Perceived Barriers and Facilitators to a Healthy Diet among Cancer Survivors: A Qualitative Exploration Using the TDF and COM-B

Abstract

Cancer survivors consider nutrition to be highly important and are motivated to seek information about lifestyle changes, including nutrition, to improve their long-term health. Despite this, suboptimal dietary intake is still reported. Understanding cancer-specific barriers and facilitators to healthy eating among this population could help develop targeted interventions for this group. This study explored the barriers and facilitators to following a healthy diet among cancer survivors using the Theoretical Domains Framework (TDF) and COM-B model. Semi-structured focus groups with 20 cancer survivors were conducted between February and August 2021, which were transcribed verbatim. Seven key TDF domains accounted for 87% of all coded responses. These were (a) environmental context and resources; (b) knowledge; (c) behavioural regulation; (d) social/professional role and identity; (e) belief about consequences; (f) social influences; and (g) skills. Key barriers were lack of knowledge, non-specific or irrelevant information, environmental aspects, and family. Facilitators were awareness of the importance of nutrition, the health benefits of a plant-based diet, confidence in cooking skills, organisation, balance, family, time, and viewing themselves as someone who eats healthily and access to fresh produce. Enablement was the most prominently linked intervention function. This work can inform future interventions in this area and ensure they are end-user-centred.

Prevalence of loneliness and associations with health behaviours and body mass index in 5835 people living with and beyond cancer: a cross-sectional study

“…Additionally, social interactions and norms can shape health behaviours and lonelier people may not be as exposed to others engaging in practices such as healthy eating and exercise due to reduced social engagement [ 90 , 91 ]. In line with the recognition of the social environment in SCT [ 44 ] and the opportunity component of the COM-B model [ 45 ], studies in both the general population and people LWBC have demonstrated that witnessing health-promoting behaviours is associated with increased likelihood of engaging in these behaviours [ 92 – 95 ]. Lastly, as demonstrated in Newall and colleagues’ study in the general population, happiness may moderate this association whereby higher levels of happiness may weaken the association between loneliness and unhealthy behaviours [ 29 ].…”

A Systematic Review of Dietary Interventions for Cancer Survivors and Their Families or Caregivers

“…Based on the current evidence, we cannot determine whether familism or caregiving relationships, frequent contact and support, or a combination of both better motivates and helps cancer survivors to eat healthy diets. However, numerous observational studies have linked the support from family members or caregivers to survivors’ adherence to healthy diets, especially for those who live with survivors [ 19 , 20 , 65 , 66 , 67 ]. Cancer survivors have also described that family intimacy and responsibilities motivate them to adhere to healthy lifestyle behaviors, including healthy diets, to regain and maintain their health for family members [ 68 ].…”

“…Families and caregivers have the potential to encourage and support survivors to adopt and maintain a healthy diet; conversely, family obligations or conflicts in food choices between survivors and their families or caregivers may become a barrier to eating healthy diets [ 19 , 20 ]. Accordingly, interventions have been developed to enhance family or caregiver support or overcome family-related barriers to adopting healthy diets [ 21 , 22 , 23 ].…”