Self-Determination Theory and Lifestyle Behaviors in Barrett's Esophagus Patients

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DESCRIPTION (provided by applicant): Highly prevalent in the U.S., Barrett's Esophagus (BE) results from chronic gastroesophageal reflux disease (GERD) and is a major risk factor for the development of esophageal adenocarcinoma (EAC). Obesity and lifestyle factors may interact to modulate individual susceptibility for the progression of BE to EAC. In fact, lifestyle counseling to achieve a healthy body weight, engage in physical activity, stop smoking, and refrain from drinking alcohol is the standard of care for newly diagnosed BE patients. The cost of non-adherence to these medical recommendations is likely to be high, as the result may be poorer quality of life (QOL), increased risk of esophageal resection, and possibly cancer. Surprisingly, no studies have prospectively examined the QOL of BE patients or whether patients make and maintain needed lifestyle changes after diagnosis. Self-determination theory (SDT) posits that people have needs for autonomy (choice), competence (self- efficacy), and relatedness to others. Autonomous motivation (i.e., behaving congruently with one's values) facilitates behavior change; controlled motivation (i.e., behaving to avoid guilt or because of a demand from an external agent) undermines it. Controlled motives often follow an illness diagnosis and can result in patients reverting to maladaptive health habits over time. Important others can positively influence patients' motivation for lifestyle behavior change by providing autonomy support (e.g., acknowledging perspectives, providing choice). Although the general role of family support has been evaluated in a few studies, little attention has been paid specifically to the role of spousal support. In addition, even though numerous successful interventions based on SDT principles exist in the chronic illness and health promotion literatures, researchers have yet to prospectively demonstrate the efficacy of SDT constructs in the context of cancer prevention. The Specific aims are: 1. To prospectively characterize the lifestyle behaviors (e.g., diet, physical activity [PA], smoking, alcohol use) of BE patients from baseline (prior to the patient's first endoscopy) to 6 months later; and, to evaluate a Self-Determination Theory process model for patient lifestyle behavior change during the same time frame. 2. To determine the effects of spousal autonomy support (spousal communication and relationship quality) at baseline on BE patients' autonomous motivation and perceived competence to engage in recommended lifestyle changes (i.e., to eat a healthier diet, engage in more PA, achieve a healthy body weight, and stop smoking and drinking alcohol) at baseline and 3 and 6 months later. Understanding the psychosocial factors that may be associated with lifestyle changes among BE patients is an important and as yet unrealized first step toward the development of future interventions targeting this population. Thus, the proposed project involves a relatively small investment that could yield great progress in understanding the health promotion needs of this understudied population.