Determinants of breast and gynecologic cancer survivors’ intention to adopt a healthy post-treatment lifestyle

Abstract

After active cancer treatment comes to an end, women can encounter multiple challenges in adopting a healthy lifestyle, despite the well-established benefits of doing so. The objective of this study was to identify the determinants of the intention to engage in regular physical activity and consume vegetables and fruits on a daily basis among breast cancer or gynecologic cancer survivors in Quebec’s Chaudière-Appalaches region. A total of 105 women with a mean age of 62 years old, who had completed active treatment within the previous year, took part in a correlational study on this topic, filling out a self-administered online questionnaire based on the reasoned action approach. Hierarchical multiple regression analyses indicated that 87% (p < .0001) of the variance in the intention to eat vegetables and fruits every day over the course of a month was explained by attitude and perceived control (together accounting for 82%), past behaviour (2%), and singlehood, university education and annual income (2%). Attitude and perceived control were also associated with the intention to engage in physical activity (R2 = 79%, p < .0001), as was past behaviour (2%). No clinical variable significantly influenced the intention to adopt either of these behaviours. These results will guide post-treatment care used to encourage women to maintain a healthy lifestyle.

INTRODUCTION

In Canada, age-specific 5-year net survival estimates are 90% to 92% for breast cancer, 57% to 87% for cervical cancer, 22% to 64% for uterine cancer, and 39% to 78% for ovarian cancer (Statistics Canada/Statistique Canada, 2025). Compared with the general population, women with cancer are nevertheless at greater risk of developing a second cancer or another medical condition (e.g., type 2 diabetes, metabolic syndrome) after active treatment ends (Kjærgaard et al., 2025; Rillamas-Sun et al., 2023). Obesity is also a major risk factor (Rock et al., 2022), and weight gain is frequently observed in breast cancer survivors, especially those who undergo chemotherapy (Makari-Judson et al., 2014). Women with cancer are therefore likely to experience health risk factors as a result of the treatment they receive, highlighting the importance of prioritizing a healthy lifestyle, both to prevent cancer and to maintain post-treatment quality of life. A healthy lifestyle encompasses behaviours that promote health, well-being, and quality of life. Regular physical activity and daily intake of fruits and vegetables are included in healthy living recommendations (National Comprehensive Cancer Network, 2024). A healthy lifestyle is the cornerstone of cancer survivorship (National Comprehensive Cancer Network, 2024). Improved quality of life and well-being, reduced fatigue during the post-treatment period and a lower risk of recurrence are among the demonstrated benefits (Campbell et al., 2019; Hamer & Warner, 2017; Vallance et al., 2020). For example, a healthy diet is associated with a lower risk of mortality among women with breast cancer or gynecologic cancer (Castro-Espin & Agudo, 2022; Cava et al. 2022; Hou et al., 2019; Lee et al., 2022; Rock et al., 2022). Canada’s Food Guide recommends eating plenty of vegetables and fruits each day (Santé Canada/Health Canada, 2019). In terms of physical activity, recommendations call for at least 30 minutes a day of moderate-intensity exercise at least 5 days a week, plus two weekly sessions of strength training (Campbell et al., 2019). Although these recommendations are key components of a healthy lifestyle (Campbell et al., 2019), the level of physical activity is generally low among women who are cancer survivors: 70% do not get the minimum recommended amount of exercise (Caperchione et al., 2019). Among the perceived barriers within this population for maintaining a healthy diet are fatigue, pain, loss of appetite, and an altered sense of taste, all of which are side effects of treatment (Beckenstein et al. 2021; Keaver et al., 2021; Limon-Miro et al., 2017; Rock et al., 2022).

