Motivational Interviewing interventions aiming to improve health behaviors among cancer survivors: A systematic scoping review

Abstract

Purpose.

The scoping review aimed to map out the literature on the utilization of Motivational Interviewing (MI) to improve health behaviors (i.e., physical activity, nutrition) in adult cancer survivors.

Methods:

This scoping review was conducted following the methods and protocol outlined by the Joanna Briggs Institute Methods Manual. Five databases, including PubMed, CINAHL, Web of Science, and SPORTDiscus, were searched in February 2022 to identify MI interventions to improve health behaviors among cancer survivors.

Results.

The review included 22 interventions mostly designed to optimize exercise/physical activity (50%). The number of sessions ranged from 2 to 19, and most MI sessions were offered via telephone calls combined with face-to-face sessions (31.8%). Of the interventions, 81.8% improved at least one outcome measurement. Most studies used principles of MI such as empathy expression, developing discrepancy, roll with resistance, and supporting self-efficacy.

Conclusion.

The use of MI appears to have the potential to improve health behaviors in various settings for individuals on different cancer care trajectories.

Implications for Cancer Survivors.

Healthcare providers can use MI to support physical activity and a healthy diet. Future research should focus on providing evidence on the utilization of MI with minimum standards and longitudinal outcome assessment for developing and maintaining sustainable healthy behaviors.

Introduction

Cancer is a major public health issue worldwide and is the second leading cause of death in the United States (US) [1]. Excluding non-melanoma skin cancer, at least 42% of newly diagnosed cancers in the US are potentially preventable, including at least 18% caused by a combination of physical inactivity, excess body weight, poor nutrition, and alcohol consumption [2]. Healthy behaviors such as being physically active, maintaining healthy body weight, and healthy dietary intake reduce comorbidities, cancer recurrence risk, and overall survival, while improving overall wellbeing and quality of life (QOL) of cancer survivors [3–6]. Well-established guidelines [4, 6] for cancer survivors recommend strategies to improve dietary intake and physical activity patterns; however, cancer survivors have a lower prevalence of physical activity and healthy body mass index (BMI) than people without a cancer history [7]. Uncertainty remains about how to assist cancer survivors in initiating and maintaining health behavior change [8]. Many cancer survivors have individualized nutritional and physical activity needs based on their specific cancer type and treatment [6], suggesting that a personalized approach is needed to facilitate sustainable behavior change.

Health behaviors among cancer survivors have been targeted through theory-based interventions in different medical, community, or home settings to improve sustainability and adaptation of health behaviors [ 9, 10]. These interventions mostly used implementation science frameworks that aim to guide the process and explain and evaluate the outcomes of the implementation [11]. Psychological behavior change theories, such as the Theory of Planned Behavior (TPB), the Transtheoretical model (TTM), and the Social Cognitive Theory (SCT), have all been used to address health promotion [12] and explore determinants of behavior change among cancer survivors [9, 10, 13]. Although there is some overlap in these frameworks and models, each model offers unique approaches to address barriers and enablers in translating theory into practice [11]. Recent studies have provided compelling evidence that using such theories improved the effectiveness of behavioral interventions [9, 10, 14]; however, theory-based interventions still require more investigation to understand the theories’ specific contributions to the targeted outcomes of the intervention [15].

Individual behavioral change is complex, and it requires both motivation (the will) and cognitive (the way) processes. The will —the motivational factors that propel behavior and the cognitive skills, capacities, and abilities collectively known as executive function— are necessary for a behavioral change [16]. Individuals are often ambivalent, simultaneously holding reasons for changing and continuing existing behavior patterns [12]. Community and built environments can create barriers or facilitators to healthy behaviors [6] and influence individual behavioral change [2]. Focusing on influencing factors may facilitate change, such as creating opportunities to feel competent, connected to and accepted by others, and autonomy in health behaviors [17]. Motivational Interviewing (MI), a person-centered approach, aims to empower individuals through developing motivations for behavioral change [12, 18]. The common principles of MI involve the application of (1) expressing empathy to establish rapport (2) developing discrepancy to understand current behavior and goal) (3) rolling with resistance to resolve ambivalence (4) supporting self-efficacy for behavioral change [18, 19].

