017; U.S. Department of Health and Human Services, U.S. Department of Agriculture, U.S. Department of Education, & U.S. Department of the Interior, 2010).…”

“…Research that relies on samples comprised of individuals who represent only a portion of the population may be useful for developing targeted or tailored interventions (e.g., (Koutoukidis et al, 2018)), but it may be less helpful for surveillance efforts that monitor awareness in the general population and across multiple demographic groups. Monitoring awareness in the population is important for identifying potential health disparities.…”

Diet, physical activity, and health-related outcomes of endometrial cancer survivors in a behavioral lifestyle program: the Diet and Exercise in Uterine Cancer Survivors (DEUS) parallel randomized controlled pilot trial

“…Strengths of the study include the systematic development of the theory-based intervention with patient input,13 use of a randomized design, validated outcome measures, masking of the 8-week assessor to intervention allocation, and medium-term follow-up. The intervention fits within the top 10 research priorities for endometrial cancer research5 and with the National Cancer Survivorship Initiative aim of delivering sustainable personalized lifestyle support to people with cancer 31.…”

“…We have previously adapted 'Shape-Up', an evidence- and group-based behavioral lifestyle intervention12 that is already running within the healthcare system, to the particular needs and preferences of this cancer group using patient input and a systematic framework 13. We piloted the program showing acceptable feasibility and high participant satisfaction 14…”

Sedentary behavior after breast cancer: motivational, demographic, disease, and health status correlates of sitting time in breast cancer survivors

“…Thus, targeting MVPA alone will not necessarily result in decreased sedentary behavior [17]. Work is beginning to be done in both breast cancer [18] as well as other tumor groups, including endometrial [19] and colon-cancer [20] survivors, to design interventions that specifically target reducing sedentary behavior beyond increasing MVPA. However, to our knowledge, no published outcomes from trials specifically focused on reducing sedentary behaviors among breast cancer survivors exist.…”