Evaluation of the Healthy Living after Cancer text message-delivered, extended contact intervention using the RE-AIM framework

Jennifer R Job,Brianna S Fjeldsoe,Marina M Reeves,Elizabeth G Eakin

doi:10.1186/s12885-021-08806-4

Abstract

BackgroundText message-delivered interventions have potential to prevent weight regain and maintain diet and physical activity behaviours through extending contact with participants following initial weight loss, lifestyle interventions. Using the RE-AIM Framework, this study evaluated the adoption, reach, implementation, effectiveness, and maintenance of an extended contact text-message intervention following the Healthy Living after Cancer (HLaC) program. HLaC was a 6-month, telephone-delivered intervention targeting healthy diet, physical activity and weight loss for adult cancer survivors, offered by Cancer Councils (CCs) in Australia.MethodsHLaC completers (n = 182) were offered extended contact via text messages for 6-months (HLaC+Txt). Text message content/frequency was individually tailored to participant’s preferences, ascertained through two telephone-tailoring interviews with CC staff. Adoption (HLaC+Txt uptake among eligible CCs), reach (uptake by HLaC completers) and implementation (intervention cost/length; text dose) were assessed. The effectiveness of extended contact relative to historic controls was quantified by pre-to-post HLaC+Txt changes in self-reported: weight, moderate-vigorous physical activity (MVPA), fruit and vegetable intake, fat and fibre behaviour. Maintenance, following 6-months of noncontact for the intervention cohort, was assessed for these same variables. Semi-structured interviews with CC staff and participants contextualised outcomes.ResultsHLaC+Txt was adopted by all four CCs who had delivered HLaC. In total, 115 participants commenced HLaC+Txt, with reach ranging across CCs from 47 to 80% of eligible participants. The mean number of weeks participants received the text message intervention ranged across CCs from 18.5–22.2 weeks. Participants received (median, 25th,75th percentile) 83 (48, 119) texts, ranging across CCs from 40 to 112. The total cost of HLaC+Txt delivery was on average $AUD85.00/participant. No meaningful (p < 0.05) differences in self-reported outcomes were seen between HLaC+Txt and control cohorts. After 6-months no contact the intervention cohort had maintained weight, fruit intake, fat and fibre index scores relative to end of HLaC+Txt outcomes. Participants/CC staff perceived an important intervention component was maintaining accountability.ConclusionsWhile feasible to implement, HLaC+Txt was not effective in the short term. However, intervention effects during the non-contact period suggest the program supports longer term maintenance of weight and diet behaviour. Intervention delivery in this real-world context highlighted key considerations for future implementation.Trial registrationAustralian and New Zealand Clinical Trials Registry (ANZCTR) - ACTRN12615000882527 (registered on 24/08/2015).

Highlights

Text message-delivered interventions have potential to prevent weight regain and maintain diet and physical activity behaviours through extending contact with participants following initial weight loss, lifestyle interventions
Using the RE-AIM framework [26], this paper describes the outcomes of a text message-delivered, extended contact intervention for Healthy Living after Cancer (HLaC)
The Cancer Council (CC) each made their own decisions regarding which staff would conduct the tailoring interviews, with two CCs using the HLaC telephone coaches who had been trained in motivational interviewing and two using research assistants who had no motivational interviewing training

Summary

Introduction

Text message-delivered interventions have potential to prevent weight regain and maintain diet and physical activity behaviours through extending contact with participants following initial weight loss, lifestyle interventions. In Australia the overall cancer survival rate was 69% in 2011–2015, a substantial increase from 48% in 1984– 1988 [2, 3] For those diagnosed with the most prevalent cancers (i.e. breast, prostate, bowel), many are more likely to die from causes other than cancer (i.e. cardiovascular disease) compared to other non-cancer survivor populations [4]. Lifestyle interventions for cancer survivors have been effective for supporting weight loss and achieving improvements in diet and physical activity behaviours [7,8,9,10,11,12,13,14]. As with interventions in the general population, maintaining dietary and physical activity behaviour changes following intervention completion remains a challenge [7, 10]

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Discussion

Conclusion