Developing a digital intervention for cancer survivors: an evidence-, theory- and person-based approach.

This paper illustrates a rigorous approach to developing digital interventions using an evidence-, theory- and person-based approach. Intervention planning included a rapid scoping review that identified cancer survivors' needs, including barriers and facilitators to intervention success. Review evidence (N = 49 papers) informed the intervention's Guiding Principles, theory-based behavioural analysis and logic model. The intervention was optimised based on feedback on a prototype intervention through interviews (N = 96) with cancer survivors and focus groups with NHS staff and cancer charity workers (N = 31). Interviews with cancer survivors highlighted barriers to engagement, such as concerns about physical activity worsening fatigue. Focus groups highlighted concerns about support appointment length and how to support distressed participants. Feedback informed intervention modifications, to maximise acceptability, feasibility and likelihood of behaviour change. Our systematic method for understanding user views enabled us to anticipate and address important barriers to engagement. This methodology may be useful to others developing digital interventions.

Is there more to the equation? Weight bias and the costs of obesity.

The costs of obesity have been well studied, with estimates in Canada reaching $7.1 billion annually. These estimates fuel public and professional discourse about obesity as an "epidemic" with substantial economic and public health consequences. However, cost estimates for obesity thus far have neglected to consider a critical variable: weight bias (i.e., negative bias towards individuals based on their body weight). In this commentary, we propose that some costs currently attributed to obesity may be partly or fully attributable to weight bias. Taking a burden of illness approach, we show that data derived from a purposeful literature search, provided as proof of concept, support the notion that weight bias may be an important variable to consider when calculating obesity-related costs. We propose that future research on costs of obesity should consider weight bias, with goals of achieving more accurate cost attributions and identifying appropriate leverage points for interventions to improve well-being of the population.

Understanding acceptability of and engagement with Web-based interventions aiming to improve quality of life in cancer survivors: A synthesis of current research.

OBJECTIVE: This review sought to summarize existing knowledge to inform the development of an online intervention that aims to improve quality of life after cancer treatment. METHODS: To inform our intervention, we searched for studies relating to Web-based interventions designed to improve quality of life in adults who have completed primary treatment for breast, prostate, and colorectal cancer (as these are 3 of the most common cancers and impact a large number of cancer survivors). We included a variety of study designs (qualitative research, feasibility/pilot trials, randomized trials, and process evaluations) and extracted all available information regarding intervention characteristics, experiences, and outcomes. Data were synthesized as textual (qualitative) data and analyzed by using thematic analysis. RESULTS: Fifty-seven full text articles were assessed for eligibility, and 16 papers describing 9 interventions were analyzed. Our findings suggest that cancer survivors value interventions that offer content specific to their changing needs and are delivered at the right stage of the cancer trajectory. Social networking features do not always provide added benefit, and behavior change techniques need to be implemented carefully to avoid potential negative consequences for some users. CONCLUSIONS: Future work should aim to identify appropriate strategies for promoting health behavior change, as well as the optimal stage of cancer survivorship to facilitate intervention delivery. CLINICAL IMPLICATIONS: The development of Web-based interventions for cancer survivors requires further exploration to better understand how interventions can be carefully designed to match this group's unique needs and capabilities. User involvement during development may help to ensure that interventions are accessible, perceived as useful, and appropriate for challenges faced at different stages of the cancer survivorship trajectory.

From headache to tumour: An examination of health anxiety, health-related Internet use and 'query escalation'.

The current study aimed to explore the phenomenon of disease-related 'query escalation' in high/low health anxious Internet users (N = 40). During a 15-minute health-related Internet search, participants rated their anxiety and the perceived seriousness of information on each page. Post-search interviews determined the reasons for, and effects of, escalating queries to consider serious diseases. Both groups were found to be significantly more anxious after escalating queries. The high group was significantly more likely to escalate queries. Evaluating personal relevance of material was the main reason for escalations and moderated anxiety post-escalation. We conclude that searching for online disease information can increase anxiety, particularly for people worried about their health.

Health-related internet habits and health anxiety in university students.

Health-related Internet use has grown rapidly, yet little research has considered how health anxious individuals use the Internet for this purpose. Our aim was to examine the relationships between health anxiety and the extent of, reasons for, and consequences of health-related Internet usage in university students (n = 255). Responses on a purpose-made Internet use questionnaire were correlated with health anxiety scores; multiple regression analyses controlling for depression and anxiety were also conducted. Health anxiety positively correlated with (all ps < .01): frequency of health-related searching (r(s) = .163), proportion of health-related information sought (r(s) = .200), time spent online for health purposes (r(s) = .166), and number of searches for both illness (r(s) = .453) and wellness (r(s) = .208) information. Health anxiety further positively correlated with advantages perceived in health-related Internet use (r(s) = .183), heightened tension (r(s) = .364) and relief (r(s) = .174) post-search, and perceived doctor disadvantages (r(s) = .306), yet a greater likelihood to visit a doctor post-search (r(s) = .217). Health anxiety also correlated with six measures of possible addiction to using the Internet for health purposes (r(s) range = .171 to .366, all ps < .01). Some (including several potentially dysfunctional) aspects of health-related Internet use correlate with health anxiety. Research evaluating the possible role of Internet use in the development and maintenance of health anxiety is warranted.