KiKli Fit: Participatory Co-Design of a Physical Activity Counseling Program for Childhood Cancer Survivors

Abstract

Introduction & Purpose: After childhood cancer therapy, many survivors experience acute and long-term effects such as fatigue, reduced strength, or movement restrictions, which can persist for years and limit engagement in physical activity (PA). In addition, psychosocial challenges, motivational barriers, and disrupted family routines further complicate the return to an active lifestyle. Although regular PA is a key component of physical and psychosocial recovery. Structured PA counselling can play a crucial role in helping survivors overcome motivational and environmental barriers and re-establish participation in school-based, organized, and self-directed PA. Within the KiKli Fit project, we developed a modular counselling program designed to support children and adolescents after cancer treatment. The program focuses on individual motives and needs, aiming to collaboratively identify and plan suitable activities for each child/adolescent, or for the family as a whole. A pilot study showed high acceptance but revealed the need for stronger family engagement and age-appropriate materials. The current study aims to co-develop an optimized counseling concept with survivors and families, ensuring that their lived experiences directly inform the program’s content and enhance its relevance and feasibility in pediatric oncology care.

Methods: This study adopts a participatory mixed-methods design, guided by the COM-B model and Experience-Based Co-Design. Initially, previous evaluation data were analyzed to identify strengths, gaps, and potential areas for refinement. The upcoming co-design workshops and focus groups will involve two target groups: children aged 6-12 with their parents, and adolescents aged 13-18 independently. These sessions will explore facilitators and barriers to PA, expectations for counseling, and co-create ideas for materials and session formats. Audio recordings, field notes, and brief questionnaires document insights. The resulting findings will guide the development of revised materials and session structures, which will be pilot tested in clinical aftercare. Iterative feedback from participants and counselors guides further refinement.

Results: The workshops are expected to reveal new perspectives on barriers, motivational drivers, and family dynamics influencing post-treatment PA. The resulting counseling prototype is anticipated to feature concise session structures, practical activity strategies, and age-adapted materials. Feasibility, acceptability, and perceived usefulness will be evaluated through qualitative and quantitative feedback from cancer survivors and their parents.

Discussion: By combining COM-B with participatory co-design, the project identifies behavioral determinants at individual and family levels and integrates them into a tailored counseling approach. This approach ensures that the counseling is relevant and applicable in participants’ everyday environments, addresses real-life barriers and facilitators, and enhances engagement. The co-design process further guarantees that counseling meets actual needs, fosters intrinsic motivation, and supports sustainable behavioral change.

Conclusion: The KiKli Fit counseling approach aims to provide a family-centered and individualized program that empowers children, adolescents, and families to re-engage in PA after cancer treatment. By addressing key psychological and behavioral determinants such as self-efficacy, intrinsic motivation, family health climate, enjoyment of PA, and volition the counseling program seeks to promote sustainable engagement in PA and facilitate the transition into aftercare.

References

Braam, K. I., van der Torre, P., Takken, T., Veening, M. A., van Dulmen-den Broeder, E., & Kaspers, G. J. (2016). Physical exercise training interventions for children and young adults during and after treatment for childhood cancer. Cochrane Database of Systematic Reviews, 3(3), 1465-1858. https://doi.org/10.1002/14651858.CD008796.pub3

Gauß, G., Kesting, S., Boos, J., Reinhardt, D., & Götte, M. (2024). Network Activeoncokids–Centralized Physical Activity Counseling for Children, adolescents, and Young Adults Across German-Speaking Countries Throughout All Oncological Treatment Phases. Klinische Pädiatrie, 236(06), 321-330. https://doi.org/10.1055/a-2381-7299

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