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Cited by 39Cancer survivorship and careMobile Health and mHealth ApplicationsCancer Risks and Factors

A qualitative evaluation of a group phone-based weight loss intervention for rural breast cancer survivors: Themes and mechanisms of success

Open access
Fazzino, Tera L., Sporn, Nora J., Befort, Christie A.·2016·Supportive Care in Cancer
DOI 10.1007/s00520-016-3149-7PMC PMC4879096
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Abstract

Purpose Obesity is prevalent in breast cancer survivors and is a significant risk factor for recurrence and mortality. Weight management interventions for survivors have been diverse in design (in-person vs. phone-based, group vs. individual) and yielded varying weight loss results. Given these issues, participants themselves may provide insight into treatment-based factors that contributed to their weight loss outcomes. Here, we report qualitative results from interviews with survivors in a group phone-based weight loss intervention, with the objective of identifying mechanisms that facilitated or hindered adherence and weight loss. We explored interest in paying for continued treatment as an indicator of dissemination potential.Methods Individual interviews were conducted with 186 rural, obese breast cancer survivors upon completion of a 6-month weight loss intervention that produced clinically meaningful weight loss (>5 %) in 91 % of participants. A thematic analysis of the interview data was performed.Results Five themes were identified as impacting adherence and success: (1) accountability; (2) importance of the group, with varying levels of connectedness; (3) dietary convenience; (4) difficulty maintaining intervention components that required more effort; and (5) importance of internal motivation to attributions of physical activity success or failure. Most were interested in paying to continue the program if it were extended beyond the study.Conclusions Key intervention components that participants attributed to their success included supportive group processes and convenience. Results highlight the group phone-based approach as a potential venue for disseminating an effective weight loss program for breast cancer survivors.Trial registration NCT01441011.

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Registry

Crossref · 10.1007/s00520-016-3149-7

Cites

48 of 48 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 40 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Most participants (82%) reported they would be willing and able to pay to continue participating in the program, depending on the price.

    “Most participants (82%) reported that they would be willing and able to pay to continue participating in the program, depending on the price.”
    • Also stated in: § Discussion · plain
      “Most participants expressed interest in paying for continued weight management treatment.”
    Quote in the paperSubstantial claim
  • Findingown data

    71% of participants lost 10% or more of their baseline body weight.

    “and 71% of participants lost 10% or more of their baseline body weight.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Most participants attributed their success or failure in reaching physical activity goals to their internal motivation level.

    “Participants commented that increasing physical activity was their own responsibility, and most attributed their success or failures in reaching their physical activity goals to their internal motivation level.”
    Quote in the paperSubstantial claim
  • Findingown data

    External barriers to physical activity, such as lack of time, scheduling conflicts, fatigue, lack of sidewalks and paved roads, lack of exercise facilities, and extreme seasonal temperatures, were viewed by participants as less influential than internal motivation.

    “Although less predominant, some participants also described a variety of external barriers that made it difficult to maintain physical activity, including lack of time, scheduling conflicts, fatigue, lack of sidewalks and paved roads, a lack of exercise facilities in their rural towns, and extreme seasonal temperatures that made outside physical activity difficult.”
    • Also stated in: § Thematic Analysis · plain
      “However, these external barriers were viewed as less influential compared to internal motivation.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Participants reported that the convenience of the diet, including protein shakes and prepackaged entrees, facilitated adherence because it was quick and easy and reduced food preparation and decision-making burden.

    “Participants reported that they liked the protein shakes and prepackaged entrees because they were “quick and easy” and required little food preparation time and forethought.”
    • Also stated in: § Thematic Analysis · plain
      “Some liked that the prepackaged entrees decreased the burden of choosing what to eat: “[following the diet] took decision making out of the game” and many reported that the diet “made life easy,” which facilitated their adherence.”
    Quote in the paperSubstantial claim
  • May combine two claims. 18
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 6

  • May combine two claims.

    Findingown data

    About half of participants found physical activity difficult to maintain, and some reported that increasing physical activity was the hardest part of the program.

    “About half of participants found the physical activity difficult to maintain and some reported that increasing physical activity was the hardest part of the program.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants reported that hearing others were going through similar challenges and successes with weight loss was helpful, and that ongoing discussions about the weight loss process were useful when they felt they were slipping from diet and physical activity compliance.