Engaging in physical activity is also an effective way of maintaining or improving quality of life during and after treatment (Rock et al., 2022). Studies have shown that regular moderate or vigorous physical activity, in particular among women with breast cancer, can counteract the fatigue and pain that are often experienced after treatment (Doré et al., 2022; Elshahat et al., 2021; Juvet et al., 2017; Leitzelar et al., 2025; Meneses-Echavez et al., 2015). Yet, treatment-induced fatigue and pain are the main barriers to physical activity reported by women with breast cancer or gynecologic cancer (Beckenstein et al. 2021; Keaver et al., 2021; Rock et al., 2022). Some characteristics are already present prior to the cancer diagnosis, such as obesity, sedentary lifestyle, and other health problems (e.g., arthritis), and can make physical activity complicated (Brown et al., 2023; Doré et al., 2022; Rock et al., 2022).

Given that cancer is now recognized as a chronic disease, women with cancer must play an active self-management role to help keep residual symptoms from getting worse, prevent a decline in quality of life and ward off cancer recurrence (Howell et al., 2021). However, most female cancer survivors appear unlikely to make the necessary lifestyle changes (Tollosa et al., 2019). Healthcare professionals face multiple challenges in motivating cancer patients to engage in the self-management of their health, specifically by promoting healthy living and targeting structured interventions, including strategies to overcome perceived barriers to adopting or maintaining a diet rich in fruits and vegetables and engaging in regular physical activity (Cava et al., 2022; Haas et al., 2016; Hanson et al., 2020; Hirschey et al., 2023; Plante et al., 2023). The after-treatment phase is a pivotal time for integrating healthy lifestyle habits (Amireault et al., 2021). It is therefore important to understand the motivational factors for adopting these habits in order to effectively guide intervention strategies. This study is the first in a two-part research project aimed at identifying these determinants (factors of influence; Phase 1) and strategies promoting the adoption of these behaviours (Phase 2). This article focuses on the first phase. The research objective was to identify the determinants of the intention to consume vegetables and fruits every day and to engage in regular physical activity during the post-treatment phase for breast and gynecologic cancer survivors. The study was initiated on March 21, 2022, and was completed in January 2023.

Theoretical framework

Fishbein & Ajzen’s reasoned action approach (RAA; 2010) was used to identify the psychosocial determinants of intention (measuring motivation) with regard to daily vegetable and fruit intake and regular physical activity. The RAA was demonstrated to be effective in predicting and explaining various health behaviours in the meta-analysis conducted by McEachan et al. (2016). The theory of planned behaviour (TPB; Ajzen, 1991) — a predecessor of the RAA — had been effective in identifying psychosocial factors that explained up to 67% of the variance in the intention to regularly engage in physical activity among women with a breast cancer diagnosis (Lévesque-Gagné & Boucher, 2022). According to the RAA, intention (level of motivation) is influenced by three factors: (1) attitude toward the behaviour; (2) perceived social norms, including subjective norm (influence of significant others on a behaviour’s adoption); and (3) descriptive norm (perceived prevalence of a behaviour in a group) and perceived control concerning the perceived ability to perform a behaviour and the autonomy to do so. These three factors are determined by three categories of personal beliefs: behavioural beliefs (perceived advantages and disadvantages), normative beliefs (perceived expectations of significant others concerning the adoption of the behaviour) and control beliefs (perceived barriers and facilitators; Figure 1).

Figure 1.

Theoretical framework adapted from the reasoned action approach (Fishbein & Ajzen, 2010)

Methodology

To meet the research objective, a correlational research design was used to identify the determinants of the intention to eat plenty of vegetables and fruits every day as recommended in Canada’s Food Guide (Health Canada/Santé Canada, 2019) and to engage in moderate physical activity for at least 150 minutes a week.

Recruitment of participants

Participants were recruited by a nurse, using a regional cancer registry. Women who had received their final chemotherapy or radiation therapy treatment at outpatient oncology and hematology clinics at rural hospitals were also invited to take part in the study. The inclusion criteria were as follows: (1) be diagnosed with breast, endometrial, ovarian, or cervical cancer; (2) have completed active treatment (surgery, chemotherapy, radiation therapy, and/or brachytherapy) within the past year; and (3) be able to read French. Women who met these criteria were contacted by the research professional (n = 164) who invited them to take part in the project and answered their questions. Those who agreed to provide an email or mailing address were sent an information sheet and a consent form. Once they indicated their desire to participate, they received a link to an online questionnaire.

