Effectiveness of an integrated adventured-based training and health education programme in promoting the adoption and maintenance of regular physical activity among childhood cancer survivors

Abstract

Background. Research indicates that increased survival rates are accompanied by an increase in associated physical and psychological problems. Whereas much of the attention has focused on the physiological care of childhood cancer survivors, the consequences of cancer and its treatments on psychological well-being remain relatively underexplored. Aims. The aims of the thesis were threefold: (1) describe the psychological well-being and quality of life; (2) assess the physical activity levels; and (3) examine the effectiveness of an integrated adventure-based training and health education program in promoting change in exercise behavior and enhancing physical activity, self-efficacy, and quality of life among Hong Kong Chinese childhood cancer survivors. Methods. Prior to the intervention study, the psychometric properties of two instruments (the Chinese Version of the Center for Epidemiologic Studies Depression Scale for Children and Coping Behaviour Checklist for Chinese Children) were evaluated and two descriptive studies were conducted to examine the psychological well-being, quality of life and physical activity level of Hong Kong Chinese childhood cancer survivors. A RCT, two-group pretest and repeated post-test, between-subjects design was then conducted in 71 childhood cancer survivors (aged 9-16-year olds). Thirty-four participants in the experimental group joined a four-day integrated adventure-based training and health education program. Thirty-seven participants in the control group received placebo intervention. Participants' exercise behavior, level of physical activity, self-efficacy, and quality of life were assessed at recruitment, and at three-, six-, and nine-month after the intervention. Results. The psychometric properties of the Center for Epidemiologic Studies Depression Scale and the Coping Behaviour Checklist for Chinese Children were confirmed. The first descriptive study showed that a significant number of children have high level of depression, low self-esteem, and undermined quality of life. The second descriptive study indicated that a significant decline in physical activity levels among childhood cancer survivors and most of them did not take physical exercise regularly. The intervention study revealed that participants in the experimental group reported statistically significant difference in physical activity stages of change, higher levels of physical activity, self-efficacy, and quality of life than those in the placebo control group from baseline to 9 months after starting the intervention. Conclusions. The two descriptive studies provided a thorough understanding of the psychological well-being and physical activity level of Hong Kong Chinese childhood cancer survivors. Most importantly, the intervention study addressed a gap in the literature by developing and evaluating the effectiveness of an integrated adventure-based training and health education program for promoting regular physical activity among childhood cancer survivors. In addition, this study demonstrated that it is feasible to implement such program in Hong Kong. The content, nature, and duration of the program appeared to be acceptable to the children and parents. Implications for practice. The study raises the awareness of regular physical activity in promoting physical and psychological well-being for childhood cancer survivors. Given the long-term health benefits, healthcare professionals should advocate regular exercising among childhood cancer survivors. This study also illustrates that the adventure-based training program is effective in promoting regular physical activity among childhood cancer survivors.