Lifestyle Support Research Articles

Nutrition and Lifestyle Behavior Peer Support Program for Adults with Metabolic Syndrome: Outcomes and Lessons Learned from a Feasibility Trial.

Background: While peer support interventions have shown to benefit adults with certain chronic conditions, there is limited evidence on its feasibility and effectiveness among people with metabolic syndrome (MetS). This paper describes the outcomes of a pre-post feasibility trial of “PEeR SUpport program for ADults with mEtabolic syndrome” (PERSUADE), an evidence-based and community-specific nutrition and lifestyle behavior peer support program for Malaysian adults with MetS. Methods: We recruited 48 peers (median age: 46 (IQR = 11) years old) into four peer groups, who underwent 3 months of PERSUADE, followed by 3 months of follow-up period. Statistical analyses were conducted at post-intervention and post-follow-up to assess the changes in nutrition intake, anthropometry, and metabolic parameters. Results: Although there were significant overall increases in total carbohydrate intake and glycemic load (both p < 0.001), we noted significant reductions in the intakes of total energy and fat (both p < 0.001). Physical activity (total METS/week) also showed a significant improvement (p < 0.001). Overall, significant but marginal improvements in anthropometric and vital metabolic parameters were also observed. Conclusions: The feasibility trial supported the adoption of PERSUADE, though there is a need to assess the long-term impact of the peer support program in local community settings.

A Report on Smoking Detection and Quitting Technologies.

Mobile health technologies are being developed for personal lifestyle and medical healthcare support, of which a growing number are designed to assist smokers to quit. The potential impact of these technologies in the fight against smoking addiction and on improving quitting rates must be systematically evaluated. The aim of this report is to identify and appraise the most promising smoking detection and quitting technologies (e.g., smartphone apps, wearable devices) supporting smoking reduction or quitting programs. We searched PubMed and Scopus databases (2008-2019) for studies on mobile health technologies developed to assist smokers to quit using a combination of Medical Subject Headings topics and free text terms. A Google search was also performed to retrieve the most relevant smartphone apps for quitting smoking, considering the average user’s rating and the ranking computed by the search engine algorithms. All included studies were evaluated using consolidated criteria for reporting qualitative research, such as applied methodologies and the performed evaluation protocol. Main outcome measures were usability and effectiveness of smoking detection and quitting technologies supporting smoking reduction or quitting programs. Our search identified 32 smoking detection and quitting technologies (12 smoking detection systems and 20 smoking quitting smartphone apps). Most of the existing apps for quitting smoking require the users to register every smoking event. Moreover, only a restricted group of them have been scientifically evaluated. The works supported by documented experimental evaluation show very high detection scores, however the experimental protocols usually lack in variability (e.g., only right-hand patients, not natural sequence of gestures) and have been conducted with limited numbers of patients as well as under constrained settings quite far from real-life use scenarios. Several recent scientific works show very promising results but, at the same time, present obstacles for the application on real-life daily scenarios.

Relación entre factores socioeconómicos y obesidad abdominal en adultos mexicanos

Objetivo: investigar la relación entre los factores socioeconómicos y la obesidad abdominal en adultos mexicanos. Metodología: se estimó un modelo Probit con variable dependiente binaria que indica la incidencia de obesidad abdominal; las variables independientes utilizadas fueron los factores socioeconómicos de adultos de entre 20 y 59 años. Los datos provienen de la Encuesta Nacional de Salud y Nutrición (ENSANUT) 2006 y 2012. Resultados: el gasto per cápita, la residencia urbana, los servicios básicos de vivienda, el acceso a los servicios de salud, el apoyo social a la alimentación, el estilo de vida sedentario y el consumo de comida chatarra aumentan la probabilidad de obesidad abdominal; mientras que otros factores asociados negativamente con la obesidad abdominal fueron la escolarización, ser hablante de lengua indígena, pertenecer a un hogar monoparental y la actividad física. Limitaciones: reducción del tamaño de la muestra en algunas variables para la encuesta de 2012 y la falta de datos más actualizados y con el mismo nivel de detalle sobre consumo de alimentos. Conclusiones: aparte de los factores genéticos, los factores socioeconómicos son determinantes de la incidencia de obesidad abdominal entre los adultos mexicanos.

Barriers and facilitators perceived by women while homeless and pregnant in accessing antenatal and or postnatal healthcare: A qualitative evidence synthesis.