Sample

The convenience sample consisted of 105 women over 18 years of age who met the inclusion criteria. It was expected that the final sample of 103 participants would be sufficient to identify predictive factors (n = 7) with a multiple regression analysis with a statistical power of 80% and a significant threshold of 5% to determine whether there is a relationship between these factors and the behavioural intention or the behaviour itself, with a medium effect size of 0.15, according to Cohen (1988). This calculation was estimated in accordance with the recommendations of Faul et al. (2009) using G*Power 3.1.9.4 software.

Developing and validating the questionnaire and measuring the variables

An 86-item questionnaire was developed based on the recommendations of Fishbein & Ajzen (2010) and de Gagné & Godin (2012). As regards the daily intake of fruits and vegetables (F&V) and regular physical activity (PA), the items used to measure behavioural beliefs (n = 8 for F&V; n = 4 for PA), normative beliefs (n = 3 for F&V; n = 4 for PA) and control beliefs (n = 10 for F&V; n = 9 for PA) were derived from the results of a previous study conducted within the target population (Boucher et al., 2018). Advantages perceived as benefits with respect to psychological and emotional state were considered to be behavioural beliefs. Fatigue, lack of appetite, high cost of produce, and aversion to vegetables all represented barriers to healthy nutrition. As for regular physical activity, having a training buddy, having a comfortable environment to exercise in, and embracing the objective of staying healthy were considered to be facilitating factors (control beliefs), whereas fatigue and lack of motivation were seen as the main barriers.

For other psychosocial variables, the affective and cognitive properties of attitude, perceived social norms and perceived control were measured using a total of 19 items concerning the intention to eat fruits and vegetables daily and a total of 18 items concerning the intention to engage regularly in physical activity as recommended. The items related to physical activity were derived from the study by Lévesque-Gagné & Boucher (2022). Statements describing the recommendations for both behaviours were included in the questionnaire. The questions about sociodemographic data (n = 5) and clinical data (n = 3) were multiple-choice, except for open-ended questions about age and past behaviour (n = 3). The questionnaire was tested prior to the study by three patients from the target population who shared their feedback during individual telephone interviews about the clarity and comprehensiveness of the instructions, the statements, and the choice of answers (Willis, 2005). In addition, the questionnaire was reviewed by two experts in RAA-based questionnaires. A nutritionist specializing in oncology also went over the statements. Her recommendations helped in editing the final version. The content was validated by a group of clinical oncology experts. The psychometric qualities of the questionnaire items were verified. An analysis of Cronbach’s alpha coefficients indicated a satisfactory level of internal consistency for the items for each psychosocial variable, ranging from 0.68 to 0.97 (Table 1).

Table 1.