    “Participants reported that it was helpful hearing others were going through similar challenges and successes with weight loss, and that ongoing discussions about the weight loss process were useful when they felt they were “slipping” from diet and physical activity compliance.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Participants reported that accountability to the group and to themselves for eating and physical activity was a helpful part of the program and motivated them to make dietary and physical activity changes.

    “Participants reported they felt accountable to the group and to themselves for their eating and physical activity during the study.”
    • Also stated in: § Thematic Analysis · plain
      “Participants expressed how having to be responsible for their behavior and being held accountable for meeting these goals during the group sessions was a very helpful part of the program and motivated them to make dietary and physical activity changes.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Participants varied substantially in their connection with the group, with some reporting strong bonds and helpful group support, while others reported uneven participation, disinterest in some discussion content, or discomfort speaking regularly.

    “However, individuals also varied substantially in their connection with the group.”
    • Also stated in: § Thematic Analysis · plain
      “Some participants commented that their groups formed “strong bonds” and that the group support was very helpful and important. Others expressed that group participation was unevenly distributed or that they themselves were not interested in some of the group discussion content.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Five themes were identified as affecting adherence and success: accountability, importance of the group with varying connectedness, dietary convenience, difficulty maintaining effortful intervention components, and importance of internal motivation to physical activity attributions.

    “Five themes were identified as impacting adherence and success: 1) accountability, 2) importance of the group, with varying levels of connectedness, 3) dietary convenience, 4) difficulty maintaining intervention components that required more effort, and 5) importance of internal motivation to attributions of physical activity success or failure.”
    • Also stated in: § Thematic Analysis · plain
      “Five themes were identified across interview questions and cohorts (Table 3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Participants appreciated the group aspect of the program, including normative group support, advice from the group leader and participants, information about nutrition, weight management, and health, and shared weight loss goals.

    “Participants reported they appreciated the group aspect of the program, particularly the normative group support, advice from the group leader and participants, information about nutrition, weight management, and health, and having shared weight loss goals.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Some participants who were generally unsuccessful at increasing physical activity reported they did not know what would have helped and viewed their motivation level as unamendable from the intervention.

    “Some participants who were generally unsuccessful reported they did not know what would have helped them increase their activity and that “the encouragement was there.” These participants tended to view their motivation level as unamendable from the intervention.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Participants reported that self-monitoring helped them stay accountable to themselves and influenced their dietary compliance.

    “In addition, participants expressed that self-monitoring helped them stay accountable to themselves by keeping them “honest when you don’t want to be,” which influenced their dietary compliance.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning

    More group leader training and quality control monitoring may be required for group phone-based interventions compared to in-person approaches.

    “More group leader training and quality control monitoring may be required for group phone-based interventions compared to in-person approaches, and these factors should be accounted for when considering potential cost savings and dissemination.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Interpretationown data

    The groups had varying levels of connectedness, suggesting that group facilitation by phone may require more nuanced facilitation skills to ensure equal participation and engagement across members.

    “However, the groups had varying levels of connectedness, suggesting that group facilitation by phone may require more nuanced facilitation skills to ensure equal participation and engagement across members.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Participants' responses may have been subject to social desirability bias, but interviewers were not involved in group counseling and participants provided both positive and negative comments.

    “Also, participants’ responses may have been subject to social desirability bias if they wished to present a positive impression to the study team. However, the interviewers were not involved with the patients’ group counseling sessions and participants provided a combination of positive and negative comments.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The study was unable to reach the 6% of participants who dropped out, so the findings do not apply to the minority of women who did not sufficiently engage in the program.

    “In addition, we were unable to reach the 6% of participants who dropped out; therefore our findings do not apply to the minority of women who did not sufficiently engage in the program.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductcitation

    The findings pertain to an initial weight loss intervention phase and do not provide information about weight loss maintenance.

    “Finally, our findings pertain to an initial weight loss intervention phase and do not provide information related to the more difficult stage of weight loss maintenance [50].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [50] Douketis JD, Macie C, Thabane L, Williamson DF (2005) Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes 29:1153–1167. doi: 10.1038/sj.ijo.0802982 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Group versus individual therapy has been demonstrated to produce clinically significant weight loss among breast cancer survivors and obese adults.