Evidence indicates that homelessness is increasing within Europe and the United States (US), particularly for women. Pregnancy rates among homeless women are exceptionally high compared to their housed counterparts and homeless women engage poorly with antenatal care. The aim of this review is to explore the barriers and facilitators perceived by homeless women, while pregnant, or within six weeks postpartum in accessing antenatal and/or postnatal healthcare. A qualitative systematic review and synthesis was conducted. Key words and search terms were derived using the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework. Titles and abstracts were screened in accordance with inclusion and exclusion criteria. The methodological quality of included papers was assessed using criteria described by the Critical Appraisal Skills Programme (CASP) with data analysis using thematic synthesis. Two primary linked themes were generated: (a) lack of person-centred care; (b) complexity of survival. At an organisational level, a fragmented health service and accessibility to the health system were barriers, and resulted in poor person-centred care. At a clinical level, attitude & treatment from healthcare providers together with health knowledge all combined to illustrate poor person-centred care as barriers to homeless women accessing antenatal/postnatal healthcare. Sub-themes associated with complexity of survival included: disillusion with life, distrust of services, competing lifestyle demands and support and relationships. The findings of this review highlight that poor engagement may be partly explained by the complex interplay between both the healthcare system (person-centred care) and the individual (complexity of survival). Future services should be delivered in a way that recognises homeless people's complex and diverse needs, and should be reconfigured in order to try to meet them, through decreasing fragmentation of health services and staff training.

Evidence and Challenges for Translation and Population Impact of the Diabetes Prevention Program.

Type 2 diabetes is common, burdensome, and preventable. Landmark trials such as the Diabetes Prevention Program (DPP) demonstrated that resource-intensive lifestyle support interventions resulting in modest weight loss via healthy diet changes and physical activity can lower the rate of diabetes development by 58%. We performed a review of efforts to translate and implement DPP-like programs throughout the USA to identify challenges and opportunities for improvement. For more than a decade, multiple stakeholders have worked to translate evidence-based principles of diabetes prevention to reach 84 million Americans with prediabetes. DPP-like programs have been delivered by over 1500 organizations, reaching almost 300,000 people, but this number represents less than 1% of the target population. Research has uncovered large gaps in efforts to diagnose, raise awareness, and provide access to DPP-like programs for adults with prediabetes, requiring further stakeholder engagement and coordination to resolve. Efforts to address prevailing gaps in diabetes prevention must address distinct and sometimes conflicting priorities and concerns of stakeholders. Our review recommends several areas of further research and action to improve type 2 diabetes prevention on a population scale.

SMART2D-development and contextualization of community strategies to support self-management in prevention and control of type 2 diabetes in Uganda, South Africa, and Sweden.

Type 2 diabetes (T2D) and its complications are increasing rapidly in low- and middle-income countries, as well as among socioeconomically disadvantaged populations in high-income countries. Support for healthy lifestyle and self-management is paramount but not well implemented in health systems, and there is need for knowledge on how to design and implement interventions that are contextualized and patient centered and address special needs of disadvantaged population groups. The SMART2D project implements and evaluates a lifestyle and self-management intervention for participants recently diagnosed with or being at increased risk for T2D in rural communities in Uganda, an urban township in South Africa, and socioeconomically disadvantaged urban communities in Sweden. Our aim was to develop an intervention with shared key functions and a good fit with the local context, needs, and resources. The intervention program design was conducted in three steps facilitated by a coordinating team: (a) situational analysis based on the SMART2D Self-Management Framework and definition of intervention objectives and core strategies; (b) designing generic tools for the strategies; and (c) contextual translation of the generic tools and their delivery. This article focuses on community strategies to strengthen support from the social and physical environment and to link health care and community support. Situational analyses showed that objectives and key functions addressing mediators from the SMART2D framework could be shared. Generic tools ensured retaining of functions, while content and delivery were highly contextualized. Phased, collaborative approach and theoretical framework ensured that key functions were not lost in contextualization, also allowing for cross-comparison despite flexibility with other aspects of the intervention between the sites. The trial registration number of this study is ISRCTN11913581.

Prevalence of depression among the elderly in urban area of Perambalur district

Background: Depression at any age needs attention. Geriatric population being most vulnerable, are more prone to many morbidities, physically and mentally. Geriatric depression is one among them which needs prompt attention. The objectives of the present study were to estimate the prevalence of geriatric depression and association of depression with various sociodemographic factors.Methods: A cross sectional study carried out among 300 geriatric subjects. A structured interview schedule was used to collect data.Results: The prevalence of depression was found to be 44.4%. Female gender, marital status, family type was found to be positively associated with depression.Conclusions: Geriatric depression in our study is found to be on little higher side. Lifestyle modifications and support from family members are needed to improve the quality of life of these people.