Psychosocial Questionnaire for Vegetable and Fruit Consumption

Variable	Number of statements	Sample statement	Sample responses	Coefficient	Mean (SD)
Intention	3	Every day, I will fill half my plate with vegetables and fruit	Very unlikely Quite unlikely Somewhat unlikely Somewhat likely Quite likely Very likely	0.951	4.7 (1.2)
Overall attitude	7
Affective dimension	4	Filling half my plate with vegetables and fruit every day for the next month would be…	Very unpleasant Quite unpleasant Somewhat unpleasant Somewhat pleasant Quite pleasant Very pleasant	0.921	5.1 (0.9)
Cognitive dimension	3	Filling half my plate with vegetables and fruit every day for the next month would be…	Very useless Quite useless Somewhat useless Somewhat useful Quite useful Very useful	0.921	5.4 (0.8)
Perceived norms	6
Subjective norm	3	Most of the people who are important to me would advise me to fill half my plate with vegetables and fruit every day for the next month	Strongly disagree Moderately disagree Somewhat disagree Somewhat agree Moderately agree Strongly agree	0.821	5.1 (0.9)
Descriptive norm	3	Of the women I know best who have been diagnosed with breast or gynecologic cancer, I think the percentage of those who fill half their plate with vegetables and fruit every day is…	Very low Quite low Somewhat low Somewhat high Quite high Very high	0.731	3.8 (1.1)
Perceived control	3	In the coming month, I feel like I would be able to fill half my plate with vegetables and fruit every day	Strongly disagree Moderately disagree Somewhat disagree Somewhat agree Moderately agree Strongly agree	0.911	4.8 (1.2)
Behavioural beliefs	8	If I filled half my plate with vegetables and fruit every day for the next month, it would help control my weight	Strongly disagree Moderately disagree Somewhat disagree Somewhat agree Moderately agree Strongly agree	n.d.	n.d.
Normative beliefs	3	The following people would advise me to fill half my plate with vegetables and fruit every day for the next month	My spouse or partner My children My friends	n.d.	n.d.
Control beliefs	10	In the coming month, I feel like I would be able to fill half my plate with vegetables and fruit every day even if I felt tired	Strongly disagree Moderately disagree Somewhat disagree Somewhat agree Moderately agree Strongly agree	n.d.	n.d.

Note.

¹Cronbach’s alpha.

Likert scale of 1 (e.g., unlikely) to 6 (e.g., likely).

SD = standard deviation.

The measures of past behaviour were defined in terms of action, target, context, and time and were assessed using the following two questions: “In the past week, how many days did you fill half your plate with vegetables and fruit?” and “In the past week, how many days did you engage in at least 30 minutes of physical activity?”. The psychosocial questions on the behaviours being studied were presented as statements with a six-point Likert scale (very unlikely–very likely, strongly disagree–strongly agree, etc.).

Data collection

Data were collected by the research professional using a self-administered electronic questionnaire (developed in Google Forms) sent via email link. The questionnaire took about 45 minutes to complete. A reminder to fill out the questionnaire was sent two weeks after the first email to those who had not yet replied. The research ethics board of the regional integrated health and social services centre (CISSS) approved the study (2022-949/08-04-2022).

Data analysis plan

Descriptive analyses (mean, standard deviation, and frequency) were used to describe the sociodemographic, clinical, and psychosocial variables (Table 2). Bivariate associations between the psychosocial variables and intention were determined by Pearson’s correlation coefficients. A hierarchical multiple linear regression analysis was conducted to identify the determinants (independent variables) of participants’ intention (dependent variable) to adopt the recommended behaviours. Stage 1 of the regression analysis was conducted by entering the RAA psychosocial variables. Past behaviour (during the previous week) was added at Stage 2, followed by sociodemographic variables at Stage 3. A Stage 4, the age (p = .3590) and employment status (p = .9226) were excluded from the model in Table 3 as they were not significant. Likewise, the sociodemographic variables (p > .1808) were excluded from Table 4. Finally, beliefs significantly associated with a strong intention to adopt the recommendations for each of these behaviours were identified using a multiple linear regression analysis by dichotomizing intention into a binary dependent variable of “strong” or “weak.” Multicollinearity was verified in the regression models to avoid redundancy among the determinants.

Table 2.

Participant Characteristics

Variable	n	%
Highest level of education completed
Elementary school	3	2.9
High school	35	33.3
Vocational school	21	20
College/CEGEP	29	27.6
University	15	14.3
Employment status
Retired	51	48.6
Full-time/part-time employment	41	39.1
Sick leave/permanent disability/ unemployed	11	10.5
Family status
Single	22	21.4
In a relationship	54	52.4
In a relationship, with children; or single parent	27	26.2
Annual household income
Less than $45,000	37	35.9
$45,000–$59,999	14	13.3
$60,000–$74,999	9	8.6
$75,000 or more	29	27.6
Prefer not to answer	14	13.3
Cancer staging
Stage I	61	69.3
Stage II	18	20.5
Stage III	6	6.8
Stage IV	3	3.4
Missing responses	17	16.2
Treatment
Surgery	88	83.8
Radiation therapy	83	79
Chemotherapy	28	26.7
Brachytherapy	8	7.6

Table 3.

