Table 2.
Overview of included quantitative studies on psychosocial determinants of (favorable) lifestyle changes in cancer survivors.
| Physical Activity (n = 45) |
Diet (n = 21) |
Smoking (n = 12) |
Alcohol (n = 4) |
Multiple Lifestyle Behaviors (n = 4) |
Sun Protection (n = 2) |
|
|---|---|---|---|---|---|---|
| Psychosocial Determinant | ||||||
| Socio-demographic | ||||||
| Age | Not Significant (NS) [1,2,3,4,5,6,7] *Older age & physically inactivity [8] *Younger age & increased exercise frequency [9] *Age differed significantly between trajectory groups of the waitlist group [10] |
NS [5,8,11] *Younger age & (favorable) dietary changes [12,13,14] *Older age & favorable dietary changes [6] |
NS [15,16,17,18]* Older age & lower likelihood of continued smoking [19] *Older age & smoking cessation [20] *Younger age & more likely to continue smoking [21] |
NS [3,11] | NS [22,23,24] | *Age > 55 & increased sun-safe behavior [6] |
| Sex/gender | NS [10] *Gender differed across classes: males more likely to be high and sustained sedentary over time; women more likely to be increasing sedentary [7] |
NS [15,16,17,18,21] *Females less likely to quit smoking [20] |
NS [22] *Females & less positive changes in substance use (alcohol and smoking) [22] |
|||
| Race/ethnicity | NS [1,4] | NS [15,16,17,18] | NS [23,24] | |||
| Educational level | NS [1,5,6,7,9,25] NS for Moderate to Vigorous Physical Activity (MVPA) [4] *Higher educational level & more likely to change towards being physically inactive post-diagnosis [8] *Higher educational level & increase in physical activity vs. no increase among lower educational level [26] *Higher educational level & more likely to be high maintainers or high decreasers of sedentary behavior, vs. low maintainers [4] |
NS [5,6,8,13,14,25] *Higher education level & (favorable) dietary changes [11,27] |
NS [16,17,19,21,28] *Lower educational level & lower long-term cessation rates [15] |
NS [28] *Temporary decreasers were more likely to have a higher education level vs. medium temporary decreasers vs. low maintainers [11] |
NS [22,23] *Higher educational level & positive changes in physical activity or diet [24] |
NS [6] |
| Employment status | NS [1,5,6,8] *Employment differed across classes (those increasing sedentary behavior over time were most often employed) [7] |
NS [5] *Being employed & increase in fiber intake [6] |
NS [22] | NS [6] | ||
| Job position | *Higher occupational positions & less improvement in moderate physical activity [5] | NS [5] | ||||
| Marital status | NS [1,3,5,6,8] | NS [5,6,8,13] | NS [15,19,21,28] #Married/partnered more likely to be abstinent [16] |
NS [3,28] | NS [22,23] | NS [6] |
| Social class | *Working occupational class more likely to increase physical activity compared to managerial and professional class [3] | *Higher social class & favorable dietary changes [12] | NS [3] | |||
| Cohabitation/living alone | *Living alone & favorable dietary changes [12] | |||||
| Income | *Higher income & more likely to be high decreaser or medium decreaser of physical activity vs. low maintainer [4] | NS [14] *Higher household income & favorable dietary changes [4] |
NS [15,21] | NS [22] | ||
| Smokers in household | *Smoking household member & higher likelihood continued smoking [19] *Second-hand smoking at home & being indecisive for abstinence [21] |
|||||
| Inter-individual | ||||||
| Social support | NS [4,29], for baseline to 6 months [32] #Social support & increasing physical activity [30] *More social support [1,31] from family [32], friends [34], or family [40] and friends [32] & (greater) increase in physical activity*Social support & increased exercise from baseline to 6 months follow-up, but not at 3-month follow-up [9] |
NS [30] *Lower friend support for eating habits-discouragement & improvements in diet [33] *Greater social support & increase in fruit and vegetable intake [4] |
NS [18,34] | NS [11] | *Social support & positive lifestyle change [23] | |
| Social modeling | *Increases in social modeling & increases in physical activity and decreases in sedentary time [31] | |||||
| Exercise role models | NS [29] | |||||
