Rural cancer survivors are less likely to meet physical activity recommendations than urban cancer survivors, contributing to physical inactivity-related cancer health disparities. Evidence-based interventions to reduce psychosocial distress and increase physical activity in cancer survivors were developed in urban or clinical settings and often fail when implemented in rural community settings. The goal of this career development award is to assist Scherezade K. Mama, DrPH in her long-term goal of becoming an independent investigator in designing and implementing physical activity interventions in underserved populations, including rural cancer survivors, to improve health outcomes and reduce health disparities. Dr. Mama?s short-term goals include gaining expertise in the use of psychosocial intervention methods, cancer survivorship and interventions to improve survivorship outcomes, intensive longitudinal methods, and dissemination and implementation research. In collaboration with her multidisciplinary team of mentors and advisors, she has developed a training plan to reach these goals via coursework, workshops, scientific meetings, directed readings, and a mentored research project. The primary objective of the proposed research project is to use a community- engaged approach to develop and evaluate an intervention to reduce psychosocial stress and increase physical activity in rural breast cancer survivors in central Pennsylvania. Focus groups (n=6) with community stakeholders and rural breast cancer survivors will be conducted to (a) determine how to best modify an evidence-based intervention for rural cancer survivors and for implementation in a community setting and (b) feedback the modified intervention. Rural breast cancer survivors (n=50) will be recruited through an existing community partnership to participate in the 3-month adapted community-based intervention or to receive usual care. The intervention consists of face-to-face and home-based sessions incorporating aerobic exercise and mind-body strategies to reduce psychosocial distress and increase physical activity. Participants complete assessments at four time points (baseline, 6-weeks, post-intervention, 6-months) and complete daily diaries assessing daily distress and physical activity throughout the 3-month intervention period. In-depth interviews will be conducted with intervention participants (n=25) and community stakeholders (n=10) after the 6-month study period to explore implementation outcomes. Findings from this study will fill a critical gap in the literature on the translation of evidence-based interventions into sustained practice in community settings and will inform the next phase of this research, an effectiveness-implementation hybrid study of a large-scale community- based randomized controlled trial to reduce psychosocial distress and increase physical activity in rural breast cancer survivors. Completion of the proposed research and training aims will provide Dr. Mama with the skills, experience, and preliminary data needed to launch a successful independent research career in physical activity promotion, cancer prevention and control, and health disparities.
/ PUBLIC HEALTH RELEVANCE STATEMENT Although numerous evidence-based interventions to increase physical activity in cancer survivors exist, there are few effective methods to reduce psychosocial distress and increase physical activity in rural populations. Using a community-engaged approach to adapt, pilot test, and evaluate a culturally and contextually modified evidence-based intervention for rural breast cancer survivors, implemented in a rural community setting, is highly relevant to public health. Findings could result in more effective, disseminable interventions for rural cancer survivors, improved survivorship outcomes, and reduced physical inactivity-related cancer health disparities in this underserved population.