|Abstract:||Purpose: Establish the perceived preferences and barriers related to breast cancer survivors’ diet and physical activity (PA) programming to inform future optimal diet and exercise combined intervention development in such a post-COVID-19 era.
Methods: This was a cross-sectional study of 224 breast cancer survivors (BCSs) aged 18 years or older and diagnosed with ductal carcinoma in situ (DCIS) or Stage I-IV breast cancer (BC). The BCSs were recruited during routine oncology appointments at a Midwestern cancer center. A survey was conducted to query survivors’ level of interest in, preferences for, and perceived barriers to participating in an exercise and dietary intervention program. The acceptability of a technology-based intervention was assessed. Data was also analyzed with pre- and post-COVID-19 comparisons.
Results: More than half of BCSs were interested in participating in a research study about exercise and diet intervention. The most-reported preferred timing(s) for participating in diet and exercise programming were immediately after diagnosis or immediately following treatment. Most participants preferred to meet in person with a Registered Dietitian Nutritionist or an exercise specialist. Participants preferred to receive nutrition and exercise education or counseling in one-on-one sessions and to receive nutrition and exercise information were from written materials such as educational handouts (Nutrition: 77%, Exercise: 69%), in-person (Nutrition: 67%, Exercise: 75%), or via internet/technology-based methods (Nutrition: 62%, Exercise: 59%). The most-reported participation barriers were the lack of extra time and energy that came from family responsibility, work, or lack of time, and physical issues such as fatigue, illness, and surgery. Most of the participants had a tablet, a smartphone that could download applications, and high-speed internet. More than half of the participants reported being comfortable using their tablets and their smartphones. The most-reported social media or visual communication platforms that they used were Facebook, YouTube, and Pinterest. Thirty Night% of the participants indicated being comfortable participating in a technology-based nutrition and exercise program. The reported preferred delivery modes for program participation were website, mobile applications (apps) for smartphones or tablets, and e-mails.
During the post-COVID-19 period, BCSs’ reported increased likeliness to participate in a BC research study testing the benefits of this diet and exercise intervention. Decreases were seen in the percentages of participants who preferred to meet with nutrition or an exercise specialist in person, in addition to receiving nutrition (p<0.05) or exercise information in person or to receive nutrition or exercise education/counseling in one-on-one sessions during the post-COVID period. There were also higher preferences for using visual communication tools (e.g., Skype or FaceTime) the most to receive nutrition and exercise information (p<0.05) and for meeting with the health specialists via distance-based methods using technology or and. Program participation barriers because of physical issues (e.g., fatigue, illness, surgery) were reported in slightly higher percentages during the post-COVID-19 period. There was lower comfort with using their smartphones (76% pre, 57% post) among BCSs. Increased percentages were seen in those who used high-speed internet (85% pre, 90% post), social media platforms to look for healthy living information (increased by 18%). The top three social media platforms with increased usage percentages were YouTube (p<0.05), Instagram and Facebook. Besides, higher percentages were also seen in those who were comfortable with participating in a technology-based nutrition and exercise program (35% pre, 46% post), and those who chose “no preference” (3% pre, 14% post) or “visual communication tools” (11% pre, 20% post) as their preferred technology delivery modes to participate in such a combined program.
Conclusion: Participants had enthusiasm about nutrition and exercise intervention, different participation preferences for different service types, and barriers of physical issues (e.g., fatigue, illness) and poor energy and time (e.g., family responsibility, work) to their participation in a diet and exercise intervention. Data from the post-COVID-19 showed not only BCSs’ increased participation interests but also their increased programming participation challenges (e.g., physical and COVID-19 related issues). Strategies should be developed to help participants of combined diet and exercise interventions overcome these barriers to participation. There is a great potential in delivering health care services via technology among BCSs, which addresses BCSs’ participation barriers related to geographic location or the COVID-19 lockdown and reduces their physical discomfort from traveling because of disease or treatment-related symptoms. However, support will be needed to address BCSs’ discomfort or unfamiliarity in using technology if they are to participate in any technology-based programs. Future studies should take the specific service preferences, perceived barriers learned from this survey into consideration and investigate in a real-world context during the COVID-19 pandemic to tailor an optimal diet and exercise combined intervention.