Effects of obesity, metabolic syndrome, and non-alcoholic or alcoholic elevated liver enzymes on incidence of diabetes following lifestyle intervention: A subanalysis of the J-DOIT1.

ObjectivesUsing annual health check‐up data, the aim of this study was to identify target populations for lifestyle interventions to effectively prevent diabetes in a real‐world setting.MethodsThe Japan Diabetes Outcome Intervention Trial‐1, a prospective, cluster‐randomized controlled trial, was launched to test if year‐long telephone‐delivered lifestyle support by health professionals can prevent the development of type 2 diabetes (T2D) in people with impaired fasting glucose (IFG) identified at health check‐ups. A total of 2607 participants aged 20‐65 years with IFG were randomized to an intervention arm (n = 1240) or a control arm (n = 1367). We performed subgroup analysis to examine the effects of the intervention on the incidence of T2D in participants with body mass index (BMI) ≥25, metabolic syndrome (MetS), and non‐alcoholic or alcoholic elevated liver enzymes at the baseline. Cox regression analysis adjusted for sex was used to calculate the hazard ratios (HRs).ResultsIn addition to IFG, the presence of BMI ≥25, MetS, and elevated liver enzymes increased the incidence of diabetes by two‐ or three‐fold. During a median follow‐up period of 4.9 years, only the non‐alcoholic elevated liver enzyme group showed a low incidence rate owing to lifestyle interventions (adjusted HR: 0.42, 95% confidence interval: 0.18‐0.98).ConclusionThe results suggest that people who have IFG and non‐alcoholic elevated liver enzymes are a good target population for lifestyle interventions to effectively reduce the incidence of diabetes in a real‐world setting.

Multiculturalism in a “homogeneous” society from the perspectives of an intercultural event in Japan

In this paper, I demonstrate how long-term multigenerational minorities and Japanese residents engage in the current socio-political discourse of “multicultural coexistence” society (tabunkakyōsei shakai), which had not previously been integral to the vocabulary of national rhetoric in Japan until the 2000s. I argue that the lack of clear definition and goals of multicultural coexistence by the current Japanese government generates obstacles in the attempt to build a multicultural society. While local municipalities’ programs, such as multilingual services and lifestyle support, are certainly needed, long-term foreign residents with linguistic and cultural competence are suspicious of the concept of multicultural coexistence due to their own embodied marginalized positions. Taking a local municipality’s intercultural event as a point of reference, this paper explores how long-term minority residents perceive their positions at the crossroads of seemingly paradoxical forces of multicultural trends and an ongoing national identity founded upon ethnic homogeneity.

Expert by Experience Involvement in Mental Health Research: Developing a Wellbeing Brochure for People with Lived Experiences of Mental Illness

This is a process paper that describes the development of a wellbeing brochure, shared between university researchers, a consumer research advocate, and fully informed by people who are living with mental illness (experts by experience). The purpose of this brochure was to provide strategies for maintaining wellbeing for EBEs, after attending a psychosocial intervention. Brochure development was guided by a mixed-methods research design, using a survey and focus group. The findings illustrate five key themes in EBEs strategies for maintaining wellbeing: good sleep hygiene, regular physical activity, maintaining a healthy lifestyle, relaxation techniques and social support. This process paper demonstrates how collaborating with experts by experience represents a valuable approach for developing mental health research and resources.

Characteristics of older people willing to offer lifestyle support to other community members living in rural areas with heavy snowfall

