| Author: | Gan, Ting |
| Title: | An evidence-based behavior change intervention for improving multiple dietary behaviors in Chinese gastric cancer survivors : intervention development and pilot randomized controlled trial |
| Advisors: | Cheng, Eileen (SN) |
| Degree: | Ph.D. |
| Year: | 2023 |
| Subject: | Stomach -- Cancer Diet Food habits Hong Kong Polytechnic University -- Dissertations |
| Department: | School of Nursing |
| Pages: | xiv, 354 pages : color illustrations |
| Language: | English |
| Abstract: | Background: Over half of the gastric cancer survivors worldwide live in China. Dietary behaviors are modifiable risk factors of cancer, but cancer survivors including gastric cancer survivors seldom adopt healthy dietary behaviors as recommended by dietary guidelines. Behavior change interventions are proven to be efficacious in improving multiple dietary behaviors in survivors with some types of cancer, but evidence has not been found for gastric cancer survivors. Nurse-led dietary interventions have successfully promoted healthy diet among diverse populations, while evidence on nurse's role in dietary care for cancer population remained limited. Hence, the aim of this study was to develop a nurse-led behavior change intervention for improving dietary behaviors in gastric cancer survivors based on multiple sources of evidence. The feasibility, acceptability, and preliminary effectiveness of delivering this intervention were evaluated to inform a future definitive trial. Methods: According to the Medical Research Council framework, the present study consisted of two phases: (1) Phase 1: intervention development; and (2) Phase 2: a pilot randomized controlled trial (RCT). For Phase 1, the initial intervention protocol was developed based on Chinese and international dietary guidelines, the Social Cognitive Theory, multiple systematic reviews, and a descriptive qualitative study involving focus group interviews with 13 gastric cancer survivors. The intervention protocol was validated through an expert panel (n=6). For the pilot RCT in Phase 2, the participants were adult gastric cancer survivors who had received a gastrectomy and were able to eat orally, all of whom were enrolled from a local cancer center in Wuhan, China. The intervention group received a four-week nurse-led behavior change intervention for improving the intake of fruit, vegetable, and soybean and reducing the intake of salt, alcohol, and processed meat. Only usual care was provided for the control group. The primary outcomes were feasibility and acceptability. Feasibility was assessed using time to complete the recruitment, eligibility rate, recruitment rate, retention rate, and attendance rate. Acceptability was assessed using a self-developed questionnaire with 20 close-ended questions and seven open-ended questions. The secondary outcomes were dietary behaviors, health-related quality of life (HRQOL), general self-efficacy, and self-efficacy for dietary behaviors. The outcomes were measured at T0 (baseline)and T1 (first week after intervention). Descriptive analysis and inferential analysis were applied for the quantitative data, while qualitative content analysis was used for the qualitative data. The intention to treat principle was also applied. Results: Thirty-five participants consented to take part in the pilot RCT. Time to complete the recruitment was 134 days. Eligibility, recruitment, retention, and attendance rates were 52.87%, 42.17%, 94.29%, and 64.71%, respectively. All the participants in the intervention group agreed or very much agreed on 17 of the 20 statements about the intervention's acceptability in the aspects of the intervention's rationale, booklet, delivery mode, location, duration, dosage, and provider. The qualitative data from the open-ended questions well echoed the quantitative data regarding the acceptability of the intervention. Fruit intake increased within both groups, with a significant mean between-group difference in change of 71.93 grams (95% CI = 20.92, 122.94; effect size = 1.04, 𝑝 = 0.007), favoring the intervention group. The mean between-group differences in change of vegetable, soybean, and salt were 18.84 grams (95% CI = -28.78, 66.46), 0.3 grams (95% CI = -4.2, 5.0), 0.53 grams (95%CI = -2.14, 1.08), respectively; all with the trend of favoring the intervention group but did not reach statistical significance (𝑝 > 0.05). Both groups had no intake of alcohol and processed meat after the intervention. No significant between-group difference was observed for all domains of HRQOL and self-efficacy (all with 𝑝＞0.5). Conclusion: The nurse-led behavior change intervention designed for improving multiple dietary behaviors had adequate feasibility and excellent acceptability among Chinese gastric cancer survivors. The study demonstrated the potential of the intervention for improving fruit intake but not for the other dietary behaviors, HRQOL and self-efficacy, possibly due to the small sample size. Before progressing to a definitive trial, modifications are needed to optimize the intervention. |
| Rights: | All rights reserved |
| Access: | open access |
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