Porter Kathleen J, Moon Katherine E, LeBaron Virginia T, Zoellner Jamie M
Department of Public Health Sciences, School of Medicine, University of Virginia, Christiansburg, VA, United States.
Department of Acute & Specialty Care, School of Nursing, University of Virginia, Charlottesville, VA, United States.
JMIR Cancer. 2021 Apr 12;7(2):e26010. doi: 10.2196/26010.
Addressing the modifiable health behaviors of cancer survivors is important in rural communities that are disproportionately impacted by cancer (eg, those in Central Appalachia). However, such efforts are limited, and existing interventions may not meet the needs of rural communities.
This study describes the development and proof-of-concept testing of weSurvive, a behavioral intervention for rural Appalachian cancer survivors.
The Obesity-Related Behavioral Intervention Trials (ORBIT) model, a systematic model for designing behavioral interventions, informed the study design. An advisory team (n=10) of community stakeholders and researchers engaged in a participatory process to identify desirable features for interventions targeting rural cancer survivors. The resulting multimodal, 13-week weSurvive intervention was delivered to 12 participants across the two cohorts. Intervention components included in-person group classes and group and individualized telehealth calls. Indicators reflecting five feasibility domains (acceptability, demand, practicality, implementation, and limited efficacy) were measured using concurrent mixed methods. Pre-post changes and effect sizes were assessed for limited efficacy data. Descriptive statistics and content analysis were used to summarize data for other domains.
Participants reported high program satisfaction (acceptability). Indicators of demand included enrollment of cancer survivors with various cancer types and attrition (1/12, 8%), recruitment (12/41, 30%), and attendance (median 62%) rates. Dietary (7/12, 59%) and physical activity (PA; 10/12, 83%) behaviors were the most frequently chosen behavioral targets. However, the findings indicate that participants did not fully engage in action planning activities, including setting specific goals. Implementation indicators showed 100% researcher fidelity to delivery and retention protocols, whereas practicality indicators highlighted participation barriers. Pre-post changes in limited efficacy outcomes regarding cancer-specific beliefs and knowledge and behavior-specific self-efficacy, intentions, and behaviors were in desired directions and demonstrated small and moderate effect sizes. Regarding dietary and PA behaviors, effect sizes for fruit and vegetable intake, snacks, dietary fat, and minutes of moderate-to-vigorous activity were small (Cohen d=0.00 to 0.32), whereas the effect sizes for change in PA were small to medium (Cohen d=0.22 to 0.45).
weSurvive has the potential to be a feasible intervention for rural Appalachian cancer survivors. It will be refined and further tested based on the study findings, which also provide recommendations for other behavioral interventions targeting rural cancer survivors. Recommendations included adding additional recruitment and engagement strategies to increase demand and practicality as well as increasing accountability and motivation for participant involvement in self-monitoring activities through the use of technology (eg, text messaging). Furthermore, this study highlights the importance of using a systematic model (eg, the ORBIT framework) and small-scale proof-of-concept studies when adapting or developing behavioral interventions, as doing so identifies the intervention's potential for feasibility and areas that need improvement before time- and resource-intensive efficacy trials. This could support a more efficient translation into practice.
在受癌症影响尤为严重的农村社区（如阿巴拉契亚中部地区），关注癌症幸存者可改变的健康行为非常重要。然而，此类努力有限，现有干预措施可能无法满足农村社区的需求。
本研究描述了weSurvive的开发及概念验证测试，这是一种针对阿巴拉契亚农村癌症幸存者的行为干预措施。
肥胖相关行为干预试验（ORBIT）模型，一种用于设计行为干预的系统模型，为研究设计提供了参考。一个由社区利益相关者和研究人员组成的咨询团队（n = 10）参与了一个参与式过程，以确定针对农村癌症幸存者的干预措施的理想特征。由此产生的为期13周的多模式weSurvive干预措施被提供给两个队列中的12名参与者。干预组成部分包括面对面小组课程以及小组和个性化远程医疗电话。使用同步混合方法测量反映五个可行性领域（可接受性、需求、实用性、实施和有限疗效）的指标。对有限疗效数据评估前后变化和效应大小。描述性统计和内容分析用于总结其他领域的数据。
参与者报告了较高的项目满意度（可接受性）。需求指标包括不同癌症类型的癌症幸存者的入组情况以及损耗率（1/12，8%）、招募率（12/41，30%）和出勤率（中位数62%）。饮食（7/12，59%）和身体活动（PA；10/12，83%）行为是最常被选择的行为目标。然而，研究结果表明参与者并未充分参与行动计划活动，包括设定具体目标。实施指标显示研究人员对交付和保留协议的保真度为100%，而实用性指标突出了参与障碍。关于癌症特异性信念和知识以及行为特异性自我效能、意图和行为的有限疗效结果的前后变化朝着预期方向发展，并显示出小到中等的效应大小。关于饮食和PA行为，水果和蔬菜摄入量、零食、膳食脂肪以及中度至剧烈活动分钟数的效应大小较小（科恩d = 0.00至0.32），而PA变化的效应大小为小到中等（科恩d = 0.22至0.45）。
weSurvive有可能成为针对阿巴拉契亚农村癌症幸存者的可行干预措施。将根据研究结果对其进行完善和进一步测试，这些结果也为针对农村癌症幸存者的其他行为干预提供了建议。建议包括增加额外的招募和参与策略以提高需求和实用性，以及通过使用技术（如短信）提高参与者参与自我监测活动的责任感和积极性。此外，本研究强调了在调整或开发行为干预措施时使用系统模型（如ORBIT框架）和小规模概念验证研究的重要性，因为这样做可以在进行耗时和资源密集的疗效试验之前确定干预措施的可行性潜力和需要改进的领域。这可以支持更有效地转化为实践。