Objective The increasing aging population has increased the number of older people who need lifestyle support because of their declining mental and physical health. In recent years, it has become necessary to increase the number of residents who can provide lifestyle support. It is highly expected that older people, as local residents, will be keen to offer lifestyle support. This study identified the characteristics of older people willing to offer lifestyle support to other members of the community living in rural areas with heavy snowfall.Methods We surveyed 801 people, aged 65 years and above, who lived in Yoshijima, Kawanishi town, Yamagata Prefecture, and were not certified in nursing care levels 1-5. A questionnaire was distributed and collected by the president of the neighborhood association and the head of the neighboring group. Data were collected from June to July 2018. The survey included items on basic attributes, health status, social relations with neighbors, and willingness to offer lifestyle support (eight types). A logistic regression analysis was conducted for each support type, with basic attributes, health status, and social relations with neighbors as independent variables and willingness to offer lifestyle support as the dependent variable.Results We analyzed the data of 586 participants (73.2% valid responses) and found that women were interested in "being a talking partner/consultant in cases of trouble," "helping with meal preparation/cleaning and laundry," and "inviting their neighbors to gatherings and events." However, they were uninterested in "performing outside work such as gardening or fieldwork" and "snow shoveling and removal." People who felt they were affluent were eager to perform "pick-ups and hospital visits," and the higher educated were more interested in "being a talking partner/consultant in cases of trouble" and "helping with meal preparation/cleaning and laundry." Those involved in highly instrumental activities were interested in "monitoring/safety confirmation," "inviting their neighbors to gatherings and events," "accompanying their neighbors for shopping or serving as a substitute," and "pick-up and hospital visits." Further, except "helping with meal preparation/cleaning and laundry" and "performing outside work such as gardening or fieldwork," people with close relationships with their neighbors were significantly more willing to offer support.Conclusion The characteristics of older people willing to support others depended on the type of lifestyle support required. This finding could help in the recruitment and facilitation of older people willing to offer lifestyle support.

More lifestyle support needed for patients starting medicines for cardiovascular disease, study concludes

More lifestyle support needed for patients starting medicines for cardiovascular disease, study concludes

Trends and determinants of quality of life and self-rated health in the course of medical education among medical students

The aim of this study is to determine the change in the self-rated health and quality of life of students of a school of medicine during the course of their education and the predictive factors of health and quality of life such as socioeconomic factors, health status and healthy lifestyle, social relationships and social support, and academic burden. The study is a cross-sectional study that aimed to reach the entire registered students of Manisa Celal Bayar University School of Medicine in 2016-2017. Dependent variables in this study are the overall quality of life, self-rated health and annual self- rated health transition About 10.1% of the students stated their overall quality of life as poor or very poor whereas nearly 10.9% were dissatisfied about their health and 20.3 % of them stated their current health as worse than the previous year. There is a linear trend in a year in medical school in terms of quality of life. The logistic regression Model suggested that having a non-depressed mood is the best predictor of a better quality of life. Lower BMI, being healthy, taking care of their health and having a nuclear family are found the most important variables that affect self-rated health positively. The final term students (interns) perceived the worse overall quality of life than the first and second-year students. Additionally, the majority of the 3rd, 4th, and 5th term students reported their health worse than the previous year. These facts in self-rated health and QOL may be regarded as pieces of evidence that may lead the university authorities to take measures especially in clinical terms of medical education.

Incentives for Smoking Cessation During Pregnancy: An Ethical Framework.

IntroductionSmoking during pregnancy increases the risk of morbidity and mortality of the mother and child. The inability of the unborn child to protect itself, raises the social and academic responsibility to protect the child from the harmful effects of smoking. Interventions including rewards (incentives) for lifestyle changes are an upcoming trend and can encourage women to quit smoking. However, these incentives can, as we will argue, also have negative consequences, for example the restriction of personal autonomy and encouragement of smoking to become eligible for participation. To prevent these negative consequences, we developed an ethical framework that enables to assess and address unwanted consequences of incentive-based interventions whereby moral permissibility can be evaluated.Aims and MethodsThe possible adverse consequences of incentives were identified through an extensive literature search. Subsequently, we developed ethical criteria to identify these consequences based on the biomedical ethical principles of Beauchamp and Childress.ResultsOur framework consists of 12 criteria. These criteria concern (1) effectiveness, (2) support of a healthy lifestyle, (3) motivational for the target population, (4) stimulating unhealthy behavior, (5) negative attitudes, (6) personal autonomy, (7) intrinsic motivation, (8) privacy, (9) fairness, (10) allocation of incentives, (11) cost-effectiveness, and (12) health inequity. Based on these criteria, the moral permissibility of potential interventions can be evaluated.ConclusionsIncentives for smoking cessation are a response to the responsibility to protect the unborn child. But these interventions might have possible adverse effects. This ethical framework aims to identify and address ethical pitfalls in order to avoid these adverse effects.ImplicationsAlthough various interventions to promote smoking cessation during pregnancy exist, many women still smoke during pregnancy. Interventions using incentives for smoking cessation during pregnancy are a promising and upcoming trend but can have unwanted consequences. This ethical framework helps to identify and address ethical pitfalls in order to avoid these adverse effects.It can be a practical tool in the development and evaluation of these interventions and in evaluating the moral permissibility of interventions using incentives for smoking cessation during pregnancy.

