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postgraduate thesis: Dietary change decision-making among Chinese breast cancer survivors
Title | Dietary change decision-making among Chinese breast cancer survivors |
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Authors | |
Advisors | |
Issue Date | 2018 |
Publisher | The University of Hong Kong (Pokfulam, Hong Kong) |
Citation | Tang, W. J. [鄧慧津]. (2018). Dietary change decision-making among Chinese breast cancer survivors. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR. |
Abstract | Objectives: Among Chinese breast cancer (BCA) survivors, (1) To describe post-diagnostic dietary changes; (2) To explore what motivates dietary change; (3) To identify correlates of dietary change decision-making processes across the illness trajectory; (4) To validate a food frequency questionnaire (FFQ) for monitoring dietary changes; (5) To examine factors associated with the dietary change decision-making process and adherence to dietary guidelines; (6) To develop a dietary intervention to improve dietary quality among Chinese breast cancer survivors.
Methods: Five independent research studies were conducted among Chinese BCA survivors. Study 1 qualitatively assessed 30 women cross-sectionally who recently completed active treatments. In-depth interviews were carried out to study Objectives 1 and 2. Study 2, a longitudinal qualitative study, followed 38 women through their first year post-diagnosis. In-depth interviews were carried out at post surgery, during adjuvant therapy, and at three- and six-months after completing adjuvant therapy to study Objectives 1, 2, and 3. Grounded theory approaches were used for both studies. Study 3 involved development and validation of a one-week FFQ designed to capture dietary pattern changes over short periods of time (Objective 4). Fifty women completed the same FFQ twice, two weeks apart, and kept a three-day dietary record (DR) in between. Spearman’s correlation tests and Bland-Altman plots were used to assess correlation and agreement between the FFQ and the reference method (DR), and the repeatability of the FFQ, in terms of nutrient and food group intake. Designed to study Objective 1 and 5, Study 4 cross-sectionally examined independent variables (illness perceptions, self-efficacy, social support and coping strategies) theoretically-derived from Leventhal’s common-sense model of self-regulation and Lazarus and Folkman’s transactional model of stress and coping, using Hierarchical multiple regressions. Study 5 piloted a randomized controlled trial of a one-time telephone-delivered nutrition counseling intervention. T-tests were used to compare pre- and post-intervention dietary and secondary outcomes, self-efficacy and psychological distress, between and within the two groups.
Major findings: Most Chinese BCA survivors made dietary changes post-diagnosis that were culturally-driven and avoidance-oriented. Foods avoided were believed to have caused cancer or that, in traditional Chinese beliefs, are considered harmful to health. Observed dietary changes were often inconsistent with existing dietary recommendations and the majority of BCA survivors did not adhere to dietary guidelines in terms of whole grains, fruits and vegetables, and red and processed meat consumption. Most BCA survivors attributed their cancer to uncontrollable factors, such as stress, suggesting a self-preserving bias in illness perceptions. Illness perceptions, self-efficacy and social support were associated with dietary change and quality and may be targets for future interventions. Additionally, most BCA survivors relied on information sources such as mass media instead of healthcare professionals for dietary information and most were unaware of dietary guidelines for cancer survivors, indicating a need for change in the current health system.
