Iris Kanera

28 Chapter 2 factors explain the different health behaviors and the adherence to an increasing number of lifestyle recommendations. Furthermore, possible correlations among lifestyle behaviors need to be identified to understand possible mutual influences. As theoretical framework for our search into factors that relate to a healthy lifestyle among cancer survivors, we applied the central thoughts and concepts from social cognitive models: the Reasoned Action Approach, the Attitude-Social influence-Efficacy (ASE) model and its successor the Integrated Model for Behavior Change (I-Change-Model; de Vries et al., 2003; de Vries et al., 1998; Fishbein & Ajzen, 2010; de Vries & Mudde, 1998). These models assume that behavior can be predicted by a behavioral intention, which is influenced by proximal factors (social cognitive concepts: attitudes, perceived social influences and self- efficacy expectancies), which in turn can be influenced by more distal factors. In the current study, as distal factors we applied socio-demographic, psychological, and cancer-related factors. In recent years, studies identified correlates of PA, however, less is known about the correlates of the other lifestyle behaviors. Regarding PA, besides cancer-related variables (fatigue, physical side effects), attitude, self-efficacy, social support and intention were important correlates in explaining PA in cancer survivors (Charlier et al., 2013; Forbes, Blanchard, Mummery, & Courneya, 2014). Additionally, exercise history could be identified as important predictor of exercise adherence. However, for intention, perceived behavior control, age, gender, education, physical fitness and psychological features the findings were inconsistent (Husebo, Dyrstad, Soreide, & Bru, 2013; Kampshoff et al., 2014). Considerably fewer publications described possible correlates of healthy diet, alcohol consumption, and smoking in cancer survivors. Madlensky et al. (2008) identified motivation and self-efficacy as strong predictors of the dietary pattern in breast cancer survivors. Current smoking in cancer survivors was correlated with younger age, lower education and income, and greater alcohol consumption, while quitting after cancer diagnosis was associated with having a smoking related type of cancer (Westmaas et al., 2014). The aims of the present study were 1) to assess the prevalence of lifestyle behaviors and the adherence to recommendations in early cancer survivors, 2) to examine correlations between the different health behaviors and 3) to explore the contribution of socio- demographic, cancer-related, psychological features, social cognitive factors, and intention to explain lifestyle behaviors and adherence to recommendations. To our knowledge, this is the first study, exploring the combined contribution of distal factors (enclosing cancer specific socio-demographic and psychological factors), more proximal factors (such as attitude, social support, self-efficacy), and intention, derived from social cognitive models to explain five lifestyle behaviors and adherence to recommendations in early cancer survivors with various types of cancer.