Co-designing preconception and pregnancy care for healthy maternal lifestyles and obesity prevention

ProblemA recognised gap exists between current and recommended practices in the provision of lifestyle advice and weight management support for women across preconception and pregnancy care. BackgroundPreconception and pregnancy are critical stages for promoting healthy maternal lifestyles and obesity prevention. Co-design is a novel approach with the potential to strengthen existing models of care to facilitate the implementation of clinical practice guidelines promoting preconception and pregnancy health, especially in relation to preconception weight management and preventing excessive gestational weight gain. Aim and methodsThe aims of this discussion paper are to (i) define co-design in the context of preconception and pregnancy care, (ii) outline key considerations when planning co-design initiatives and (iii) describe co-design opportunities in preconception and pregnancy care for promoting women’s health and obesity prevention. DiscussionWhile several definitions of co-design exist, one critical element is the meaningful involvement of all key stakeholders. In this discussion, we specifically identified the involvement of women and expanding the role of practice nurses in primary care may assist to overcome barriers to the provision of healthy lifestyle advice and support for women during preconception. Co-designing pregnancy care will involve input from women, nurses, midwives, obstetricians, allied health and administration and management staff. Additional attention is required to co-design care for women considered most at-risk. ConclusionThere is potential to enhance current provision of preconception and pregnancy care using co-design. Nursing and midwifery professions are active across both preconception and pregnancy and therefore, they have an important role to play.

Assessing the feasibility and acceptability of Changing Health for the management of prediabetes: protocol for a pilot study of a digital behavioural intervention

BackgroundThe prevalence of prediabetes is rapidly rising in the UK, largely associated with an increase in obesity. Lifestyle programmes that provide support to make and sustain dietary and physical activity behavioural changes are necessary to initiate and maintain weight loss. However, these programmes are often intensive and time consuming. Given the magnitude of the problem, there is a need for behavioural interventions that can be delivered at scale. Digital interventions can address some of the aforementioned issues. The primary aim of the present study is to assess the feasibility and acceptability of a digital intervention called Changing Health that provides structured education and lifestyle behaviour change support to adults with prediabetes.MethodsA single-group pilot study will be undertaken. We aim to recruit 40 participants with prediabetes defined by HbA1c or fasting plasma glucose (FPG), aged between 18 and 75 years with a BMI ≥ 25. Participants will receive the digital intervention (a mobile phone app incorporating structured education and behavioural tools to support lifestyle behaviour change) with the aim of losing and maintaining 5–6% of their baseline body weight. Each participant will receive 100 min of lifestyle coaching over the 9-month intervention period and will have continued access to the digital intervention. Clinical outcome measures will be collected during four visits to our clinical research facility: two visits at baseline, one visit at month 3, and one visit at month 9. These secondary outcome measures will include diet, physical activity, sleep, metabolic control, body composition, cardiorespiratory fitness, and cardiovascular function. To measure primary outcomes, an embedded qualitative study will be conducted to obtain data on feasibility and acceptability of the intervention.DiscussionThis pilot study will establish whether Changing Health is feasible and acceptable to adults with prediabetes. Clinical outcome measures will provide estimates of variability to inform sample size calculations, and qualitative data generated will inform any necessary refinements to the intervention. This will provide a platform for a larger evaluation to assess the effectiveness of Changing Health for changing diet and physical activity to initiate and maintain weight loss in adults with prediabetes.Trial registrationISRCTN Registry: ISRCTN69270299.