Implications: The series of studies identified targets for intervention to improve dietary quality among Chinese BCA survivors and suggested improvements to the current healthcare system in terms of dietary information delivery in the oncology care spectrum. |
Degree | Doctor of Philosophy |
Subject | Breast - Cancer - Nutritional aspects |
Dept/Program | Public Health |
Persistent Identifier | http://hdl.handle.net/10722/280865 |
DC Field | Value | Language |
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dc.contributor.advisor | Lam, WWT | - |
dc.contributor.advisor | Fielding, R | - |
dc.contributor.author | Tang, Wei-chun, Julia | - |
dc.contributor.author | 鄧慧津 | - |
dc.date.accessioned | 2020-02-17T15:11:34Z | - |
dc.date.available | 2020-02-17T15:11:34Z | - |
dc.date.issued | 2018 | - |
dc.identifier.citation | Tang, W. J. [鄧慧津]. (2018). Dietary change decision-making among Chinese breast cancer survivors. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR. | - |
dc.identifier.uri | http://hdl.handle.net/10722/280865 | - |
dc.description.abstract | Objectives: Among Chinese breast cancer (BCA) survivors, (1) To describe post-diagnostic dietary changes; (2) To explore what motivates dietary change; (3) To identify correlates of dietary change decision-making processes across the illness trajectory; (4) To validate a food frequency questionnaire (FFQ) for monitoring dietary changes; (5) To examine factors associated with the dietary change decision-making process and adherence to dietary guidelines; (6) To develop a dietary intervention to improve dietary quality among Chinese breast cancer survivors. Methods: Five independent research studies were conducted among Chinese BCA survivors. Study 1 qualitatively assessed 30 women cross-sectionally who recently completed active treatments. In-depth interviews were carried out to study Objectives 1 and 2. Study 2, a longitudinal qualitative study, followed 38 women through their first year post-diagnosis. In-depth interviews were carried out at post surgery, during adjuvant therapy, and at three- and six-months after completing adjuvant therapy to study Objectives 1, 2, and 3. Grounded theory approaches were used for both studies. Study 3 involved development and validation of a one-week FFQ designed to capture dietary pattern changes over short periods of time (Objective 4). Fifty women completed the same FFQ twice, two weeks apart, and kept a three-day dietary record (DR) in between. Spearman’s correlation tests and Bland-Altman plots were used to assess correlation and agreement between the FFQ and the reference method (DR), and the repeatability of the FFQ, in terms of nutrient and food group intake. Designed to study Objective 1 and 5, Study 4 cross-sectionally examined independent variables (illness perceptions, self-efficacy, social support and coping strategies) theoretically-derived from Leventhal’s common-sense model of self-regulation and Lazarus and Folkman’s transactional model of stress and coping, using Hierarchical multiple regressions. Study 5 piloted a randomized controlled trial of a one-time telephone-delivered nutrition counseling intervention. T-tests were used to compare pre- and post-intervention dietary and secondary outcomes, self-efficacy and psychological distress, between and within the two groups. Major findings: Most Chinese BCA survivors made dietary changes post-diagnosis that were culturally-driven and avoidance-oriented. Foods avoided were believed to have caused cancer or that, in traditional Chinese beliefs, are considered harmful to health. Observed dietary changes were often inconsistent with existing dietary recommendations and the majority of BCA survivors did not adhere to dietary guidelines in terms of whole grains, fruits and vegetables, and red and processed meat consumption. Most BCA survivors attributed their cancer to uncontrollable factors, such as stress, suggesting a self-preserving bias in illness perceptions. Illness perceptions, self-efficacy and social support were associated with dietary change and quality and may be targets for future interventions. Additionally, most BCA survivors relied on information sources such as mass media instead of healthcare professionals for dietary information and most were unaware of dietary guidelines for cancer survivors, indicating a need for change in the current health system. Implications: The series of studies identified targets for intervention to improve dietary quality among Chinese BCA survivors and suggested improvements to the current healthcare system in terms of dietary information delivery in the oncology care spectrum. | - |
dc.language | eng | - |
dc.publisher | The University of Hong Kong (Pokfulam, Hong Kong) | - |
dc.relation.ispartof | HKU Theses Online (HKUTO) | - |
dc.rights | The author retains all proprietary rights, (such as patent rights) and the right to use in future works. | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject.lcsh | Breast - Cancer - Nutritional aspects | - |
dc.title | Dietary change decision-making among Chinese breast cancer survivors | - |
dc.type | PG_Thesis | - |
dc.description.thesisname | Doctor of Philosophy | - |
dc.description.thesislevel | Doctoral | - |
dc.description.thesisdiscipline | Public Health | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.5353/th_991044122098403414 | - |
dc.date.hkucongregation | 2019 | - |
dc.identifier.mmsid | 991044122098403414 | - |