Determinants of the Intention to Eat Vegetables and Fruits

Variable	Regression coefficient	P-value	Regression coefficient	P-value	Regression coefficient	P-value	Regression coefficient	P-value
	Model 1		Model 2		Model 3		Model 4
Overall attitude	0.22	0.0114 *	0.19	0.0224 *	0.30	0.0012 *	0.29	0.0011 *
Subjective norm	0.08	0.2154	0.07	0.2605	0.04	0.5571	0.057	0.3815
Descriptive norm	0.02	0.7347	0.03	0.5592	0.04	0.3877	0.04	0.4686
Perceived control	0.82	< 0.0001 *	0.72	< 0.0001 *	0.68	< 0.0001 *	0.68	< 0.0001 *
Past behaviour			0.10	0.0015 *	0.11	0.0008 *	0.11	0.0004 *
Age					0.009	0.3590
Family status
In a relationship					Reference		Reference
Single					0.41	0.003 *	0.37	0.0048 *
In a relationship, with children/ single parent					−0.03	0.80	−0.12	0.2695
Highest level of education completed
Elementary/high school					Reference		Reference
Vocational school (DEP/DVS)					−0.17	0.2371	−0.19	0.1772
College/CEGEP (DEC/DCS)					−0.10	0.4359	−0.11	0.3794
University					−0.27	0.0858	−0.31	0.0368 *
Employment status
Retired					Reference
Full-time/part-time employment					0.01	0.9282
Sick leave/permanent disability/ Unemployed					0.02	0.9226
Annual household income
$45,000–$74,999					Reference		Reference
Less than $45,000					−0.27	0.0418 *	−0.27	0.0379 *
$75,000 or more					0.08	0.5355	0.05	0.7229
Prefer not to answer					−0.02	0.8914	−0.04	0.7929
Adjusted R 2	0.83		0.84		0.8682		0.8707
P -value (model)	< 0.0001*		< 0.0001*		< 0.0001*		< 0.0001*

Note.

^*Significance threshold: p < .05

Results of hierarchical multiple regression models; R²: the squared multiple correlation coefficient representing the percentage of variance explained by the final regression model.

Table 4.

Determinants of the Intention to Engage in Physical Activity

Variable	Regression coefficient	P-value	Regression coefficient	P-value	Regression coefficient	P-value	Regression coefficient	P-value
	Model 1		Model 2		Model 3		Model 4
Overall attitude	0.33	0.0020 *	0.27	0.0089 *	0.27	0.0155 *	0.27	0.0089 *
Subjective norm	−0.11	0.1768	−0.07	0.3717	−0.05	0.5738	−0.07	0.3717
Descriptive norm	0.11	0.0985	0.13	0.0506	0.12	0.1086	0.13	0.0506
Perceived control	0.84	< 0.0001 *	0.76	< 0.0001 *	0.76	< 0.0001 *	0.76	< 0.0001 *
Past behaviour 1			0.08	0.0080 *	0.07	0.0299 *	0.08	0.0080 *
Past behaviour 2			0.03	0.3656	0.02	0.5231	0.03	0.3656
Age					0.01	0.3044
Family status
In a relationship					Reference
Single					−0.12	0.5175
In a relationship with children/single parent					−0.24	0.2125
Highest level of education completed
Elementary/high school					Reference
Vocational school (DEP/DVS)					0.15	0.4000
College/CEGEP (DEC/DCS)					0.12	0.4593
University					0.28	0.1808
Employment status
Retired					Reference
Full-time/part-time employment					0.18	0.3723
Sick leave/permanent disability/Unemployed					0.34	0.2543
Annual household income
$45,000–$74,999					Reference
Less than $45,000					−0.03	0.8433
$75,000 or more					−0.10	0.5925
Prefer not to answer					−0.06	0.7518
Adjusted R 2	0.79		0.81		0.80		0.81
P-value (model)	< 0.0001*		< 0.0001*		< 0.0001*		< 0.0001*

Note.

