Effectiveness of an Integrated Adventure-Based Training and Health Education Programme in Promoting the Adoption and Maintenance of Regular Physical Activity Among Childhood Cancer Survivors
The aim of this study was to examine the effectiveness of an integrated adventure-based
training and health education programme in promoting the exercise behavior changes and
enhancing the physical activity levels, self-efficacy and quality of life of Hong Kong
Chinese childhood cancer survivors.
Placebo control group
Participants received medical follow-up according to the schedule of the oncology units.
Besides, participants received an amount of time and attention that mimicked that received
by the experimental group, but which is thought not to have any specific effect on the
outcome measures. They were invited to attend leisure activities organized by a community
centre in four different days during the study period. Activities included cartoon film
shows, handicraft workshops, chess games, health talks on the prevention of influenza and
healthy diet, day visit to museum and theme park.
Besides receiving medical follow-up, participants joined a four-day integrated
adventure-based training and health education programme, which contains education talks, a
workshop to work out a feasible individual action plan for regular physical activity and
adventure-based training activities. Previous research showed that working out individual
action plan is important, which can increase the possibility for people to turn their
intentions into health promotion action. The content of the education talks were tailor-made
for participants in which they did not engage in regular physical activity.
To ensure the dosage of intervention delivered in terms of the amount, frequency, duration,
and breadth would be adequate to assess the quality and to manage outcomes, such as physical
activity levels, self-efficacy, stages of change and quality of life, the following measures
were taken. An advisory committee was set up with the purpose to develop an appropriate
integrated programme for Hong Kong Chinese childhood cancer survivors. The committee
included the researcher, an assistant professor at a local university with considerable
experience of conducting psychological interventions among children, a paediatric oncologist
and a oncology nurse specialist with rich experience in taking care of children with cancer,
two professional adventure-based trainers and one assistant professor of Sports and
Recreation Management with extensive experience and professional knowledge in conducting
adventure-based training for children. In addition, the content of the programme that
related to adventure-based training activities was sent to a professional adventure-based
training centre for content validation. The programme was implemented on four different days
within six months in a day camp training centre, such as at 2-week, 2-month, 4-month and
6-month after the day of recruitment. The programme was implemented in small group with
maximum 12 participants in one group. Health education talks and workshop were implemented
in between adventure-based training activities in day camp centre, which were conducted by
healthcare professionals working in a local university. Adventure-based training activities
were led by two qualified adventure-based training instructors with extensive experience and
professional knowledge in conducting such training for children. Additionally, at least two
healthcare professionals joined the adventure-based training to monitor the physical
condition of the survivors and their fitness to join the adventure-based training
Data Collection Methods
Approval for the study was obtained from the hospital ethics committees. To identify
potential subjects, a leaflet containing details of the study and a demographic sheet were
mailed to all parents of childhood cancer survivors in the Sunshine Parents Club. If
children and their parents were interested in the research, they could return the
demographic sheet by using the enclosed return-envelop to convey their willingness to
participate in the study. A briefing session would then be conducted in the out-patient
clinic to those eligible children and parents. Written consent was then obtained from the
parents after they were told the purposes of the study, although they were of course given
the option of allowing or refusing the involvement of their child. The children were also
invited to put their names on a special children's assent form and told that their
participation was voluntary.
After obtaining demographic data of participants, they were asked to respond to the Chinese
version of the PA-SE, CUHK-PARCY, PASCQ and PedsQL. Participants were then randomly assigned
to the experimental and control groups. All participants received a telephone call inviting
them to join the interventions according to their group assignment at an appointed time.
Data collection was conducted again at 3, 6 and 9 months after starting the intervention.
All participants were informed that there would be home visits for data collection.
The Statistical Package for Social Sciences (SPSS) software, version 19.0 for Windows was
used to analyze quantitative data. Intention-to-treat analysis was used and missing data
was substituted by the last-observation-carried-forward procedure. The comparability of the
experimental and control groups was assessed by using inferential statistics (independent
t-test and chi-squared test). Descriptive statistics was used to calculate the mean scores
and standard deviation of different scales. The interrelationships among the scores of
physical activity levels, self-efficacy, stages of changes and quality of life at nine
months after starting the intervention were investigated by means of the Pearson
product-moment correlation coefficient. Mixed between-within subjects ANOVA (split-plot
ANOVA) was used to determine whether the integrated adventure-based training and health
education programme was effective in increasing childhood cancer survivors' levels of
physical activity and self-efficacy and enhancing their quality of life. In addition,
Friedman Test was used to determine any changes in exercise behavior of survivors between
the experimental and control groups.
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Supportive Care
Change from baseline Physical activity levels activity at 3 months
The physical activity levels of participants were assessed using the CUHK-PARCY, which is an 11-item activity rating modified from the Jackson Activity Coding and the Godin-Shephard Activity Questionnaire Modified for Adolescents. Participant were asked to respond to the Chinese version of the CUHK-PARCY at 3 months after the intervention.
3 months after the intervention
William Ho Cheung Li, PhD
The School of Nursing, The University of Hong Kong
Hong Kong: Ethics Committee