Multiple Levels of Influence on Lifestyle Behaviors among Cancer Survivors in Racial and Ethnic Minority Groups: A Systematic Review

Objective. This systematic review aimed to provide a critical summary of studies of physical activity (PA) and diet among racial/ethnic minority cancer survivors. Guided by the socio-ecological model, we identified factors across multiple levels - individual, family/social support, provider/team, and organization/local community/policy environment - that affect PA and diet among racial/ethnic minority survivors. Methods. We searched the Ovid MEDLINE, EBSCO CINAHL, Ovid PsycInfo, and PubMed databases. We extracted the behavior of focus (i.e., PA and diet), cancer type, race/ethnicity, and the level(s) of influence (and the corresponding factor(s)), and each eligible study investigated individual (e.g., demographic characteristics, psychological factors), family/social support, provider/team (e.g., healthcare provider recommendations), and organization/local community/policy environment (e.g., neighborhood/social environment). Results. Of 1,603 studies identified, 23 unique studies were eligible. Most studies included breast cancer survivors (n = 19) and Black survivors (n = 13). Seventeen studies assessed associations between PA and factors at the level of the individual (16 studies), family/social support (two studies), provider/team (one study), or organization/local community/policy environment (four studies). Eleven studies assessed associations between diet and factors at the level of the individual (11 studies), family/social support (two studies), provider/team (one study), or organization/local community/policy environment (two studies). Only five studies simultaneously investigated factors across multiple levels. Most demographic and cancer-related factors were not associated with PA or diet. Overall, factors from social-cognitive theories (e.g., self-efficacy) were positively associated with PA. Less consensus was found regarding diet because fewer studies existed, and they also investigated a diverse range of eating behaviors. Conclusions. There is a critical need for studies of PA and diet that investigate multiple levels of influence particularly for Asian American survivors, male survivors, and cancers other than breast cancer. Social-cognitive theories may help guide the designing of multilevel PA interventions for racial/ethnic minority survivors. Studies assessing overall eating quality or adherence to dietary guidelines are needed.