^*Significance threshold: p < .05

Results of hierarchical multiple regression models; R²: the squared multiple correlation coefficient representing the percentage of variance explained by the final regression model.

RESULTS

Sample profile

A total of 105 women with breast cancer or gynecologic cancer who were in the post-treatment phase took part in this study. The mean age of the participants was 62 years old, ranging from 39 to 81 years old. Table 2 presents additional sociodemographic and clinical characteristics of the sample. Descriptive analyses of participants’ lifestyle habits showed that, on average, they had filled half their plate with fruits and vegetables on 5.5 days in the preceding week. Participants also indicated that they had engaged in moderate physical activity (enough to make them breathe harder than normal) for 30 or more minutes for 4 days on average during the preceding week. For strength-building exercises, the average was 2 days out of the previous 7.

The level of motivation (intention) for the two targeted behaviours was assessed using a Likert scale of 1 (very unlikely) to 6 (very likely). The mean scores reveal that the participants had a somewhat favourable opinion (score of 4 out of 6) of the recommendation to eat vegetables and fruits every day and to engage in moderate physical activity at least 30 minutes a day, 5 days a week.

Correlations between variables

A Pearson correlation analysis revealed that all of the psychosocial variables were significantly linked to the intention to eat fruits and vegetables in the following month (correlation coefficients varying between r = .39 [descriptive norm] and .90 [perceived control]; p < .0001).

The intention to regularly engage in physical activity was also significantly correlated with all of the psychosocial variables. The correlations varied between r = .28 for the descriptive norm and r = .88 for perceived control. The correlation between this intention and the descriptive norm was the weakest (p = .0036). The sociodemographic and clinical variables were not significantly linked to the intention to eat fruits and vegetables or to the intention to engage in regular physical activity, except in the case of women with a university degree, whose intention to engage in physical activity (regression coefficient = 0.94; p = .02) was greater than women with an elementary or secondary education.

Determinants of intention

As regards the intention to consume fruits and vegetables every day for the following month, it was significantly predicted by overall attitude toward the behaviour and the perceived control. The first step of the hierarchical multiple regression analysis indicated that 83% (p < .0001) of the variance in intention was explained by the two variables of attitude and perceived control. At the second step, past behaviour was also a significant variable, although it accounted for a mere 2% of the variance (p = .0004). The third step showed that this intention was significantly associated with singlehood (p = .0048) and a university education (p = .0368). In contrast, participants with an annual income of less than $45,000 reported a lower intention (p = .0379). Age and employment status were excluded from the fourth model because they were not statistically significant. Clinical variables (cancer staging, type of treatment, date of last treatment) were not significant predictors of intention (Table 3). The final model accounted for 87% of the variance in intention.

Regarding the intention to engage in regular physical activity in the following month, it was also significantly influenced by attitude and perceived control. The first step of the hierarchical regression analysis revealed that overall attitude (p = .0089) and perceived control (p < .0001) were the two significant predictors of intention, accounting for 79% of the variance in this behaviour. At the second step, past behaviour (during the previous days) explained 2% (p = .0080) of this variance. At the third step, none of the sociodemographic or clinical variables significantly influenced intention. Together, the predictors in the final model explained 81% of the variance (Table 4). The analysis was conducted on 103 participants, as two questionnaires were excluded due to a large proportion of missing data on psychosocial variables.

