All ETDs from UAB

Advisory Committee Chair

Dori W Pekmezi

Advisory Committee Members

Kevin R Fontaine

Laura Q Rogers

Mohanraj Thirumalai

Suzanne Perumean-Chaney

Document Type

Dissertation

Date of Award

2019

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

Physical activity (PA) is important for health outcomes like breast cancer, but most U.S. adults do not meet recommended guidelines. Behavioral theories like the Social Cognitive Theory (SCT) have demonstrated success in PA behavior change, but perceived benefits and barriers are understudied. PA time barriers are shared between healthy and cancer survivor populations, and study of time use in breast cancer survivors using mobile phone technology like the Life in a Day (LiaD) app would support future intervention development. We conducted 3 studies to investigate benefits and barriers to PA in adults and time use among breast cancer survivors to fill these evidence gaps. Study 1 was a secondary analysis of inactive adults (N=63) in a 12-week IVR-supported randomized-controlled PA trial. Exercise Benefits and Barriers Scale (EBBS) data was summarized; associations (Pearson’s correlation), within-group differences (paired t-test), and between-group differences (independent t-test) related to benefits and barriers were explored. Open-ended exit interview responses were qualitatively examined. Study 2 tested the acceptability of a 5-day LiaD app trial in breast cancer survivors (N=40), explored between-group differences (independent t-test) in LiaD app satisfaction, and qualitatively examined open-ended survey responses. Study 3 was a secondary analysis of breast cancer survivor (N=97) time use in a 6-month randomized-controlled PA trial. Within-group (paired t-test) and between-group (independent t-test) changes in LiaD-reported time use minutes and intensity were explored. Time use data was compared to total self-report/accelerometer MVPA measures. In study 1, time and physical exertion were leading exercise barriers. Intervention arm barriers significantly decreased relative to control from baseline to week 12; intervention females increased benefits and decreased barriers while men did not. Benefits and barriers were associated with other SCT constructs but not with baseline MVPA. Qualitative themes corroborated quantitative findings. In study 2, LiaD was found to be acceptable for breast cancer survivor time use measurement; age-related problems with remembering to track or edit activities were indicated. Themes corroborated quantitative results and suggested future app improvements. In study 3, intervention sleep/rest time use minutes increased relative to usual care from baseline to month 6; trends were noted for between-group changes in sitting minutes at month 3 and participant-labeled physical activity intensity at month 6. In conclusion, lack of time remains a common barrier among adults, but remote intervention shows promise for targeting barriers in women. Further, mobile phone time use measurement is an acceptable approach for understanding daily living in breast cancer survivors and provides a different perspective of PA behavior compared to measures of total PA. We can better inform future intervention efforts for breast cancer survivors by improving our understanding of time use in this population.

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