A few systematic reviews and meta-analyses reported that MI has been used in cancer care. Chan et al. [19] focused on MI use in cancer screening, and Pudkasam et al. [13] focused on different motivational strategies, including MI for improving physical activity [13]. Another review also reported on MI use in different aspects of cancer care, such as diet and symptom management [12]. Although research on the use of MI on health behaviors for cancer survivors has grown recently, limited research explicitly synthesizes MI literature specific to health behaviors among people affected by cancer. Synthesizing the MI approaches used in multiple health behavior changes in cancer survivors is essential to guide the development of sustainable and resource-appropriate interventions for cancer survivors, specifically those who struggle to initiate and maintain healthy behaviors. This knowledge will be an essential step toward improving the long-term effect of health behavior interventions to optimize the wellbeing and QOL of individuals affected by cancer.

Aims

The purpose of this systematic scoping review was to map out the literature on the utilization of MI to improve health behaviors (i.e., physical activity, nutrition, or diet) in adult cancer survivors. We specifically aimed to explore the use of MI interventions to improve physical activity and diet. To achieve this, this review aimed to summarize a) the characteristics of MI interventions (e.g., type of delivery, duration, providers) that are used to improve health behaviors (physical activity and nutrition) in adult cancer survivors; b) the effects of the interventions that used MI on health behavior optimization in cancer survivors, c) characteristics of MI (duration, mode of delivery, providers, main MI principles) used to improve cancer survivors’ health behaviors.

Protocol

This review used the protocol outlined by the Joanna Briggs Institute (JBI) Methods Manual for systematic reviews. The findings were reported using the elements provided in the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-Scr) [20].

Inclusion and exclusion criteria

Studies were required to deliver an MI intervention to participants. Study designs included were experimental or quasi-experimental and randomized or nonrandomized designs with qualitative and quantitative assessments. Cancer survivors included individuals with a recent cancer diagnosis, those in active treatment and recovery or living after recovery, those with advanced cancer, and those at the end of life [4]. This review included studies in which the authors reported using MI techniques in any part of the intervention. MI was used to improve physical activity, healthy diet, weight management, or sedentary behavior among cancer survivors aged 18 years and older.

The exclusion criteria were non-English language studies; theses and dissertations (not published in peer-reviewed journals); conference abstracts published in journals, exclusively descriptive and non-interventional studies, and retrospective or secondary data analyses that did not report primary data on MI interventions on health behaviors and/or studies reporting only study protocol. We also excluded studies using other motivational strategies (motivation support, wearable devices such as fitness tracker pedometer) to improve health behaviors.

Data Sources and Search Strategy

We searched five databases, including PubMed, CINAHL, Web of Science, PsycINFO, and SPORTDiscuss in February 2022, with the following search terms (Motivational Interviewing) AND ((Neoplasm) OR (Cancer) OR (Oncology) OR (Malignant*) AND (health behaviors or healthy lifestyle or health practices OR physical activity OR exercise OR diet OR nutrition)).

Study selection process

Rayyan QCRI web application was used to manage articles from multiple database searches [21]. Titles and abstracts of articles identified in the search process were imported into the application. Study selection was made in two stages: in the first stage, titles and abstracts were reviewed; in the second stage, full texts of the articles were reviewed for inclusion. Two authors (MS, SA) reviewed the articles separately using the same inclusion and exclusion criteria, and a consensus was reached for each article included among all authors.