Additional multiple regression analyses showed that certain beliefs were associated with stronger intention to follow the recommendations for the two behaviours under study. They indicated that a positive attitude toward a daily diet rich in vegetables and fruits was influenced by the belief that “it would make eating enjoyable” (p = 0063). Furthermore, for the respondent who stated that it was “already a well-established habit in my life,” this belief was significantly associated with the fact that she felt she would be able to eat fruits and vegetables every day for the following month (p < .0001).

In terms of regular physical activity, the intention to heed the recommendations provided during the month was strongly linked to the attitudinal belief that it “would be good for morale” (p = .0142). Participants also indicated that “if physical activity were integrated into their routine,” their intention to adopt the behaviour would be stronger (p < .0001). This belief influenced respondents’ perceived control over this behaviour.

DISCUSSION

This study achieved its objective of identifying the psychosocial factors associated with the intention to consume vegetables and fruits daily and engage in regular physical activity among 103 women in Quebec who had completed treatment for breast cancer or gynecologic cancer. The intention to adopt these behaviours were, in both cases, strongly shaped by attitude and perceived control. Generally speaking, the intention to eat vegetables and fruits every day and to engage regularly in physical activity was attributable to a favourable attitude toward each of these behaviours and a perception of feeling capable and autonomous with regard to the adoption of these recommendations (perceived control). Other studies have yielded similar results. For example, Min et al. (2022) found that attitude and perceived control were significantly associated with the intention to engage in physical activity for a sample of breast cancer survivors in the post-treatment phase, albeit it to a lesser degree (R² = 44%). Similarly, Husebø et al. (2013) came to the conclusion that intention and perceived control are the best predictors for healthy behaviours among women with breast cancer.

The results also reveal that certain beliefs are associated with attitude and perceived control for the two healthy behaviours that are the focus of this study. The belief that eating fruits and vegetables is enjoyable and that physical activity is good for mental health are linked to a more positive attitude toward each behaviour. The literature review conducted by Elshahat et al. (2021) found that cancer patients reported positive attitudes to physical activity and acknowledged its health benefits. The authors also pointed out that the perceived benefits outweighed the perceived barriers with regard to the likelihood of engaging in physical activity.

However, as our study suggests, healthy behaviours are considered to be easier to adhere to if they are part of a regular routine. Beliefs associated with perceived control emphasized the ease of eating vegetables and fruits and engaging in physical activity if these were already deep-seated everyday habits. Beckenstein et al. (2021) arrived at similar conclusions.

The results of the study also showed that the participants were already adhering to healthy living recommendations. They said that fruits and vegetables filled half of their plate 5.5 days of the week and that they engaged in 150 minutes of physical activity per week. These findings are surprising. According to Rock et al. (2022), breast cancer survivors’ adherence to nutrition and exercise recommendations is, at best, moderate. This suggests that an adherence rate greater than 30% may not be an accurate reflection of reality. Consequently, it is possible that the women in our study responded in a socially desirable manner with answers that gave the perception that they were engaging in healthy eating habits and getting the recommended amount of physical activity, even if this was not the case.

Outcomes

Considering that attitude and perceived control are predictors of the intention to adopt behaviours, these findings may influence oncology nursing practices in the post-treatment phase. Specific implications pertaining to four dimensions of nursing practice are listed in Table 5. Promoting daily intake of vegetables and fruits and regular physical activity can help breast and gynecologic cancer survivors self-manage their health as part of an interdisciplinary approach. Currently in Quebec, there is no standardized nursing care plan in the care trajectory for women with cancer once active treatment is over. And yet multiple authors and researchers agree that follow-up care is essential to all groups of cancer survivors (Balneaves et al., 2014; Hirschey et al., 2023; Howell et al., 2021; Phothikul et al., 2025). The results of our study may help guide future strategies for encouraging women to adopt healthy living behaviours included in a post-treatment care plan. Furthermore, the essential partnership between academic researchers and clinicians must embrace a pragmatic approach to addressing the needs for information and support once active treatment has been completed, in addition to contributing to an integrated research culture.