    “Overall, the benefits of group versus individual therapy have been demonstrated in producing clinically significant weight loss among breast cancer survivors [27], and also obese adults [28]”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [27] Befort CA, Donnelly JE, Sullivan DK et al (2010) Group versus individual phone-based obesity treatment for rural women. Eat Behav 11:11. doi: 10.1016/j.eatbeh.2009.08.002 source

      Not checked in the free run.

    • cites [28] Paul-Ebhohimhen V, Avenell A (2009) A systematic review of the effectiveness of group versus individual treatments for adult obesity. Obes Facts 2:17–24. doi: 10.1159/000186144 source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Weight loss interventions for overweight or obese breast cancer survivors have yielded mixed results, with some reporting minimal to modest weight loss and others reporting clinically significant weight loss of 5% or more.

    “Weight loss interventions for overweight/obese breast cancer survivors have been developed to address this issue and have yielded mixed results; some studies reported minimal to modest weight loss [9–12], while others reported clinically significant weight loss of 5% or more [13–22].”
    Quote in the paperNot a substantial claim0 of 10 sources checked
    • cites [9] Pakiz B, Flatt SW, Bardwell WA et al (2011) Effects of a weight loss intervention on body mass, fitness, and inflammatory biomarkers in overweight or obese breast cancer survivors. Int J Behav Med 18:333–341. doi: 10.1007/s12529-010-9079-8 source

      Not checked in the free run.

    • cites [10] Djuric Z, Mirasolo J, Kimbrough L et al (2009) A pilot trial of spirituality counseling for weight loss maintenance in African American breast cancer survivors. J Natl Med Assoc 101:552–564 source

      Not checked in the free run.

    • cites [11] Greenlee HA, Crew KD, Mata JM et al (2013) A pilot randomized controlled trial of a commercial diet and exercise weight loss program in minority breast cancer survivors. Obesity 21:65–76. doi: 10.1002/oby.20245 source

      Not checked in the free run.

    • cites [12] McTiernan A, Ulrich C, Kumai C et al (1998) Anthropometric and hormone effects of an eight-week exercise-diet intervention in breast cancer patients: results of a pilot study. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol 7:477–481

      Not checked in the free run.

    • cites [13] Befort CA, Klemp JR, Austin HL et al (2012) Outcomes of a weight loss intervention among rural breast cancer survivors. Breast Cancer Res Treat 132:631–639. doi: 10.1007/s10549-011-1922-3 source

      Not checked in the free run.

    • cites [14] Travier N, Fonseca-Nunes A, Javierre C et al (2014) Effect of a diet and physical activity intervention on body weight and nutritional patterns in overweight and obese breast cancer survivors. Med Oncol Northwood Lond Engl 31:783. doi: 10.1007/s12032-013-0783-5 source

      Not checked in the free run.

    • cites [15] de Waard F, Ramlau R, Mulders Y et al (1993) A feasibility study on weight reduction in obese postmenopausal breast cancer patients. Eur J Cancer Prev Off J Eur Cancer Prev Organ ECP 2:233–238 source

      Not checked in the free run.

    • cites [16] Mefferd K, Nichols JF, Pakiz B, Rock CL (2007) A cognitive behavioral therapy intervention to promote weight loss improves body composition and blood lipid profiles among overweight breast cancer survivors. Breast Cancer Res Treat 104:145–152. doi: 10.1007/s10549-006-9410-x source

      Not checked in the free run.

    • cites [17] Thomson CA, Stopeck AT, Bea JW et al (2010) Changes in body weight and metabolic indexes in overweight breast cancer survivors enrolled in a randomized trial of low-fat vs. reduced carbohydrate diets. Nutr Cancer 62:1142–1152. doi: 10.1080/01635581.2010.513803 source

      Not checked in the free run.

