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Predicting Engagement With Online Walking Promotion Among Metropolitan and Rural Cancer Survivors

Frensham, Lauren J., PhD; Parfitt, Gaynor, PhD; Dollman, James, PhD

doi: 10.1097/NCC.0000000000000649
Article: PDF Only

Background Physical activity has numerous associated benefits for cancer survivors. Compared with their urban counterparts, rural Australians experience a health disadvantage, including poorer survival rate after diagnosis of cancer.

Objective The aims of this study were to test the effectiveness of an online 12-week walking intervention designed for cancer survivors and explore region-specific psychological predictors of behavior change.

Methods This was a quasi-randomized controlled trial of an online resource designed according to Social Cognitive Theory and Self-determination Theory, based on individualized goal setting. Measures of habitual walking, motivation, and self-efficacy were taken at baseline, postintervention, and 3-month follow-up in an intervention group (n = 46) and active control group (n = 45). The control group was provided a pedometer but did not have access to the online program.

Results An increase in steps/day at 12 weeks was observed in both groups, with a larger increase in the intervention group; these increases were not sustained at the 3-month follow-up. Psychological predictors of maintained change in steps per day (motivation, barrier self-efficacy, and relapse self-efficacy) did not differ between metropolitan and rural participants. Changes in steps per day among intervention participants were predicted by changes in relapse self-efficacy and barrier self-efficacy.

Conclusions The intervention was successful in increasing physical activity postintervention; however, changes were not maintained at follow-up. There were no region-specific predictors of engagement in the intervention.

Implications for Practice Nurses are seamlessly positioned to promote health interventions like walking. Nurses should reframe physical activity with patients so that relapse is seen as common and possibly inevitable when adopting a regular physical activity habit.

Author Affiliations: Adelaide Nursing School, Faculty of Health and Medical Sciences, Adelaide University (Dr Frensham); and Sansom Institute for Health Research, School of Health Sciences, University of South Australia, Adelaide, Australia (Drs Parfitt and Dollman).

This study was supported by a grant from the Cancer Australia Supporting People With Cancer Grant initiative. It was also supported by Country Health SA.

The authors have no conflicts of interest to disclose.

Correspondence: Lauren J. Frensham, PhD, Adelaide Nursing School, Faculty of Health and Medical Sciences, Adelaide University, Adelaide Health & Medical Sciences Building, Crn North Terrace & George Street, Adelaide, SA, 5000 Adelaide, Australia (

Accepted for publication July 5, 2018.

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