| Role model | *Contact (vs. no contact) with a role model & increase in exercise levels [35] | |||||
| Social constraints | NS [23] | |||||
| Social smoking environment |
*Having a spouse who did not smoke, and having fewer peers who smoked & higher likelihood to quit [34] | |||||
| Second-hand smoke exposure at home | *Exposed to send-hand smoke at home & smoking over time [21] | |||||
| Intra-individual | ||||||
| Depressive symptoms | NS [4,8,30,32,36] *Higher levels of depressive symptoms & less likely to remain consistently sufficiently active [2] *Depression perceived barrier [30] |
NS [4,8,30,37]; NS for those with better fruit and vegetable and fiber intake at baseline [38] *For those with less fat consumption at baseline, increase in fat intake, depressive symptoms were not associated with decreases in the first year, whereas it was associated with the increase between year 1 and 4 [38] |
NS [16,18,21] *Depression & higher likelihood of continued smoking [19] * Patients with depression symptoms reported significantly lower abstinence rates [39] *Depression & relapse after quitting [15] |
NS [11] | NS [40] | |
| Anxiety symptoms | NS [8] *Higher anxiety & less likely to increase physical activity [36] |
NS [8,37] | NS [18,21] *Lower anxiety & abstinence [17] |
* Higher anxiety & unhealthy lifestyle [40] | ||
| Psychological distress | NS [18] *Higher psychological distress & initiating dietary changes [14] *Decrease in psychological distress & dietary changes [14] |
*Lower psychological distress & abstinence rates [17] | ||||
| Emotional distress | *Higher emotional distress & decrease in physical activity [41] | NS [42] | *Higher emotional distress & increased alcohol consumption [41] | NS [41] | ||
| Stressful life events | NS [30] | NS [30] *Greater number of stressful events & initiating dietary changes [14] |
||||
| Life stress | NS [36] | |||||
| Perceived stress | *Perceived stress as barrier [30] | *Lower perceived stress & smoking abstinence [17] | NS [43] | |||
| Cancer-related stress |
*Higher stress & greater decrease in fruit and vegetable intake in first 6 months after diagnosis [44] *Higher stress & greater increase in fruit and vegetable intake 12 months post-diagnosis [44] |
NS [22] | ||||
| Traumatic stressor response | NS [23] | |||||
| Cancer-related intrusions | *Cancer-related intrusions & positive lifestyle change [23] | |||||
| Cancer-related avoidance | NS [23] | |||||
| Fear of exercise | NS [29] | |||||
| Fear of recurrence | NS [30] *Higher fear of cancer recurrence & reduced physical activity [41] |
NS [30,41] | NS [16] | *Higher fear or recurrence & increased alcohol consumption [41] | NS [41] | |
| Fatigue (vitality) | NS [28] *Less fatigue & increase in exercise [30] *Higher levels of fatigue at baseline & less likely to remain consistently sufficiently active [2]*Baseline fatigue & physical activity maintenance [45] |
# Less fatigue (greater vitality) & dietary changes [30] | NS [16,18] | |||
| Mood | *Lower mood disturbance at baseline & low and sustained sedentary behavior over time [7] | NS [18] | ||||
| Anger | NS [18] | |||||
| Confusion | NS [18] | |||||
| Vigor | *Higher vigor for continuous abstainers than relapsers [18] | |||||
| Dispositional optimism | NS [4] | *Higher dispositional optimism & higher fruit and vegetable intake [4] | NS [11] | *Dispositional optimism & positive lifestyle change [23] | ||
| Contemporary life stress | NS [46] | |||||
| Sexual activity, sexual functioning | NS [27] | |||||
| Satisfaction with sexual functioning | NS [30] | NS [30] | ||||
| Body satisfaction | NS [30] | NS [30] | ||||
| Health related quality of life | *Poor health related quality of life on two or more domains & exercising less [47] *Higher mental and physical component scores & increase in physical activity [32] |
NS [47] *Lower general quality of life, lower cognitive functioning, lower levels of emotional functioning, & dietary changes [27] |
||||
| Perceived mental health status | *Better mental health status & increased exercise frequency from baseline to 3 months follow-up, but not at 6 months follow-up [9] *Perceived reduced mental function as barrier [30] |
|||||
| Health awareness | *Higher health awareness & less physical activity [48] | NS [48] | ||||
