Improving cancer preventive behaviours in cancer patients and their families in a prehabilitation/rehabilitation cancer surgery context

Kurtidu, Clara Esther Malou (2026) Improving cancer preventive behaviours in cancer patients and their families in a prehabilitation/rehabilitation cancer surgery context. PhD thesis, University of Glasgow.

Abstract

Background: A cancer diagnosis offers a potential opportunity for health behaviour change through prehabilitation, with interventions comprising physical activity, weight/diet and psychological support. However, current prehabilitation interventions lack systematic family integration and consistent application of behaviour change techniques. This thesis aims to explore how prehabilitation interventions for cancer surgery patients may be optimised and how family members can be engaged in behaviour change.

Methodology: The thesis included five studies, beginning with a systematic review of behaviour change techniques (BCTs) in prehabilitation for colorectal and ovarian cancer patients (Study 1). Semi-structured interviews with health care professionals and service providers (n=5) (Study 2). Patient-family dyads interviews (n=6 dyads, n=2 individual interviews) (Study 3). Findings from Studies 1-3 were synthesised using the COM-B model and Family Systems Theory to develop an optimised family-inclusive intervention (Study 4). A multi-stakeholder focus group (n=3) evaluated the proposed intervention and its acceptability (Study 5).

Main Findings: Study 1 found that BCTs were present in all 16 reviewed interventions but were inconsistently implemented; effective studies used more BCTs overall, self-monitoring was linked to better adherence, and social support was entirely absent across all interventions. Study 2 found that healthcare professionals recognised family members’ value but faced implementation barriers, including time constraints, scheduling conflicts, and staffing pressures, and advocated for earlier patient referral to maximise the prehabilitation window. Study 3 found that patients valued technology-enhanced delivery, identified significant gaps in nutritional support, as family members wanted systematic inclusion, but felt their own needs were overlooked. Study 4 developed an optimised intervention comprising technologyenhanced delivery, comprehensive nutritional support, and flexible family inclusion pathways. Study 5 found stakeholders supported the intervention, while highlighting the need for automated exercise progression and simplified terminology.

Conclusions: This thesis demonstrates the potential for optimising prehabilitation through systematic family integration, technology-enhanced delivery, and comprehensive nutritional support. The absence of social support BCTs in current interventions represents a significant gap, given evidence that family involvement enhances adherence. However, findings must be interpreted cautiously, given sample limitations and the predominance of engaged participants with functional family relationships. Future research should test effectiveness through trials comparing family-inclusive versus standard approaches, examine implementation across diverse healthcare settings, and ensure that technology solutions do not exacerbate health inequalities. This work contributes to recognition that effective prehabilitation must address the relational context in which health behaviours occur.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Subjects: R Medicine > R Medicine (General); R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
• Colleges/Schools: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Supervisor's Name: Robb, Professor Katie
• Date of Award: 2026
• Depositing User: Theses Team
• Unique ID: glathesis:2026-85995
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 10 Jun 2026 09:10
• Last Modified: 10 Jun 2026 09:10
• Thesis DOI: 10.5525/gla.thesis.85995
• URI: https://theses.gla.ac.uk/id/eprint/85995