Model of Sustainable Village for Kampung Sedili Kecil in Johor, Malaysia

The economic growth and energy consumption come at the cost of environmental degradation, sustainability experts are trying to find the way which can reduce pollution, conserve the natural resource and protect the environment. Moreover, regional and rural development strategy pay attention to the goal of sustainability to ensure its continuum. Sustainability such as sustainable ecosystem, sustainable community, sustainable village, and sustainable lifestyle support itself and its surrounding. Moreover, Sustainability ensuring access of human beings to the basic resource, healthcare facilities, education facilities, good quality of life, with capacity of conserving environmental capital, human capital, social capital, economic capital, and cultural capital. Therefore, a sustainable village is designed to achieve the highest levels of ecological and environmental sustainability with a holistic approach to the basic site selection, sub-division planning, and construction, through to the requirements of the built environment. Malaysia is one of the countries which has many villages, the villages are not without problems, which are lagging behind in socio-economic development due generally to prevalence of very low level of literacy, and education and, heavy dependence on primary production, agriculture, animal husbandry, and fishery. Therefore, it is needed to conduct a study to find the strengths, weaknesses, opportunities, and threats of the village. Thus, this research has been conducted to study the Kampung Sedili Kecil village which one of the villages in the Johor state of Malaysia. The main aim of the research is to prepare a model of a sustainable village for Kampung Sedili Kecil to ensure that all capital to be integrated and symbiosis relationship that may enable the continuation of the community and conserved and enhanced the environmental capital, human capital, social capital, economic capital, and cultural capital in the Kampung Sedili Kecil.

Individuals With Type 2 Diabetes: An Exploratory Study of Their Experience of Family Relationships and Coping With the Illness.

The purpose of this qualitative study is to explore familial patterns that may be related to type 2 diabetes (T2DM) and to patients' ways of coping with the illness. A purposive sample of 32 Israeli Jewish (n = 12) and Arab (n = 20) individuals with T2DM were recruited from a community population and interviewed about their familial experiences and their illness. Interview data were analyzed using Colaizzi's phenomenological method. Many participants, particularly from the Arab society, reported familial patterns that suggest fused relationships and emotional cutoff. They described highly close and positive family relationships, on one hand, but demonstrated unwillingness to share their difficulties with their family members, on the other hand. Precipitating stressful or traumatic events and day-to-day stress appeared as leading perceived causes of the illness. Maintaining an appropriate lifestyle, stress reduction, and family support were the main coping strategies with the illness. The findings suggest a possible avenue in which fusion with family members and inability to attenuate emotional distress by sharing difficulties with others may contribute to the development of T2DM. Assessment of such family dynamics and ways of coping with stress could lead to more appropriately nuanced treatment for individuals with T2DM and prediabetes.

Depressive symptoms are related to boredom proneness in patients receiving hospital care, regardless of alcohol status, lifestyle, or social support

We examined the relationship between boredom proneness and psychological distress in patients receiving hospital care due either to excessive alcohol consumption or to gastrointestinal diseases. Sociodemographic data were collected together with boredom proneness subscales (internal/external lack of stimulation), psychological distress, physical activity, and social support. Boredom proneness due to a lack of external stimulation seemed to constitute a prominent personality trait in patients with alcohol consumption. But depressive symptoms were related only to boredom proneness due to a lack of internal stimulation in all patients, regardless of alcohol status, lifestyle, or social support. Potential implications for practice and future research are discussed.

Prospective, longitudinal study of risk factors for cancer-related distress in colorectal cancer survivors from prior to surgery until one year after surgery: Results from the ColoCare study.

146 Background: Although cancer-related distress is known to persist long after completion of colorectal cancer (CRC) treatment, factors related to distress are largely unexplored in CRC survivors. We examined changes over time and risk factors for distress in CRC patients over the first year after surgery. Methods: We included 212 CRC patients who consented pre-surgery, with data at 6 and 12 months post-surgery from the ColoCare Study in Heidelberg, Germany. Sociodemographic and lifestyle factors, social support and health-related quality of life (QOL) prior to surgery were evaluated as predictors of cancer-related distress. Distress was measured with the Cancer and Treatment Distress instrument (CTXD). Linear regression analyses examined associations between risk factors and distress. Results: Although overall mean of six distress subscales did not change from 6 to 12 months, distress subscale scores varied over time: health burden subscale score increased ( p &lt; .001), while finances ( p = .004), medical demands ( p &lt; .001), and identity ( p &lt; .001) subscale scores decreased from 6 to 12 months. Uncertainty and family strain subscale scores did not change. Younger age, lower income, advanced cancer stage, poorer social support, and poorer baseline QOL scores predicted worse distress at 6 and 12 months. Conclusions: Cancer-related distress continues unresolved at 6 and 12 months post-surgery in this population of CRC survivors. Although some risk factors are difficult to alter, lack of social support may be modifiable and those at risk can be identified early after diagnosis. Screening for risk factors pre-surgery would allow for targeted interventions including strategies to improve resources for those with low support, thereby reducing long-term distress in CRC survivors.