    • cites [18] Goodwin PJ, Segal RJ, Vallis M et al (2014) Randomized trial of a telephone-based weight loss intervention in postmenopausal women with breast cancer receiving letrozole: the LISA trial. J Clin Oncol Off J Am Soc Clin Oncol 32:2231–2239. doi: 10.1200/JCO.2013.53.1517 source

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Study design and conductown data

    Two investigators independently identified predominant codes, met with a third independent evaluator to resolve inconsistencies and reach consensus, and identified high intercoder reliability.

    “The third investigator identified high intercoder reliability and confirmed that they were sufficiently inclusive.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The interviews were not audio-recorded and therefore could not be transcribed and analyzed in that format.

    “First, while the interviewers took detailed notes of participant responses to the interview questions, the interviews were not audio-recorded and thus could not be transcribed and analyzed in this format.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Willingness to pay is an established economics measure that indicates how much a group values a service and is commonly used to inform treatment funding models.

    “willingness to pay for a service is an economics measure that indicates the degree to which a group values a service; this measure is commonly used to inform the design of treatment funding models [31]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [31] Scott A, Maynard A, Elliott R (2005) Advances in health economics. Wiley

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    Interviewers did not conduct interviews with participants from their own weight loss intervention groups to limit social desirability bias.

    “To limit the chance of eliciting biased responses due to social desirability effects, interviewers did not conduct interviews with participants from their own weight loss intervention groups.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Five interviewers were trained to take detailed notes on a standardized form, and the primary investigator reviewed notes and met with interviewers to ensure standardization.

    “Five interviewers were trained to take detailed notes of participant comments on a standardized interview data capture form and subsequently administered all interviews. After each round of interviews, the primary investigator (CAB) reviewed the detailed notes and met with each interviewer to help ensure the interviews and documentation were completed in a standardized manner.”
    Quote in the paperNot a substantial claim
20 of 20

  • The paper relies on this without support.

    Mechanisms that facilitate and hinder weight management success with distance-based interventions are largely unknown.

    “However, mechanisms that facilitate and hinder weight management success with distance-based interventions are largely unknown.”

  • The paper relies on this without support.

    Patients themselves can provide insight into treatment-based factors that contributed to their weight loss outcomes.

    “patients themselves may provide insight into treatment-based factors that contributed to their weight loss outcomes.”

  • The paper relies on this without support.

    Patients can provide valuable initial information about their interest in participating in and paying for weight loss treatment outside of a research study.

    “Patients may also provide valuable initial information regarding their interest in participating in and paying for weight loss treatment outside of a research study.”

  • The authors state this as an assumption.

    Patients' responses directly reflected their experiences and would allow identification and articulation of their experiences during the intervention as related to their weight loss.

    “with an epistemological assumption that patients’ responses directly reflected their experiences and would allow us to identify and articulate their experiences during the intervention as related to their weight loss.”
4 of 4

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Abstract classifies all interviewees as obese

    Minor

    The abstract describes all 186 interviewees as obese, but the participant characteristics state that 18% were overweight rather than obese.

1 of 1

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Authors
Fazzino, T. L., Sporn, N. J., & Befort, C. A.
Affiliations
  • University of Kansas Medical Center (US)
  • University of Kansas (US)
Corresponding author
Fazzino, Tera L.
ORCID
Venue
Supportive Care in Cancer
Publisher
Springer Science and Business Media LLC
Published
2016-03-02
Volume
24
Issue
7
Pages
3165-3173
ISSN
  • 0941-4355 (ISSN-L)
  • 1433-7339
DOI
10.1007/s00520-016-3149-7
PMC
PMC4879096
OpenAlex
W2291969108
Cited by
39
References
48
Citations by year
2025: 2 · 2024: 6 · 2023: 6 · 2022: 3 · 2021: 4 · 2020: 6 · 2019: 5 · 2018: 3 · 2017: 2 · 2016: 2
FWCI
2.16
Type
journal article
Language
en
Open access
Licence
Locations
  • Supportive Care in Cancer (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Cancer Institute (R01 CA155014)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Oncology › Cancer Risks and Factors
Keywords
breast cancer survivors, weight loss interventions, obesity, rural population, telephone-delivered intervention, group intervention, intervention adherence, accountability, intrinsic motivation, physical activity, weight management
MeSH terms
Breast Neoplasms, Female, Humans, Middle Aged, Obesity, Rural Population, Weight Loss, Survivors

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