A preliminary evaluation of the feasibility, acceptability, and health behavior outcomes of a community-based group health coaching for cancer survivors program: a mixed-methods RE-AIM study

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University of Delaware
In the United States, there are currently more than 18 million people living with and beyond cancer with that number expected to increase to 22 million by 2030. This growing population often experiences additional long-standing health challenges, including long-lasting side effects from treatment, an increased risk of cancer recurrence, and having or developing a comorbidity such as diabetes or cardiovascular disease. This can have impacts throughout the lifetime in both physical and mental health, as well as quality of life. It has been found that a substantial cancer burden may be prevented through behavioral lifestyle modifications, such as increasing physical activity, improving diet habits, improving duration and quality of sleep, and managing stress. However, adherence to these behaviors remains low. ☐ Health coaching, a process by which trained coaches help clients establish sustainable behavior changes that align with their strengths and values through client-centered interactions and goal setting, has been shown to be effective at eliciting improvements in the aforementioned behaviors in a variety of populations, including cancer patients and survivors. While typically delivered in a one-on-one format, it can be costly, requires more trained coaches, and is not time efficient to reach a large number of people. As such, health coaching in a group format has started to emerge, however, less is known about this mode as it is still in its early stages of development. Therefore, the purpose of this dissertation was to (1) explore existing group health coaching interventions targeting cancer survivors, specifically examining program composition and measured outcomes, (2) to develop and assess the feasibility and acceptability of a group health coaching program for cancer patients and survivors in a community-based setting using a videoconferencing platform, as well as to assess the preliminary effects of the program on a variety of behavioral lifestyle factors, and (3) to evaluate the program using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. ☐ A scoping review of the literature was first conducted. A systematic search strategy was used between October 2021 and February 2023 to identify intervention studies focused on group health coaching with cancer patients and survivors. Seven studies met the criteria. These studies focused on physical activity, diet, weight loss, or some combination thereof utilizing group health coaching by itself or as one component of an exercise and/or diet intervention. There was a wide range of measured outcomes, which loosely grouped into: feasibility/acceptability; physical activity/exercise; body composition and biomarkers; diet; distress, quality of life, fatigue; and other. Overall, studies were found to be feasible and showed positive results for weight loss, diet, and quality of life. Findings for physical activity, distress, and fatigue were mixed. Additionally, variability was found in many of the group health coaching components. This review suggests group health coaching in the cancer patient and survivor population is still in the nascent stages. However, these studies were deemed highly feasible and satisfactory to the participants, and positive outcomes were associated with these interventions. Future research should consider expanding upon these findings with more robust studies. ☐ Guided by the findings of the scoping review, a community-based group health coaching program was developed. Six group health coaching sessions over a three-month period addressing the topics of stress management, physical activity, sleep, and diet were offered to cancer patients and survivors across the state of Delaware using a videoconferencing platform. Sessions were facilitated by health coaches trained through a National Board for Health and Wellness Coaching accredited training program. Data was collected using a convergent mixed methods approach. Surveys were sent pre- and post-intervention on topics including physical activity, eating habits, perceived stress, anxiety, depression, sleep, and quality of life, followed by post-program focus groups and in-depth interviews. Data on recruitment, attrition, attendance, fidelity, retention, safety, and barriers and facilitators to implementation were also assessed. Survey results were analyzed using repeated measures multilevel modeling. Inductive thematic analysis was used to analyze qualitative data. Overall, this intervention was considered feasible to implement and found acceptable by both participants and health coaches. A total of 26 participants attended an average of 74% of coaching sessions. Coaching participants also noted a moderate increase in total weekly physical activity minutes (p= 0.032, d=0.50). A small increase was seen in weekly moderate-vigorous physical activity frequency (p=0.045, d=0.39). Additionally, a moderate increase was found in functional wellbeing (p<0.001, d=0.50). This suggests group health coaching may be a feasible and acceptable way to promote behavior change in cancer patients and survivors, particularly for physical activity and functional wellbeing. ☐ The group health coaching program was then evaluated using the RE-Aim framework. The main outcomes of this study were mapped onto the five dimensions of RE-AIM. As mentioned, 26 participants attended an average of 74% of coaching sessions with an overall fidelity rate of 89.7%. Participants were more likely to be female, White, older, have a higher educational attainment, and have had breast cancer than the state population. The biggest adaptation included extending the time of sessions. The primary support to implementation included the use of NBHWC trained coaches while the primary barrier was the videoconferencing platform. While some challenges for recruitment and implementation were noted, the program will transition to a completely community-based project going forward. ☐ In summary, group health coaching with the cancer population was feasible to implement and found to be acceptable to cancer patients and survivors in the state of Delaware. It was successfully implemented within a community setting and may be particularly effective for changing physical activity levels and physical functioning scores. Provided in this format, the cancer patients and survivors are provided with peer support beyond what the coach alone can provide and allows for ongoing learning and connection with others, despite participants having different cancers and being in different places in their journey. Going forward, the program will be refined based on feedback from participants and coaches before being implemented within Cancer Support Community Delaware locations across the state.
Cancer, Health behavior change, Health coaching, Functional wellbeing, Videoconferencing platform