5. Conclusions
cancer, weight loss
CANCER, ADIPOSITY
The use of web-based interventions is increasing in all populations, including cancer survivors. Online programs increase scalability and can maximize standardization and fidelity to health behavior theory to promote lifestyle change. However, there is a need to understand theoretical constructs that lead to behavior change. The present findings suggest that the effect of the DUET web-based intervention on diet and adiposity stems from reducing perceived barriers to a healthy, low-calorie diet. However, the intervention effects on self-efficacy and social support, along with our small sample size, likely contributed to null findings related to the lack of mediation by these constructs. Therefore, in applying these findings to the field of health education, particularly the growing field of eHealth, the ungirding of behavioral theory (whether it be social cognitive theory or another) and the systematic application of BCTs appears key in understanding and promoting behavior change. Health educators who deliver these interventions or those who procure eHealth programs for patient populations and other end-users need to familiarize themselves with the “active ingredients” that lead to desired outcomes, such as weight loss or improved health. In the case of DUET, we found that by reducing perceived barriers to a low-calorie diet, we may have been able to achieve the reductions in calorie intake and subsequent weight loss that were sought. Findings from this study should be replicated in future website-based interventions, implemented on a larger scale, to understand the “active ingredients” behind successful web-based lifestyle interventions.