A mixed-methods evaluation of a group based trail walking program to reduce anxiety in cancer survivors

Background Cancer survivorship results in an increased number of physical and psychosocial health issues. Engaging in physical activity in natural environments is often thought of as restorative. Despite the potential benefits of engaging in physical activity in natural environments there are no sustainable community-based programs for cancer survivors that employ this form of physical activity. This study aims to evaluate the impact of an 8-week trail-walking (TW) program on anxiety in a population of adult cancer survivors. Methods The TW program consisted of two trail walks per week for 8 weeks led by a hiking guide. Individuals were eligible to participate if they were 19 years or older, were a cancer survivor, were not on active immunotherapy, and had medical clearance from their physician for physical activity. While 12 participants signed up for the program, 9 participants (N = 9, 8 F, 1 M) completed the program. A mixed methodology included pre-and-post quantitative program surveys and post-program interviews. Questionnaires measured generalized anxiety, sleep disturbances, self-efficacy, self-esteem, psychological well-being and depression as well as pre-and-post hike state anxiety. Data was analysed using paired t-tests. Interviews were transcribed verbatim and an inductive thematic analysis was conducted to consolidate meaning and identify themes using NVivo 11 software. Results Average attendance was 74% of the 16 hikes. There was no significant reduction in the primary outcome of generalized anxiety (p = .38). There was a significant reduction in perceived stress after 8-weeks (p = .03) and a significant reduction in state anxiety after TW (p < .001). None of the other secondary outcomes were statistically significant (p > .05). Four overarching themes, or benefits, emerged from qualitative data analysis: (a) benefits of program design (b) physical benefits, (c) psychological benefits, and (d) social benefits. Conclusions These findings demonstrate the utility of a TW program for cancer survivors in order to promote physical, psychological and social health. Feasibility of a TW program would be contingent on access to natural areas for TW and an instructor-led program with other cancer survivors.

Using the Glasgow Benefit Inventory questionnaire to quantify the health benefits of lymphoedema treatment in patients with head and neck cancer

Background Lymphoedema is a common side effect after treatment for head and neck cancer. Our treatment protocol involves staging the degree of lymphoedema and then offering treatment comprising skin care, manual lymphatic drainage, simple lymphatic drainage, compression and elastic therapeutic tape. The Glasgow Benefit Inventory is a validated post-interventional questionnaire applicable to otorhinolaryngology interventions which measures changes in health status. The aim of this study was to quantify the health benefits of lymphoedema treatment using the Glasgow Inventory Benefit questionnaire, in patients with a history of treated head and neck cancer. Methods Any patient who had undergone treatment with curative intent of a primary head and neck malignancy who had been referred for lymphoedema treatment within a 6 month period was eligible for inclusion. Patients completed a questionnaire after finishing the course of lymphoedema treatment. Results A total of 15 patients completed the questionnaire. Ten patients (67%) demonstrated some level of improvement in quality of life, while two (13%) reported no benefit and three (20%) reported negative improvements. The average score for the total Glasgow Benefit Inventory scale was + 7.2. The greatest benefit was demonstrated with the physical benefit subscale (+ 13.1). The average general benefit score was + 9.0. Conclusions Lymphoedema treatment involves techniques which can fairly easily be taught to patients to complete at home. In this study, there were mild improvements in patient reported quality of life using the Glasgow Benefit Inventory in the majority of patients. Clinical interest has increased in lymphoedema recently, but there is still limited information about the effectiveness of treatments and future research should look to address these issues.

Prevalence and determinants of cervical cancer awareness among women of reproductive age: evidence from Benin and Zimbabwe population-based data

Background Cervical cancer is a prominently diagnosed form of cancer in several resource-constrained settings particularly within the sub-Saharan African region. Globally, Africa region has the highest incidence and mortality rates of cervical cancer. The high prevalence has been attributed to several factors including lack of awareness of the disease. The aim of this paper is to explore the prevalence and factors associated with awareness of cervical cancer among women of reproductive age in Republic of Benin and Zimbabwe, sub-Saharan Africa. Methods We used population-based cross-sectional data from Benin Demographic and Health Survey (BDHS) and Zimbabwe Demographic and Health Survey (ZDHS) respectively. BDHS 2017–18 and ZDHS - 2015 are the 5th and 6th rounds of the surveys respectively. About 15,928 and 9955 women aged 15–49 years were included in this study respectively. The awareness of cervical cancer among women of reproductive age in Benin and Zimbabwe was measured dichotomously; yes (if a woman heard of cervical cancer) vs. no (if a woman has not heard of cervical cancer). All significant variables from the bivariate analysis were included in the multivariable logistic regression model to calculate the adjusted odds ratios (AOR) with corresponding 95% confidence interval. Results While majority (79.2%) of women from Zimbabwe have heard about cervical cancer, only about one-tenth (10.2%) of their Beninese counterparts have heard about the disease. Advanced maternal age, having formal education, use of internet, having professional/technical/managerial occupation significantly increased the odds of awareness of cervical cancer after adjusting for other confounders. However, in Benin, women who resided in the rural area and those of Islamic belief had 20% (AOR = 0.80; 95%CI: 0.64, 0.99) and 35% (AOR = 0.65; 95%CI: 0.50, 0.86) reduction in the odds of awareness of cervical cancer respectively, when compared with women from urban residence and Christianity. Results from the predictive marginal effects showed that, assuming the distribution of all factors remained the same among women, but every woman is an urban dweller, we would expect 11.0 and 81.0% level of awareness of cervical cancer; If everywoman had higher education, we would expect 20.0 and 90% level of awareness of cervical cancer and if instead the distribution of other maternal factors were as observed and other covariates remained the same among women, but all women were in the richest household wealth quintile, we would expect about 11.0 and 83.0% level of awareness of cervical cancer, among women of reproductive age from Benin and Zimbabwe respectively. Conclusion The study has revealed that socio-demographical factors including geographical location and selected economic factors explained the inequality in distribution of women’s awareness on cervical cancer in both countries. Designing an effective population-based health education and promotion intervention programs on cervical cancer will be a great way forward to improving women’s awareness level on cervical cancer.