Background
Methods
Steps | Description |
---|---|
Step 1 | Needs assessment, organizational capacity, and logic models |
1a | Describe organizational capacities and goals |
1b | Conduct a needs assessment to describe the health/behavior problems and develop a logic model of the problem |
1c | Develop a logic model of change |
1d | Write program goals |
Step 2 | Search for evidence-based interventions (EBIs) |
2a | Search for EBIs to address the health problem/ risk behavior/ environmental factor |
2b | Judge basic fit to health problem, behavior, priority population, and organizational capacity |
Step 3 | Assessment of detailed fit and planning of adaptations |
3a | Judge behavioral and environmental fit and list adaptations |
3b | Judge determinants and change methods fit and list adaptations |
3c | Judge delivery, design, and cultural fit and list adaptations |
3d | Judge implementation fit and list adaptations |
3e | Identify essential elements of the selected intervention and how to retain them |
Step 4 | Adaptation of materials and activities |
4a | Prepare design documents for adaptation |
4b | Pre-test adapted materials |
4c | Produce final adaptations |
Step 5 | Planning of implementation |
5a | Identify facilitators, facilitation behaviors, and outcomes |
5b | Develop facilitation scope, sequence, and instructions |
5c | Plan activities to motivate and train for facilitation |
5d | Plan logistics including budget, staffing, and materials |
Step 6 | Planning of evaluation |
6a | Write evaluation questions |
6b | Choose indicators and measures |
6c | Choose the evaluation design |
6d | Planning data collection, analysis, and reporting |
Step 1 Needs assessment, organizational capacity, and logic models
Step 2 Search for evidence-based interventions (EBIs)
Step 3 Assessment of detailed fit and planning of adaptations
Step 4 Adaptation of materials and activities
Step 5 Planning of implementation
Step 6 Planning of evaluation
Results
Step 1 Needs assessment, organizational capacity, and logic models
1a. Organizational capacity
1b. Needs assessment and logic model of the problem
1c. Logic model of change
1d. Program goals
Step 2 Search for evidence-based interventions (EBIs)
2a. Search for EBIs
2b. Judge basic fit
Step 3 Assess (detailed) fit and plan adaptations
Judging | Adaptations |
---|---|
Behavioral and environmental fit | Shifting the focus from weight loss to healthy eating and physical activity |
Emphasize the importance of healthy lifestyle on overall HRQoL | |
Acknowledge the difficulty of behavior change given the symptoms and side effects burden | |
Keep their health care team updated of any weight changes > 5% | |
Diet quality: Stronger focus on a plant-based diet (based on vegetables, fruits, whole grains, beans,nuts and limiting the amount of red and processed meat, other processed foods, salt, added sugars, refined grains, and saturated fats) | |
Diet quantity: Portion recommendation based on a 2.000 kcal diet. “Cut down on quantity” section rephrased to “Keep an eye on portion sizes” with respective changes in food portion recommendations | |
Physical activity: Emphasize the link between physical activity and cancer and its benefits particularly for cancer survivors | |
Addition of muscle strengthening exercises | |
Addition of section on sleep hygiene | |
Update of the suggested cookbooks | |
Reference to potentially useful mobile applications | |
Determinants and change methods fit | Addition of practical applications: • Understanding the risk benefits of supplements • Approval of the booklet content from cancer nurses • Recognize ways of maintaining a balanced diet in the presence of bowel symptoms • Recognize ways of avoiding risk for food born-illnesses • Be prompted to carry wallet-size cards with healthy and unhealthy options in various types of restaurants • Be prompted to identify the triggers for unhealthy eating and generate a strategy to overcome them (e.g. do not skip meals before going to a party to avoid overeating) • Know about the link between physical activity and sleep • Provide pictures of cancer survivors demonstrating sample strength, balance, and flexibility exercises and instructions of how to perform those • Practice some of the resistance exercises during the session following the booklet’s instructions • Be prompted to identify the triggers for sedentary behaviors and generate a strategy to overcome them (e.g. have an alternative PA plan in case of foul weather) • Understand what fatigue is • Select strategies from a list of suggestions to help them overcome fatigue and facilitate physical activity |
