Table 2.

Summary of Themes Identified

Main themes	Sub-themes	Third-tier sub-themes	Sample survivor quotes
Barriers to exercise and healthy eating	Lack of resources	Financial challenges	“Being whatever, a college student, or whatever it is, it's easier to get a dollar cheeseburger at McDonald's than to make a meal, and buy fish. You know, I like it, but it's more expensive to eat healthy than it is not to.”
		Insufficient information
	Negative thoughts and feelings	Emotions, fatigue	“When you finish cancer and they say, ‘Okay, no more. We're going to call you in remission. Go ahead.’ It's like, ‘Okay, the walls are coming down, honey! I'm eating whatever and as much as I want because I would have been dead by now if I hadn't had chemo.’”
		Cognitive factors (attitudes, goals)
	Negative social and environmental influences	Environmental influences (family, co-workers)	“Lots of times when I go to family gatherings, if I'm not sure what food will be served, I'll bring something of my own, and people give you a hard time.”
		Lack of social support for healthy lifestyle behaviors
		Advice “overload”
Facilitators of exercise and healthy eating	Cognitive motivators	Belief in and evidence of positive effects of healthy behaviors	“It's like I woke up one night and I felt stressed out, felt overweight, just felt sick, and I was like, man, I'm going to die of a heart attack or something, and for me that thought was frightening enough that I was like I need to do something … I think that's what sparked me to start working out again, and hit the gym, and just starting somewhere.”
		Perceived control over health
		Fear of consequences
		Setting goals
	Tools for health behavior implementation	Access to resources	“I went to the wellness center and found out about their nutrition program, I found out about their exercise program. I started working with [the wellness center] the day that I stopped radiation, and that helped me so much because I was never an exercise person.”
		Skill acquisition
		Building new habits, sustaining changes
	Social relationships	Companionship	“Something that's been a lot easier for me—I have a three-year-old daughter—and so it's been easier for me because I don't have to just worry about myself. I have to feed her right, too. That's been helpful for me.”
		Accountability to others
Intervention implications	Information and education	Improve motivation	“Introducing people to new sports or activities that they maybe haven't done before and then helping them get ready for, ‘Hey, want to do a triathlon? Great, here's some information. Here's what you need to do to do that.’ Similarly, introducing interesting activities, such as video games involving physical activities, can motivate survivors, particularly young ones, to do exercise.”
		Knowledge of and managing physical, psychological effects of cancer
		Develop new interests and skills for health behaviors
	Social support	Interaction with other AYA survivors	“What if you [survivor] could sign up to be a supporter, so if they [patients] had survivors up there or people going through treatment and the people, of course treatment isn't the most pleasant thing, so why not have somebody up there to motivate you.”
	Survivor-specific needs	Programs tailored to abilities and needs of survivors	“Even do a gym that would cater to different physical abilities and make it more comfortable for them, because it could be intimidating to go to a normal gym … so maybe a cancer survivor only gym that does have all the different levels of weights for them.”