CN81 - How to use a theoretical framework to inform intervention development in a breast cancer study?

Background

Exercise can enhance the self-esteem of breast cancer survivors (BCSs) through reducing physical and psychological distress, thereby enhancing their well-being and quality of life (QOL). Tai Chi, a traditional moderate intensity Chinese exercise with its internal harmony effects, appears to be a promising strategy in this context. However, methodological limitations in limited studies make the evidence of Tai Chi for improving self-esteem among BCSs less convincing.

Using theoretical frameworks to inform intervention development is advised. The Exercise and Self-Esteem Model (EXSEM) supports a proposed mechanism of action for how exercise may contribute to self-esteem. This presentation describes the process of applying EXSEM to inform the study intervention development through Tai Chi.

Methods

The hierarchical theory of self-esteem, EXSEM, indicates that exercise acts on a parallel level with exercise self-efficacy through mediation of four subdomains and level of physical self-worth to enhance global self-esteem. For BCSs, Tai Chi addresses improvements in three EXSEM subdomains (physical condition, attractive body and strength) to maximize boost their self-esteem. Strategies for enhancing adherence were developed based on the self-efficacy concept from EXSEM, aiming to motivate BCSs to integrate regular exercise into daily life.

Results

A complex intervention was designed, incorporating group-based Tai Chi training and group-based health counselling to create the group environment that boosted BCSs’ self-efficacy through mastery experiences, vicarious experiences, social persuasion, and physical or emotional states. Tai Chi was trained by a qualified instructor, and individual health counselling was provided to deepen mastery experiences. All elements of the intervention synergized to improve BCSs’ self-esteem by enhancing their physical condition, attractive body, and strength. Outcome measures, including self-esteem, exercise self-efficacy, physical and mental health, QOL and well-being, were used to examine intervention effects and assess the mediating mechanisms.

Conclusions

Findings will offer vital practical insights for a theory-guided and evidence-based Tai Chi intervention tailored for BCSs.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

General Research Fund, University Grants Committee (Hong Kong). Project No. 14103822.

Disclosure

All authors have declared no conflicts of interest.