Iris Kanera

1 13 INTRODUCTION to interventions (Coups & Ostroff, 2005). As a first step for intervention development, a systematic assessment is needed to get insights into cancer survivors’behavioral risk factors related to lifestyle behaviors such as PA, a healthy diet, and refraining from smoking. The current state of knowledge on lifestyle determinants of cancer survivors is outlined in the next section. Determinants of lifestyle behavior It is important to identify factors that determine health behaviors in order to change them. Several barriers were reported by cancer survivors regarding adopting and maintaining a physically active and healthy lifestyle. These factors were residual symptoms such as pain, fatigue, physical limitations, and negative emotions, as well as insufficient knowledge of guidelines, poor motivation, lack of willpower, insufficient support fromhealth professionals, and social and environmental barriers (Bluethmann et al., 2015; Maxwell-Smith, Zeps, Hagger, Platell, & Hardcastle, 2016; Wu et al., 2015). Moreover, cancer survivors’ knowledge about healthy lifestyle issues might be low and they might not be aware of their own lifestyle risk and therefore have no intention to change (Hawkins, Berkowitz, & Rodriguez, 2015; Niu et al., 2015; Weinstein & Sandman, 1992; Winkels et al., 2016). Prior research identified that cancer survivors experience unmet information needs concerning support for lifestyle behavior changes, such as the provision of evidence-based information regarding diet, PA, and weight management as well as informational and practical support for resuming daily activities and work (Boyes, Girgis, D’Este, & Zucca, 2012; James-Martin, Koczwara, Smith, & Miller, 2014; Kwok, Palermo, & Boltong, 2015; Pullar, Chisholm, & Jackson, 2012). Theories, such as the Social CognitiveTheory (Bandura, 2004), the ReasonedActionApproach (Ajzen, 2011; Fishbein & Ajzen, 2010), and the Attitude-Social Influence-Efficacy (ASE) model (De Vries, Mudde, Dijkstra, &Willemsen, 1998) propose explanations why individuals engage or do not engage in lifestyle behaviors by describing determinants of lifestyle behaviors. Determinants are modifiable influential factors that are specific to behavior, population, and context (Kok et al., 2015). For example, the determinant attitude comprises thoughts about the advantages and disadvantages of a specific behavior. The determinant social influence includes perceived expectations and support from important persons, and the determinant self-efficacy concerns thoughts about the perceived ability and control to perform a specific action. Determinants such as self-efficacy, attitude and social influence have been targeted in lifestyle behavior interventions for cancer survivors, and they were associated with PA and dietary changes (Green, Steinnagel, Morris, & Laakso, 2014; Stacey, James, Chapman, & Lubans, 2016). Determinants of different lifestyle behaviors among cancer survivors require further study. It should be investigated whether different lifestyle behaviors are driven by the same determinants as well as whether the behaviors are interrelated (Kampshoff et al., 2014; Koutoukidis, Beeken, Lopes, Knobf, & Lanceley, 2016; Westmaas et al., 2014).