4. Discussion
cancer survivors, cancer, urinary incontinence, pain, adiposity, DUET
CANCER, ADIPOSITY, URINARY INCONTINENCE
Scalable and effective diet and PA interventions that promote weight management among cancer survivors, as well as their family and friends, are needed [Surprisingly, self-efficacy—one of the more robust constructs of SCT—was not found to mediate DUET’s effect on diet, MVPA, and adiposity. These results differ remarkably from larger, traditionally delivered interventions among cancer survivors [Social support also was not found to mediate DUET’s effects on diet, MVPA, and adiposity. Our findings are similar to other website-based lifestyle interventions conducted among U.S. adults, such as the Guide-to-Health [Although self-efficacy and social support were not found to mediate DUET’s effect on diet, PA, and adiposity, our results found a significant mediating effect on caloric intake, weight, and WC through reductions in dietary barriers. These findings concur with the results of mediation analyses from many traditionally delivered lifestyle interventions [In contrast, our study results did not show that exercise barriers were a significant mediator of DUET’s effect on MVPA. Similar to dietary barriers, the DUET intervention focused on overcoming exercise-related barriers through weekly, self-paced website e-learning sessions that provided strategies to overcome common barriers (e.g., lack of time or energy), as well as barriers that are more specific and treatment-related (e.g., pain or urinary incontinence during exercise). However, our study did not show evidence of mediation through a reduction in perceived barriers to exercise and, therefore, is similar to an app-based physical activity program conducted among adults, as well as other studies utilizing web-based platforms [There are several strengths of this current study. DUET included a heterogeneous sample of cancer survivors and their partners in age (23–81 years) and broad reach across the U.S. (Alabama, Illinois, Mississippi, North Carolina, and Tennessee). Additionally, DUET enrolled dyads with diverse family relationships and social networks (i.e., spouse, child, siblings, and friends) as compared to other dyadic interventions delivered among cancer survivors and their spouses or children [