The initial search yielded a total of 1157 articles. After removing duplicates, the title and abstract of 705 articles were reviewed. A total of 36 primary research articles remained for full-text review. Nineteen were excluded in this stage due to reporting only study protocol (n=3), including people not affected by cancer (n=5), secondary analyses of interventions (n=1), abstract only (n=3), dissertation (n=5), and non-English article (n=1). Five articles were found through the reference check of the included article. The review included 22 articles (Figure I. Prisma diagram).

Figure I.

Prisma Diagram

Data Extraction

We created a data extraction tool to code the following: year of publication, country of study setting, study design, characteristics of the population studied, description of the intervention (i.e., aim, duration, format, and theory used), main principles of MI used, and main findings on behavioral changes and health outcomes (Supplement 1). MI principles were described in terms of application of the following techniques: (1) empathy expression (building a meaningful connection and establishing rapport) (2) develop discrepancy (understanding of current behavior and goal, developing a specific direction about change) (3) roll with resistance (attention to resistance, eliciting motivation to change) (4) supporting self-efficacy (commitment to change by developing a concrete plan of action [18].

Appraisal of the quality of the studies

Because this is a scoping review, we did not conduct a risk of bias assessment, which is consistent with the Joanna Briggs Institute Scoping Review Methods Manual [20].

Results

Descriptive characteristics of studies

There were 22 interventions published between 2007–2020 included in this review. Most of the interventions were conducted in the US (n =14, 63.6%), other interventions were conducted in New Zealand (n=1, 4.5%), Australia (n=5, 22.7%), the United Kingdom (n=1, 4.5%) and Luxemburg (n=1, 4.5%). Most interventions evaluated used a randomized controlled trial design (n= 13, 59.1%), followed by a pre-post-test study design (n=5, 22.7%).

Targeted Population and Health Behaviors

Many of the studies targeted individuals with breast cancer (n= 15, 68.2%) and who completed their medical treatment (n=16, 72.7%). The majority of interventions were designed to modify some aspects of exercise and physical activity (n=11, 50%), diet (n=5, 22.7%) exclusively or in combination with nutrition optimization among cancer survivors (n=3, 13.6%) (Table 1).

Table 1.

Descriptive Characteristics of The Interventions (n=22)

	n	%
Cancer types
All cancers	4	18.2
Head and neck cancers	2	9.1
Breast (or mostly) cancer	15	68.2
Colorectal cancers	1	4.5
Cancer care points of the study sample
During active treatment (chemotherapy)	2	9.1
During active treatment (radiotherapy)	2	9.1
After completion of active treatment	16	72.7
During active treatment or after completion of active treatment	1	4.5
Unknown	1	4.5
Targeted health behaviors
Exercise / Physical activity	11	50.0
Nutrition / Diet	5	22.7
Exercise / Physical Activity and Nutrition	3	13.6
Exercise / Physical Activity and Nutrition and Weight Management	2	9.1
Weight Management	1	4.5
Theory/ framework used with MI constructs (n=13)
Social Cognitive Theory	5	23.8
Transtheoretical Theory	3	14.3
Cognitive Behavioral Theory	2	9.5
Stage of Change framework	1	4.8
Social Contextual Model	1	4.8
Social Cognitive Theory of behavior change	1	4.8
Transtheoretical model of stress and cope	1	4.8
Theory of Planned Behavior	1	4.8
Physical Activity Adherence Model	1	4.8
Fidelity of MI
Trained providers	17	77.3
Audie recording and expert check/supervision	11	50.0
Mode of MI delivery
Face to face	4	18.2
Phone call	4	18.2
Face to face and phone calls combined	7	31.8
Phone calls with other in-person activities	7	31.8
Main outcome measures *
Physical Activity level
Subjective (self-administered survey)	14	63.6
Objective (wearable devices)	10	45.5
Body composition (e.g., height, weight, body mass index)	9	40.9
Nutrition / Diet (self-administered survey)	11	50.0
Self-efficacy	6	27.3

^*Studies included more than one outcome measures

The characteristics of MI interventions

Most of the studies reported who provided the MI sessions and the methods used to ensure the fidelity of delivery of MI. Providing MI by a trained health provider or researcher was the most reported method (n=17, 77.3%). In some studies, trained non-profession behavioral health counselors [22], survivor coaches [23], and patient navigators [24] led the MI sessions. Audio recording MI sessions and an expert check for compliance on MI were also utilized (n= 11, 50%).

