Perceived barriers and facilitators to health behaviors in European childhood cancer survivors: A qualitative PanCareFollowUp study

Healthy behaviors, that is, engaging in regular physical activities, maintaining a healthy diet, limiting alcohol consumption, and avoiding tobacco and  drug  use,  decrease  the  risk  of  developing  late  adverse  health  conditions  in  childhood  cancer  survivors.  However,  childhood  cancer  survivors  may  experi-ence  barriers  to  adopting  and  maintaining  healthy  behaviors.  This  study  aimed  to assess these barriers and facilitators to health behavior adoption and mainte-nance in childhood cancer survivors.

A  focus  group  (n= 12)  and  semi-structured  telephone  interviews  (n=20) were conducted with a selected sample of European and Dutch childhood cancer survivors, respectively. The Theoretical Domains Framework (TDF) was used to inform the topic guide and analysis. Inductive thematic analysis was ap-plied to identify categories relating to barriers and facilitators of health behavior adoption and maintenance, after which they were deductively mapped onto the TDF.

Ten  TDF  domains  were  identified  in  the  data  of  which  “Knowledge,”  “Beliefs  about  consequences,”  “Environmental  context  and  resources,”  and  “Social  influences”  were  most  commonly  reported.  Childhood  cancer  survivors  expressed  a  need  for  knowledge  on  the  importance  of  healthy  behaviors,  possi-bly provided by healthcare professionals. They indicated physical and long- term benefits  of  healthy  behaviors,  available  professional  support,  and  a  supporting  and  health-  consciously  minded  work  and  social  environment  to  be  facilitators.  Barriers were mostly related to a lack of available time and an unhealthy environ-ment.  Lastly,  (social)  media  was  perceived  as  both  a  barrier  and  a  facilitator  to  healthy behaviors.

This study has identified education and available professional sup-port  in  health  behaviors  and  the  relevance  of  healthy  behaviors  for  childhood  cancer survivors as key opportunities for stimulating health behavior adoption in childhood cancer survivors. Incorporating health behavior support and interven-tions for this population should therefore be a high priority.