Other Theories
Mock and colleagues17,18 used the Roy Adaptation
model49 and the Levine Conservation model of adaptation
50 to guide their exercise interventions for
women treated for breast cancer. These rehabilitation
models focused on physiological and psychosocial
interventions to promote positive, adaptive
responses to a cancer diagnosis and treatment.
In the Roy model, adaptation is viewed as an active
process initiated by the individual of adjusting
to environmental changes through physiological
or psychological modes and, in turn, affecting
the environment. The walking intervention that
was offered to breast cancer patients was conceptualized
as a physiological intervention with psychosocial
effects that had the potential to
promote adaptive responses among women undergoing
chemotherapy17or radiation treatment for
breast cancer.18 The physiological mode was assessed
via tests of physical functioning and symptom
assessments and the psychosocial modeswere assessed via measures of self concept, body
image, and adjustment.17,18
The Levine model is based on conserving individual
integrity for maintenance of life. Four principles
underlie the model: conservation of energy,
structural integrity, personal integrity, and social
integrity. The exercise program offered by Mock
et al19 was viewed as an intervention that could
support the conservation of energy and structural
integrity by increasing functional capacity. The intervention
also aimed at reducing distress and increasing
quality of life (personal integrity) and
maintaining social integrity as demonstrated by
maintenance of social functioning.
Only one group of researchers has used these
theories to guide their study design and assessments.
The interventions produced promising results
both for exercise and psychosocial
outcomes. However, it does not appear that the
walking interventions manipulated the various
modes of adaptation with one exception: group
social support was offered along with the exercise
intervention in one study.17
Finally, other theories that have been used in
health promotion interventions for cancer patients
include the social ecological theory51 used
in a smoking cessation trial.11 This approach encompasses
individual, interpersonal, and systems
level factors that are hypothesized to affect behavior
change.
CONCLUSION
Changing health behaviors after cancer has
a relatively short history. Some but not all
of the interventions tested among cancer patients
have been theory-based. There is much scope for
offering interventions based on theories found to
be useful in promoting behavior change in noncancer
populations. There is also a need to test
the effects of the interventions on the corresponding
theory-based constructs and examine their mediational
effects. The latter will help identify
components of an intervention that are critical to
treatment efficacy. It is parsimonious to identify
and use only those components of the intervention
that have contributed to treatment efficacy. Given
the ever-present pressures to develop interventions
that are not time or labor intensive, researchers
including those in nursing, are always
challenged to offer interventions that are not
only efficacious but are also cost-effective and
easy to deliver to a large number of cancer patients.