Barriers and enablers of weight management after breast cancer: a thematic analysis of free text survey responses using the COM-B model

Abstract Background Weight gain is common after breast cancer. The aim of this study was to identify and describe the barriers to and enablers of successful weight management for women with breast cancer. Methods This was a combined inductive and deductive framework analysis of free text responses to an anonymous cross-sectional survey on weight after breast cancer. Women were recruited mainly through the Breast Cancer Network Australia Review and Survey Group. We applied deductive thematic analysis to free text responses to questions on barriers, enablers, research priorities, and one open-ended question at the end of the survey using the Capability, Opportunity, Motivation and Behaviour (COM-B) model as a framework. Subthemes that arose from the inductive analysis were mapped onto the COM-B model framework. Findings were used to identify behaviour change intervention functions. Results One hundred thirty-three women provided free text responses. Most women were of Caucasian origin and had been diagnosed with non-metastatic breast cancer, with a mean age of 59.1 years. Women's physical capability to adopt and sustain healthy lifestyle habits was significantly affected by treatment effects and physical illness, and some lacked psychological capability to self-regulate the face of stress and other triggers. Limited time and finances, and the social impact of undergoing cancer treatment affected the ability to control their diet. Frustration and futility around weight management were prominent. However, some women were confident in their abilities to self-regulate and self-monitor lifestyle behaviours, described support from friends and health professionals as enablers, and welcomed the physical and psychological benefits of being active in the context of embracing transformation and self-care after cancer. Conclusion Women need specific advice and support from peers, friends and families and health professionals. There is a substantial gap in provision of supportive care to enable women to adopt and sustain healthy lifestyles. Environmental restructuring (including financial support), incentivization (creating an expectation of looking and feeling better), persuasion and coercion (aiming to prevent recurrence), and equipping women with specific knowledge and skills, would also facilitate optimal lifestyle behaviours and weight management.

【摘要】 研究背景 乳腺癌患者术后体重增加较为常见。本研究旨在明确并阐述乳腺癌女性患者成功开展体重管理的阻碍因素与促进因素。研究方法 本研究针对一项关于乳腺癌患者术后体重情况的匿名横断面调查的自由文本回复，采用归纳与演绎相结合的框架分析法展开分析。研究对象主要通过澳大利亚乳腺癌网络评审与调查小组招募。本研究以能力-机会-动机-行为（Capability, Opportunity, Motivation and Behaviour, COM-B）模型为分析框架，针对调查中关于阻碍因素、促进因素、研究重点的问题以及末尾的开放式问题的自由文本回复开展演绎式主题分析。将归纳分析得出的子主题映射至COM-B模型框架中，并基于研究结果明确行为改变干预的相关功能。研究结果 共计133名女性提供了自由文本回复。多数研究对象为高加索人种，确诊为非转移性乳腺癌，平均年龄为59.1岁。患者养成并维持健康生活习惯的身体能力，显著受到治疗不良反应与躯体疾病的影响；部分患者在面对压力及其他诱发因素时，缺乏自我调节的心理能力。有限的时间与经济条件，以及癌症治疗带来的社会影响，均对患者的饮食控制能力造成阻碍。体重管理相关的挫败感与无力感尤为突出。但部分患者对自身调节与监控生活方式行为的能力充满信心，将亲友及医疗专业人员的支持视为体重管理的促进因素，并认可在拥抱癌症康复后的蜕变与自我关怀的过程中，坚持运动带来的身心益处。研究结论 乳腺癌女性患者需要来自同伴、亲友以及医疗专业人员的针对性建议与支持。当前在提供支持性照护以帮助患者养成并维持健康生活方式方面存在显著缺口。环境重构（包括经济支持）、激励机制（即塑造"体态与状态更佳"的预期）、劝导与干预（旨在预防癌症复发），以及为患者传授针对性知识与技能，均有助于优化生活方式行为与体重管理效果。