Some interventions added MI into the existing program to evaluate the added effect on current programs (n=2, 9.1%) [25, 26]. One intervention was explicitly reported as community-based [27], and three interventions were home-based [28, 29, 30]. The duration of the interventions varied between 5 weeks to 12 months, with a few studies lasting one year (n=3, 13.6%).

Most MI interventions were conducted via telephone calls combined with face-to-face sessions (n= 7, 31.8%) or supported by face-to-face other interventions (n=7, 31.8%) such as group gardening, physical activity, or workshops on diet and nutrition. The number of sessions ranged from 2 to 19, with an average session of 7.6 (±4.9). However, in some studies, the number of sessions was tailored based on participants’ progress [31], or weekly tele-MI was attempted for those who wanted to use it [32, 33]. The number of sessions was not well described in some studies [27].

Most studies (n=14, 63.6 %) reported using a framework or model to support the intervention in addition to MI principles. The most commonly used framework was Social Cognitive Theory (n=5, 23.8%) (Tables 1 and 2). Although most studies used supporting frameworks to enhance the effects of MI or to evaluate the implementation process, the principles of other frameworks used were not well defined in the studies included in this review. Some studies reported the use of additional frameworks to tailor MI sessions based on the stage of readiness [34, 35], stage of behavioral change of the participants [29, 33,36], to support outcomes measures such as self-efficacy [23, 26], or to expand the consideration of factors affecting behavioral change [ 23; 29].

Table 2.

Use of other frameworks/models with The Motivational Interventions (MI) (n=14)

Reference	Used frameworks/models	Use of additional frameworks/ models
Britton et al. 2019 [42]	Cognitive behavior therapy (CBT)	No specific details are given
Bennet et al. 2007 [36]	Transtheoretical model (TTM)	Since MI builds on TTM, the behavioral change stage is measured to support individuals based on the behavioral change stage as described by TTM
Braun et al. 2018 [33]	Social Cognitive Theory (SCT)	Since MI builds on SCT, MI counseling used components of self-monitoring, judgment of one’s own actions, and choosing behaviors based on anticipated internal reactions,
Britton et al. 2017 [31]	Cognitive behavior therapy (CBT)	CBT is used to improve depressive symptoms for only those with depression as a second-tier intervention component, followed by an MI session.
Djuric at al. 2011 [40]	Social cognitive theory (SCT)	No specific details are given
Eakin et al. 2020 [26]	Social Cognitive Theory (SCT)and health behavior coaching techniques	SCT constructs including self-efficacy, social support, and outcome expectancies guided by techniques of MI and health behavior coaching were used.
Garrett et al. 2013 [42]	Transactional Model of Stress and Coping (TMSC)	TMSC is used to mobilize individuals’ sources of stress and enhance emotional and tangible social support to improve coping efforts
Harris et al. 2013 [34]	Behavioral stage of change model for telephone-based interventions	Behavioral change techniques were adapted based on individuals’ stage of readiness
Hoy et al. 2009 [44]	Social cognitive theory of behavior change, Transtheoretical Model (TTM)	Social cognitive theory of behavior change was combined with TTM and MI to promote tailoring of counseling. No specific details are given
Quintiliani et al. 2016 [22]	Social Contextual Model	No specific details are given
Sheppard et al. 2016 [23]	Theory of Planned Behavior (TPB) and Social Cognitive Theory (SCT)	MI sessions were tailored based on individuals’ TPB constructs such as attitudes, norms, and perceived control and aimed to increase SCT constructs such as improving self-efficacy and addressing environmental influences.
Swenson et al. 2010 [29]	Physical Activity Adherence Model (PAAM)	PAAM is developed to consider the profound physiologic effects of cancer treatments on exercise adherence, which are lacking in the TPB and SCT, through description and explanation of the experiences over time
Zuniga et al. 2019 [24]	Stage of Change (SOC)	The behavioral stage of change was assessed to tailor the intervention
Campbel et al. 2009 [35]	Transtheoretical Model (TTM) and Social Cognitive Theory (SCT)	MI intervention was tailored based on TTM and SCT constructs such as perceived barriers to change, motivation, stage of readiness, self-efficacy, and social support.

