Prostate Cancer Health and Fitness Online: The Development and Pilot Testing of an Internet Physical Activity Program for Prostate Cancer Survivors

Globally, prostate cancer is one of the leading causes of older male mortality and morbidity. Following treatment, these men have a reduced quality of life, often with lasting physical (e.g., incontinence, impotence and physical decline) and psychological (anxiety and depression) sequela. Supporting participation in physical activity can assist to mitigate these issues. However, most prostate cancer survivors do not participate in the recommended 150 minutes of moderate to vigorous physical activity and two-resistance training sessions per week. As Internet access and technology adoption increase in older populations, one method to support physical activity levels is via online computer-tailored programs. These programs algorithmically provide a unique combination of messages to an individual. These are based on pre-measured behavioural, psychological, and demographical characteristics. This increases the message personalisation, leading to greater cognitive internalisation of the messages, and enhancing behaviour change outcomes. While computer-tailored programs have shown promise, non-usage attrition and disengagement can compromise efficacy. To potentially improve engagement, one understudied aspect is a program’s website architecture. That is, the manner in which the participant receives and interacts with the program. Computer-tailored programs usually provide small packages of information in set schedule (e.g., daily, weekly, fortnightly etc.) over a set period time. This is known as linear ‘tunnelling’ and is a standard approach to computer tailoring. However, Self-Determination Theory suggests that this may reduce participant intrinsic motivation by limiting user autonomy. Therefore, programs that promote autonomy could improve engagement, and therefore impact efficacy. To test this concept, two computer-tailored interventions (standard tunnel versus free choice) were systematically developed and compared in a 3-armed randomised controlled arm trial. The trial also contained a non-tailored control for secondary outcome comparison, including perceived acceptability, usability and relevance, changes in physical activity levels (aerobic and resistance), as well as overall study feasibility. This thesis by publication contains manuscripts pertaining to the systematic development of (three manuscripts) and evaluation (one manuscript) of the computer-tailored interventions. The trial was marketed as Prostate Cancer Health and Fitness online (PCHF). Chapter 1 provides the background literature; thesis aims and hypotheses. Chapter 2 reports the results of a systematic review that assessed previous behaviour change interventions and efficacious study characteristics. Chapter 3 is the manuscript for a qualitative investigation. This study asked prostate cancer survivors to provide written feedback on four non-tailored health promotion messages to identify potential tailoring factors (i.e. what is missing from the message). Chapter 4 provides the results of semi-structured interviews with prostate cancer survivors. The aim of this qualitative study was to analyse themes on topics of ‘prostate cancer’, ‘physical activity’ and ‘Internet use’. This was also used to identify preferred website features from participants, and the findings influenced the design of PCHF. Chapter 5 outlines the main findings of the 3-armed randomised controlled trial testing the two versions of the PCHF intervention to the non-tailored control. Finally, Chapter 6 broadly discusses key thesis findings and overall contribution to research, thesis strengths and limitations, as well as the implications for future research and clinical practice within prostate cancer survivorship.Thesis (Ph.D.) -- University of Adelaide, Adelaide Medical School, 201