It is commonly accepted that healthy eating and physical activity will promote a healthy lifestyle, but the special sauce of how to implement and adhere to these healthy habits long term is at times an obscure recipe. Dr. Heather Greenlee from the Fred Hutchinson Cancer Center expanded on the benefits of a healthy lifestyle, “Many types of studies, ranging from basic science to observational studies to clinical trials, have shown that both a healthy diet and regular physical activity are beneficial for many health outcomes – cancer prevention, preventing cancer recurrence, preventing heart disease and diabetes, etc. However, few studies have shown how to effectively encourage people to achieve and maintain these behaviors for the long term.” This is especially true for underserved and under-resourced populations, including Latina breast cancer survivors living in NYC. This target cohort was selected by Dr. Greenlee when she was a faculty member at Columbia University in NYC, and these ties remained following her move to the Fred Hutchinson Cancer Center. Dr. Greenlee advocated for this cohort of woman through the design of a multi-modal diet and physical activity intervention program specifically geared towards Latina breast cancer survivors, published recently in the journal Cancer Control.
“Our goal is to identify effective, scalable methods to help people achieve and maintain these healthy lifestyle goals,” stated Dr. Greenlee. The Greenlee lab used the Nutrition Education DESIGN procedure framework to design an implementation program for promoting a lasting healthy diet and physical activity lifestyle for Latina breast cancer survivors. This procedure was selected based on its goal to facilitate direct and indirect education aimed at behaviors and determinants of change. Dr. Greenlee’s research group is trying to answer the question, “What behavioral supports do people need to be able to achieve and maintain changes in diet and physical activity?” To identify how Latina breast cancer survivors need to be supported, the Greenlee lab followed the 6-step DESIGN procedure which maps out target behaviors, determinants of adopting these behaviors, the appropriate behavioral theory, program objectives, planning program activities and resources, and lastly, methods of program evaluation.
In this study, the target behaviors included increasing daily fruit/vegetable intake, increasing moderate/vigorous physical activity, and decreasing both daily dietary fat and sugar intake. The general objectives were built from known determinants and approached with the best-fit theory-based model. This work was also based on prior work by Dr. Greenlee and colleagues at Columbia University. Dr. Greenlee explains, “Our prior work showed that a 9-session course over 3-months increased fruit and vegetable intake by 2+ servings/day, and these effects were maintained at 6 months.” For the Mi Vida Saludable (My Healthy Life) program, the researchers reduced the number of sessions to determine if a shorter program would show similar results. This shortened program included a 4-session course over 4 weeks and added an 11-month e-Health program with weekly text messages, biweekly emailed newsletters, and a bilingual study website. The in-person sessions included experiential cooking and physical activity components, facilitator-led education and discussions on nutrition and physical activity, and field trips to a local grocery store and farmer’s market. These activities and the e-Health program all enforced the program objectives. Lastly, the researchers designed program assessment tools to measure both determinants and behaviors of the participants.
Guidance on how to educate cancer survivors on diet and physical activity recommendations is limited, especially among underserved and under-resourced populations. Dr. Greenlee and her lab used the DESIGN procedure to provide the practical framework for developing Mi Vida Saludable program geared towards implementing sustainable healthy lifestyles for Latina breast cancer survivors. “The program used what is now the bilingual (English/Spanish) Fred Hutch Cook for Your Life website, which provides evidence-based nutrition information on cancer prevention, managing cancer treatment related side effects, and for improving cancer survivorship,” stated Dr. Greenlee. This website can be used by all those looking to make a change and find support and recipes to aid in their pursuit of a healthy lifestyle. “Due to COVID, we had to shift other research intervention programs to be delivered online. We are now developing and getting ready to test an online nutrition education course for breast cancer survivors,” stated Dr. Greenlee. This resource lacks the in-person aspect of Mi Vida Saludable, however the online program is geographically more lenient, providing support to a previously untapped population.
The spotlighted research was funded by the National Institutes of Health Cancer Institute, National Cancer for Advancing Translational Sciences and Herbert Irving Comprehensive Cancer Center Avon pilot study funding.
Fred Hutch/University of Washington/Seattle Children's Cancer Consortium member Heather Greenlee led this work.
Contento I, Paul R, Marin-Chollom AM, Ogden Gaffney A, Sepulveda J, Dominguez N, Gray H, Haase AM, Hershman DL, Koch P, Greenlee H. 2022. Developing a Diet and Physical Activity Intervention for Hispanic/Latina Breast Cancer Survivors. Cancer Control. 29:10732748221133987.