A few studies provided details on how they used MI principles [25, 27, 28, 32, 36–39]. Although which MI principles used were not exclusively extracted from the studies, many studies described some MI principles used in the intervention (Supplement 1). One study [34] provided details on the key behavioral constructs, components, and topic details used during the MI intervention. In a few studies, the use of MI principles was not well defined [27, 32], or just reported with general aims of the MI, such as focusing on nutritional self-care and compliance with nutrition recommendations [31]. One study referred to another publication on the intervention protocol [26]. In addition to the use of MI, an accelerometer was also commonly provided (n=13, 59.1%) to track physical activity or increase motivation of participants.

Outcome measurements of the interventions

Many studies only reported the outcomes measured at the end of the intervention or shortly after the completion of the intervention (n= 18, 77.2%). Measurement of the long-term effects of the interventions varied in the included studies; participants were followed for one month (n=1, 4.5 %), three months (n=1, 4.5%), six months (n=1, 4.5%), and up to 5 years (n=1, 4.5%) after the completion of the interventions.

Most studies (n= 14, 63.6%) used subjective measures (e.g., self-administered surveys) to assess self-reported physical activity levels, or nutrition or diet (n=11, 50%). Some studies objectively measured PA via wearable devices (n=10, 45.5%) to track changes in weekly or daily step count or measured body compositions (n=9, 40.9%) such as body weight and BMI. As an objective measurement of nutrition or diet, a few studies used blood analyses such as cholesterol, high-density lipoprotein-HDL-, and triacylglycerol [28, 34, 40]. Self-efficacy for the adoption of physical activity or adhering to a healthy diet was also measured in some studies (n=6, 27.3%) (Table 1).

Effects of the interventions on outcome measures

Of the interventions, 81.8 % (n=18) reported improvement in at least one health behavior outcome measure, such as physical activity level or health nutrition intake. Improvement was described as a statistically significant increase (such as fruit and vegetable intake, self-reported physical activity level, or step count) or decrease (such as body weight or BMI) in outcome measures as aimed by the intervention. Only a few studies (n= 5, 22.7%) reported no improvement in at least one outcome measurement of the targeted health behavior(s). Dennett et al. [25] compared MI intervention integrated with an ongoing rehabilitation program for physical activity and reported no added value of MI. Tsianakas et al. [27] reported some positive effects measured by interviews but not quantitative measurements. The other studies reporting no improvement targeted physical activity [38], fruit and vegetable consumption. [35] and nutrition [31]. Among these studies, Tsianakas et al. [27] included only one brief MI session (15 min), and Campbel et al. [35] included four MI sessions over nine months in the interventions. Moreover, among five studies (22.7%) targeting multibehavioral changes such as physical activity and diet, only Campbell et al. [35] did not find any improvement in outcome measurements. In the rest of the studies with no improvement, MI sessions were provided weekly [31, 38] over the 5–12 weeks of intervention. In addition to these studies, Harris et al. [34] reported that the effect of group-based MI intervention was not sustained at 12 months of follow-up compared to the telephone-based MI intervention.

Discussion

This scoping review synthesized the evidence on MI interventions aiming to optimize health behaviors among cancer survivors. We identified 22 published articles reporting health behavior interventions using MI for cancer survivors through our review process. The studies in this review published from 2007 to 2020 show the growing use of MI on health behavior change among cancer survivors.