Removal of practical applications: • Recognition of the various factors that influence weight and the health consequences of obesity • Differentiate refined and unrefined carbohydrates and low/high GI • Calculate % calories from fat in food and compare it with guidelines • Recognize the value of healthy range of weight rather than an ideal weight and the benefits of gradual weight loss • Set a realistic weight goal (either loss or maintenance) as an outcome of changed eating and physical activity patterns • Receive advice to weight themselves on a regular basis that they will decide upon • Record weight in the diaries • Demonstrate BMI calculation • Apply the BMI to their own weight and height and] compare it with standard cut-offs • Recognize the connection between weight control and PA • Recognize approximate energy expenditure (kcal) for various lifestyle activities | |
Design, delivery, and cultural fit | Addition of motivational quotes from other cancer survivors Addition of cancer-specific resources (e.g. Macmillan Cancer Support) Addition of recommendations for managing fatigue and bowel issues Addition of a section on healthy lifestyle specifically for endometrial cancer survivors |
Implementation fit | Addition of short briefing about the adapted program in the facilitators’ training |
3a. Behavioral fit
3b. Determinants and change methods
3c. Delivery, design, and cultural fit
3d. Implementation fit
3e. Essential elements
Performance objectives | Change objectives | BCTs | Theory | Practical application | S/SB/B |
---|---|---|---|---|---|
PO 1. Have a regular eating pattern | OE 1.1. Identify their current eating pattern | Feedback on behavior | CT | From a list of 7 different eating patterns, the person picks the one that applies to them and reads feedback based on their choices | B |
KN 1.1. Recognize the benefits of regular eating and breakfast | Information about health consequences | SCT | Verbal and written explanation that regular eating can regulate hunger and that breakfast can improve cardio metabolic risk | SB | |
SE 1.1. Express confidence in their ability to start following a regular eating pattern and eating breakfast regularly | Habit formation | SCT | Be prompted to start eating at the same time each day | SB | |
SE 1.2. Express confidence in eating regularly | Problem solving and social support (unspecified) | SCT | Identify barriers to eating regularly during the previous week | S | |
Generate strategies (as a group) to overcome barriers and increase facilitators to regular eating | S | ||||
GO 1.1. Be prompted to increase the difficulty of their goals slowly until behavior is performed | Graded tasks | SCT | Be prompted to make behavioral changes in the following order • Changes towards PO 1 • Changes towards PO 2 • Changes towards PO 3 | SB | |
GO 1.2. Set a regular eating goal | Behavioral goal setting | SCT | Set a SMART regular eating goal based on GO 4.1. | S |
Performance objectives | Change objectives | BCTs | Theory | Practical application | S/SB/B |
---|---|---|---|---|---|
PO 1. Reduce sedentary behaviors | OE 1.1. Assess their current PA and evaluate required PA changes | Feedback on behavior | CT | Complete a quiz about physical activity levels and receive written feedback based on their score. | SB |
OE 1.2. Understand the difference between physical activity and exercise | Framing/reframing | CT | Understand that exercise is only one of a range of physical activities that can promote health | S | |
KN 1.1. Recognize the benefits of PA | Information about health and emotional consequences | SCT | Know about the physical and emotional benefits of physical activity | SB | |
Know about the link between physical activity and sleep | |||||
SE 1.1. Express confidence in being more physically active | Problem solving | SCT | Identify potential barriers to physical activity and generate strategies to overcome them | SB | |
SE 1.2. Express confidence in reducing sedentary behaviors | Instructions on how to perform the behavior | SCT | Recognize ways of reducing sedentary behaviors | B | |
Recognize ways of improving sleep quality | B | ||||
GO 1.1. Set a goal to reduce sedentary time | Behavioral goal setting | SCT | Set a SMART physical activity goal based on GO 4.1. | S |