Table 5.

Potential Outcomes of the Study Results on Oncology Nursing Care in the Post-Treatment Phase of Cancer Survivorship

Dimension	Implications
Clinical	For cancer nurse navigators (CNNs) providing outpatient services: Raise awareness among patients who are the most likely to benefit from a physical activity program with the goal of improving their functional autonomy. Talk to patients about perceived barriers to physical activity and daily intake of vegetables and fruits (e.g., fatigue, lack of time). Identify solutions for overcoming these barriers. Use motivational interviewing to invite patients to set realistic goals and create a plan to achieve these goals. Suggest patients take advantage of health-promoting initiatives in their community. For residual symptoms, refer the patient to the nutritionist or kinesiologist in the cancer support team.
Management	For outpatient nurse managers: Develop a standardized nursing care plan in the care trajectory once active treatment is over. Encourage CNNs to sign up for training on promoting healthy living habits for this group of cancer survivors. Foster a culture of research among nursing staff by asking them to get involved in research projects (e.g., recruitment, data collection). Once active treatment is complete, promote the involvement of patient “partners” in studies to bring a diversity of viewpoints to research.
Education	Inform patients about the demonstrated benefits of regular physical activity and healthy diet to cultivate a healthy attitude about these behaviours. Discuss the resources available to support patients in improving their cooking skills so they are better equipped to adhere to healthy eating practices.
Research	Promote integrated research projects that bring oncology clinicians and researchers together. Hold focus groups with post-treatment survivors to identify strategies for maintaining a healthy lifestyle. Include motivational strategies into a standardized nursing care plan once active treatment is over. Talk to the interdisciplinary team to develop a research project aimed at implementing a healthy living support program. Incorporate patient partners into research projects to tap into their experiential knowledge and expertise.

Strengths of the study

The study has several strengths, both theoretical and methodological. First, it uses a widely recognized and detailed theoretical model as the foundation for the entire scientific process. In fact, most of the studies reviewed by Bluethmann et al. (2016) and Husebø et al. (2013) mention constructs specific to behavioural theories (e.g., self-efficacy, intention, barriers) but without describing the theoretical framework or referring to them to interpret the findings or underpin the foundations for future intervention. Additionally, according to Rock et al. (2022), the factors that influence the adoption of these behaviours among gynecologic cancer survivors are largely unknown, as most studies have focused on breast cancer survivors. Breast cancer is indeed the most common cancer in women (Canadian Cancer Society/Société canadienne du cancer, 2023), but it is also important to identify and understand healthy lifestyle factors for women diagnosed with gynecologic cancers (Rock et al., 2022). Finally, the sample size was sufficient to conduct multiple regression analysis, and the content validity assessment carried out by a team of experts, along with the pre-study testing, demonstrates the rigorous process used to develop the questionnaire.

Limitations

The study is limited to identifying the factors associated with the intention to adopt these two behaviours, not adoption per se. The findings obtained from a sample of Francophone women in a single region of Quebec cannot be generalized to a wider population with the same diagnosis. It is reasonable to assume that the participants who volunteered to take part in this study would be women who are already motivated to improve their lifestyle, which may affect the representativeness of the results. In addition, the questions concerning the intention to consume vegetables and fruits daily, as indicated in Canada’s Food Guide (Health Canada/Santé Canada, 2019), can be difficult to quantify, even though the image of the plate was included in the questionnaire. Moreover, although the respondents were assured of anonymity, a study on health-related behaviours is still vulnerable to social desirability bias. Participants’ responses regarding their intention to engage in a future action are likely to be biased toward reporting that intention. (Godin et al., 2012).

CONCLUSION

This study identified modifiable factors, including attitude and perceived control, that are related to the intention to consume fruits and vegetables daily and to engage in regular physical activity. Based on these results, several implications for nursing practices can be drawn, such as the development and implementation of a support program, which will constitute Phase 2 of this research project.