| Meaning of cancer | NS [48] | NS [48] | ||||
| Survivor concerns | NS [37] | |||||
| Cancer-specific concerns | NS for breast cancer survivors [49] *For prostate cancer survivors, cancer-specific concern of ‘activities limited by urination’ & lesser increases in physical activity [49] |
|||||
| Appearance concerns | NS [48] | NS [48] | ||||
| Body change concerns | * Higher body change concerns & less physical activity [48] | NS [48] | ||||
| Life interferences | * Higher life interferences & less physical activity [48] | NS [48] | ||||
| Worry | *Worry & less physical activity [48] | NS [48] | ||||
| Cancer worry | *Higher levels of cancer worry & more likely to remain consistently sufficiently active [2] | |||||
| Illness representations (timeline acute/chronic, timeline cyclical, consequences, personal control, treatment control, illness coherence and emotional representations) | NS for illness coherence or consequences [50] NS for timeline acute/chronic, timeline cyclical, consequences, illness coherence and emotional representations [25] *Lower personal control & decrease in exercise [50] *Lower emotional representations & decrease in exercise [50] *Lower illness identity, higher personal control, higher treatment control & increase in physical activity [25] |
*Higher personal control & healthier changes [25] *Higher negative emotional representations & healthier changes [25] |
||||
| Self-efficacy | NS [7,9,25,45,51,52,53,54,55] NS in the control group [56] *Higher self-efficacy & higher (increase in) physical activity [31,33,57,58,59] (in the intervention group [56]), being sufficiently active [60] *Lower self-efficacy & decreasers [50], lower physical activity [10] |
NS [25] *Higher (changes in) self-efficacy & (favorable) dietary changes [15,33,61,62] #Higher self-efficacy & target fruit and vegetable intake [37] |
NS [16,42] *Higher self-efficacy & quit attempts [15] *Higher self-efficacy & continuous abstainers [18] *Lower self-efficacy for not smoking & still smoking over time [21] |
|||
| Task self-efficacy | NS [29,53] *Increase in task self-efficacy & improved physical activity [63] |
|||||
| Barriers self-efficacy | NS [59] *Changes in barrier self-efficacy & changes in steps per day in the intervention group [64]. *Increased barrier self-efficacy & improved vigorous physical activity [63] #Increase in barrier self-efficacy & increase in walking and decrease in sitting time [31] |
|||||
| *Improvements in barriers self-efficacy mediated intervention effect on physical activity maintenance [29] | ||||||
| Relapse self-efficacy | *Changes in relapse self-efficacy & changes in steps per day, in the intervention group [64] | |||||
| Maintenance self-efficacy | NS [51] *Higher (change in) self-efficacy & increase in physical activity during intervention, but not at 10 week follow-up [65] |
|||||
| Perceived behavioural control | *Lower external locus of control & dietary changes [27] | |||||
| Positive outcome expectations | NS [59] | |||||
| Negative outcome expectations | NS [59] | |||||
| Outcome expectations | NS [29,53,57] *Exercise outcome expectancy (beliefs that exercise has beneficial consequences) & increased exercise from baseline to 6 months follow-up, but not at 3 month-follow-up [9] |
|||||
| Sociostructural factors | *Reductions in motivation & improved follow-up vigorous physical activity [63] | |||||
| Locus of control | NS [37] | |||||
| Stage of change | *Higher stage of change & increased exercise since diagnosis [25] | NS [37] *Higher stage of change & healthier eating since diagnosis [25] |
*Lower readiness to change & continuous smoker vs. quitter [15] *Higher readiness to change & quit attempts [15], less likely to relapse [18] #Higher stage of change & smoking cessation [66] *Quit motivation & smoking cessation [42] |
|||
| (Exercise) Processes of change (behavioral and cognitive) | NS for behavioral processes [31] NS for cognitive processes [32] *Cognitive processes & increasing sedentary time [31] *Behavioral processes & greater change in physical activity at 6 months and 12 months [32] *Behavioral processes & greater odds of being sufficiently active at follow-up [60] |