Half of the MI interventions included in this review were exclusively designed to improve physical activity among cancer survivors, but few combined physical activities with diet/healthy eating (13.6%) and weight management (9.1%). A systematic review [12] of 15 interventions using MI for behaviors, stress, and fatigue management among cancer survivors reported that intervention targets were exclusively activity level, physical activity combined with fruit/ vegetable consumption, or smoking cessation. Previous research indicates that multiple behavior change interventions may be more efficient for health optimization. For instance, a recent systematic review reported that multiple health behavior interventions (including diet, exercise, and psychosocial support) resulted in greater reductions in body weight, BMI, and waist circumference than diet intervention alone [41]. Another review reported small to moderate improvements in healthy eating and physical activity among cancer survivors through multiple health behavior interventions [8]. In this study, except for one study [35], all interventions targeting multibehavioral change reported some level of improvement in outcome measures such as increased physical activity or positive change in diet pattern. Considering the evidence on multiple behavior change interventions and the nature of behavioral change (i.e., motivation and cognitive process), it might be more cost-effective to use MI to target more than one behavior among cancer survivors.

In this review, MI interventions employed different strategies aligned with MI principles, such as eliciting the participant’s intrinsic values and desires for engagement, goal setting [42], reinforcing behavioral change [43], relapse prevention and management technique [44], and supporting self-efficacy or self-confidence to achieve behavior change [30]. Most studies used different frameworks and models to support MI interventions, such as Transtheoretical Model (TTM), Social Cognitive Theory (SCT), Cognitive Behavioral Therapy (CBT), and Theory-based health behavior programs employ strategies such as social or peer support, self-efficacy promotion, or self-monitoring to promote adherence [45]. Historically, MI grew out of the TTM of behavior change (the ‘Stages of Change’) [46], and William Miller adapted MI to develop and sustain collaboration and agreement between clinicians and clients for behavioral change by resolving ambivalence toward change [45, 46]. There are similarities between TTM and MI, including that individuals approach change with varying levels of readiness and that ambivalence about behavior change is considered normal during the process [18]. However, MI aims to enhance motivation by resolving ambivalence in the intended direction of change. The MI also includes self-efficacy as a construct which is similar to the SCT. The SCT suggests reciprocal interactions between personal, environmental factors, and behavioral change, and individuals learn from their own experiences [47]. In contrast to MI, CBT, commonly used with MI in this review, is a reasonably didactic approach to teach individuals new behaviors and methods to improve beliefs. Building on CBT, MI also addresses resistance and ambivalence by creating equal partnership among individuals and providers [18]. MI practitioners use reflective listening to help individuals explore their own goals and motivations to develop individualized plans for change in desired health behavior(s) [12]. MI has its own common principles, and this scoping review described how MI is supported by other frameworks. However, due to the interconnectedness of the different frameworks and lack of details on how the principles of MI were exclusively used in the interventions, a summary conclusion on the effect of MI with or without any other frameworks was not produced. There is a need to understand the effect of established MI principles with well-defined descriptions of supported frameworks on behavioral change among cancer survivors. Moreover, health behaviors occur within a community, and environmental factors (e.g., neighborhood safety), food insecurity, and social/cultural factors may impact the adoption of health behaviors [6]. Because these factors are critical to developing personal solutions to incorporate behavior changes into daily life, using MI supported by other frameworks that consider social determinants of behavioral change may be more effective in health promotion and maintaining healthy behaviors.

