CONSORT-EHEALTH Checklist V1.6.2 Report

1b-i) Key features/functionalities/components of the intervention and comparator in the METHODS section of the ABSTRACT "test the effectiveness of a six-week online multiple health behavior program for adult survivors" 1b-ii) Level of human involvement in the METHODS section of the ABSTRACT "Participants (n = 352) were recruited from oncology clinics, a tumor registry, as well as through online mechanisms, such as Facebook and Association of Cancer Online Resources (ACOR). " 1b-iii) Open vs. closed, web-based (self-assessment) vs. face-to-face assessments in the METHODS section of the ABSTRACT The abstract doesn't speak to whether data was collected online. 1b-iv) RESULTS section in abstract must contain use data "303 survivors completed the follow-up survey (6 months after completion of the baseline survey) and participants in the online intervention condition had significantly greater reductions in insomnia, and greater increases in minutes per week of vigorous exercise, and stretching compared to controls" 1b-v) CONCLUSIONS/DISCUSSION in abstract for negative trials "The online intervention impacted insomnia and exercise; however, a majority of the sample met or exceeded national recommendations for health behaviors and were not suffering from depression or fatigue at baseline" INTRODUCTION 2a-i) Problem and the type of system/solution "However, physical and psychological sequelae may persist after treatment leading to chronic, latent side effects, with survivors reporting symptoms that occur 12-months or longer post treatment [2,3]. Cancer-related fatigue is the most persistent side effect regardless of tumor or treatment type [4]. Fatigue and other side-effects (e.g., edema, pain) can also lead to depression and anxiety [5]. After recovering from months of cancer therapy or surgeries, many cancer survivors want to not only return to their previous lifestyle but often have an interest in making positive changes in their health and quality of life. The point in time where this interest occurs has been coined a “teachable moment” [6,7] and can serve as an opportune time to introduce health behavior change strategies regardless of the type of cancer, stage at diagnosis, or the presence of late effects. " "Despite these developments, health-behavior change interventions for healthy cancer survivors are seldom conducted in a group setting where social support from other survivors is encouraged. Interventions that include a social support component (e.g., support groups) are much more prevalent, especially when the intervention is focused on psychosocial behavior change (i.e., anxiety and depression) [12,13]. " 2a-ii) Scientific background, rationale: What is known about the (type of) system "Since over 83% of adults aged 50-64 and 56% of adults aged 65 and over have access to high-speed Internet connections via computers/laptops/Smartphones [15] and due to the somewhat anonymous nature of online cancer survivors’ support groups, online venues have become appealing to adult cancer survivors. However, the impact of online multiple health behavior change interventions tailored to cancer survivors has been limited. Some of the first online research was conducted by Gustafson and colleagues [16] and suggested that computer-based programs focused on specific physical or psychological symptoms could lead to improvements in those symptoms. Some of the initial work consisted largely of transferring the content of workbooks to an online format with very little interactivity or interaction between survivors [17]. Some online distress management interventions have been associated with benefit in terms of mood, perceived stress, and cancer-related trauma [13, 18], while other interventions have similar results for both face-to-face and online interventions with the same content (e.g., sexual counseling following prostate cancer treatment) [19], with one study demonstrating a negative impact [20] on distress and quality of life. Recent Internet interventions designed to change health behaviors vary substantially in terms of their design, online features and length of follow-up. Such differences in online features can make comparisons between the results from these interventions difficult. Some online interventions have a social networking component [18] while other interventions serve as more of an online repository for information [21]. The length of interventions also vary greatly, with some interventions being short and structured [21], while others are much longer [23]. In addition to differing lengths of intervention trials for cancer survivors, most trials include participants with one type of cancer [13,18,21] while few trials have brought together people with a range of cancer types [23]. There has been a limited amount of research focusing on people with a range of cancer types or multiple health behaviors. The Chronic Disease Self-Management Program (CDSMP) was developed for people with chronic conditions and focuses on multiple health behaviors. Because the population is heterogeneous there is no expectation that all participants will make similar behavior changes. This program has been shown to be effective across numerous health conditions (e.g., diabetes, arthritis) and across multiple formats (face-to-face groups and online groups) [24,25]. More detailed description is provided in the methods section, but key components include: Action Planning, Problem Solving, Decision Making and Self-Tailoring. CDSMP is facilitated by two trained peer facilitators, one or both of whom have experienced a chronic disease. Facilitators read every post or “comment” made by a course participant, stimulate peer-to-peer interactions, and personally advise participants about how to set realistic, confidence building health behavior goals. This format allows for peer interaction as well as structured facilitation. " METHODS 3a) CONSORT: Description of trial design (such as parallel, factorial) including allocation ratio