|||||
| Change processes | Behavioral processes of change & increase in pounds lifted for leg exercises, but not for arm exercises [52] | |||||
| Perceived access (to healthy eating; to exercise) | *Higher perceived access to exercise & increased physical activity [34] | NS [33] | ||||
| Perceived neighborhood safety | NS [34] | NS [33] | ||||
| Change in barriers | *Perceiving less barriers & diet quality [62] | |||||
| Healthy food beliefs | NS [37] | |||||
| Behavioral capabilities | NS [37] | |||||
| Difficulty finding fruit and vegetables in the neighborhood | NS [37] | |||||
| Difficulty eating fruit and vegetables as snack | NS [37] | |||||
| Taste and snack preferences for fruit and vegetables | *Improved taste/snack preferences for fruit and vegetables & increase in fruit and vegetable intake [37] | |||||
| Family opinions on fruit and vegetables | NS [37] | |||||
| Cancer coping style | NS [67] | *Fatalists (vs. fighting spirits) & increase in fruit and vegetable intake [67] | ||||
| Fatalism | NS [42] | |||||
| Coping behaviors to resist smoking | NS [18] | |||||
| Stress coping | NS [17] | |||||
| Risk perception | NS [16,42] | |||||
| Cancer threat appraisal | NS [36] | |||||
| Decisional balance: Pros and cons | NS [52,60] *Higher decisional balance pros and lower decisional balance cons & greater physical activity at 6 months, but not at 12 months [32] |
*Cons & smoking cessation at 3 months [42] | ||||
| Pain | NS [16] | |||||
| Benefit finding | *Benefit finding & increase in lifestyle behavior [22] | |||||
| Motivational regulation (self-determined motivation, amotivation, external regulation and introjected regulation) |
*Increase in self-determined motivation & increase in moderate to vigorous physical activity [68] NS: other subscales [68] |
|||||
| Motivation | NS [64] | |||||
| Motivational processes (instrumental attitudes, affective attitudes, perceived capability and perceived opportunity) |
Higher perceived opportunity & greater changes in physical activity [69] Other subscales NS [69] |
|||||
| Behavioral regulations (exercise action and coping plans, and social support) | NS [69] | |||||
| Reflexive processes (anticipated regret, habit, exercise identity, exercise obligation, and regulation of alternatives) | NS [69] | |||||
| Somatization | *Increased somatization increased & less likely to increase physical activity [36] | |||||
| Belief that exercise has a negative impact on cancer | *Main effect NS, but decreasers were more concerned about the negative impact of exercise on cancer than increasers [50] | |||||
| Perceived benefits of exercise | NS [50] | |||||
| Perceived barriers (of exercise) | NS [50,63] *Perceived barriers & increased exercise frequency from baseline to 3 months, but not at 6 months follow-up [9] *Reductions in barriers & greater physical activity [53] |
|||||
| Barrier interference | *Barrier inference mediator of intervention effect on physical activity [29] | |||||
| Perceptions of physical activity | NS for maintenance of physical activity after diagnosis [70] For patients not meeting guidelines before diagnosis, perceptions of physical activity improving quality of life and overall survival & increased physical activity after diagnosis [70] |
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| Physical activity enjoyment | NS [29] *Increase in physical activity enjoyment significantly predicted physical activity at post-intervention [71] |
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| Coping planning | NS [72] | |||||
| Action planning | *Action planning & MVPA [51] *Greater action planning & maintenance of exercise for more than 6 months [72] |
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| Intention | *Intention & MVPA [51] | |||||
| Self-leadership (behavior awareness and volition, task motivation, and constructive cognition) | *Higher self-leadership in the subscales: behavior awareness and volition, task motivation, and constructive cognition & maintenance of moderate exercise during 6 months [38] |
* = p < 0.05; # = Trend; p-value between 0.05 and 0.10; NS = Not (statistically) Significant; MVPA = Moderate to Vigorous Physical Activity.