Studies in this review delivered MI by various methods, including in-person, telephone, or combined, and lasted between 5 weeks to one year. Most of them combined phone call MI interventions with other face-to-face activities to increase the development and sustainability of the behavioral change. More than half of the MI interventions used accelerometers to keep individuals motivated or track individuals’ progress in physical activity development. In a meta-analysis, Pudkasam et al. [13] reported three studies using motivational strategies provided MI alone or combined with a pedometer, and all MI consisted of in-person sessions continued by phone calls. This review suggested using a step tracker combined with MI based on behavioral change theory to have a consistent positive effect on adherence to self-directed physical activity among breast cancer survivors [13]. The number of MI sessions also varied widely from 2 to 19 sessions over 5 weeks to 7-week intervention periods provided by health professionals. The effectiveness of MI relies on clinicians’ skills in applying minimum interviewing principles, and implementation and maintenance of skills are required among people using MI for behavioral change [48]. Studies mainly reported that MI providers were trained in the use of MI, and audio recording was used to check the fidelity of MI sessions. These findings show that planning MI interventions may involve consideration of available resources and the acceptability of intervention among the targeted population. However, there may be a need to describe the minimum standard in MI for behavioral change to ensure and sustain effective long-term integration of MI in practice.

Most studies in this review reported a significant improvement in at least one outcome measure, such as physical activity level and dietary patterns among cancer survivors. Recent systematic reviews reported that the use of MI has demonstrated improvements in cervical and breast cancer screening rates [19, 46], smoking cessation, physical activity, fruit/vegetable consumption, psychosocial well-being, self-care for pain, fatigue, and lymphedema management among cancer survivors [12, 49]. Moreover, Copeland et al. [49] also reported that use of individual MI in the context of health behaviors improved health behavior outcomes through increased motivation among different populations. However, almost one-fourth of the MI interventions did not affect targeted outcome measures in the studies included in this review. Lion et al. [38] reported that due to the low recruitment rate and compliance, no conclusion could be drawn regarding the efficacy of MI in increasing PA behavior in cancer survivors. Dennett et al. study [25] integrated MI into an ongoing face-to-face oncology rehabilitation session and reported adding MI into rehabilitation programs did not increase moderate-intensity physical activity compared to individuals who only participated in the oncology rehabilitation program. However, outcome measures were mostly assessed at the end of or shortly after interventions. MI aims to initiate and maintain behavior change; therefore, it is important to assess the long-term effect of established MI interventions on behavior that may be adopted during the intervention but not sustained upon completion of the intervention. Therefore, longitudinal studies are needed to assess and follow behavior change over time to understand how to best support those who struggle to maintain healthy behaviors. Combining MI with transtheoretical model techniques focused on the maintenance period may be needed to translate initial behavior change among cancer survivors into long-term habits.

Study Limitations

We only included articles published in English found through a literature search in the five databases. Due to our search strategy, we may not have found other work published in another language or other databases. We also were not able to synthesize detailed steps and protocol of each MI session due to limited information provided in the studies. A further potential limitation relates to combining other frameworks and models with MI interventions, which prevented us from exploring MI’s effects exclusively.

Conclusions and future directions

Recent studies used MI exclusively or in combination with other face-to-face health behavior change interventions to adopt healthy behaviors. Most reported significant improvements in at least one health behavior outcome. However, there is a need for future endeavors to establish the effectiveness and added value of MI, specifically to the long-term sustainability and benefit of health behavior. Multi-modal behavioral change interventions using MI for those who struggle to develop and maintain healthy behaviors are needed, along with a longitudinal assessment of long-term behavior change effects. There are various methods of utilizing MI, such as in-person, telephone calls, or combining these two methods as a single intervention or combined with other behavioral interventions. Variety in the mode of delivery, length, number of sessions, and use of MI with or without well-defined theory and frameworks requires future research to determine minimum standards of MI for specific health behavior development among cancer survivors. We explored the current use of MI to improve health behaviors (physical activity, diet/nutrition, and weight management) among those affected by cancer without producing a summary conclusion on the effects of MI; therefore, a systematic review and meta-analyses of the literature on the effect of these interventions on initiation and maintenance of health behaviors is warranted to provide a statement of conclusion on their effectiveness with specific outcomes.

Data availability

Data sharing is not applicable to this article as no new data were created or analyzed in this study.