Interventions promoting physical activity among cancer survivors improve their functioning, reduce fatigue and offer other benefits in cancer recovery and risk reduction for future cancer. There is a need for interventions that can be implemented on a wider-scale than in research settings. Our 12-week theory-based exercise intervention that was delivered by research staff by telephone was efficacious in improving fitness, and increasing moderate-to-vigorous physical activity (MVPA) among breast, colorectal and endometrial cancer survivors. To widen the intervention?s reach, we trained peer coaches in the American Cancer Society?s Reach to Recovery program to deliver the same MVPA intervention called Moving Forward Together (MFT) to other breast cancer survivors. In a randomized controlled trial, MFT significantly increased MVPA and provided psychosocial benefits for these survivors (Pinto, Stein & Dunsiger, 2015). Now, our goal is to prepare for wider implementation of MFT by automating key resource-intensive components such as matching survivors with a coach by using a web-based peer mentoring platform and to collect key indices to prepare for large scale implementation. InquistHealth?s web platform (Mentor1to1?) has demonstrated to be effective in peer mentoring for chronic disease management (e.g., diabetes). We will partner with InquisitHealth to adapt their web platform for MFT.
The aim i s to streamline intervention delivery, assure fidelity and improve survivor outcomes. There will be two phases in this 4-year R01 application: in Phase 1, we will work with 6 peer coaches who have already delivered MFT (our original evidence-based MVPA intervention) in prior work. Using iterative user-centered design principles, we will modify the web platform for MFT, creating webMFT. In Phase 2, we will conduct a randomized controlled trial in which 10-12 peer coaches will deliver webMFT to 56 breast cancer survivors who will be randomized to receive either webMFT or MVPA Tracking. We will recruit and train coaches nave to MFT from three cancer care organizations with peer mentoring programs. We will collect feasibility and acceptability data about webMFT from the coaches. We will examine survivor outcomes (objectively measured MVPA and self-reported fatigue, quality of life, physical functioning and mood) by using mixed effects regression models to compare groups at 12 weeks. We will obtain survivors? feedback on their experience with webMFT. Based on the RE-AIM framework and PRISM, we will collect data on implementation indices at the organizational level by conducting key multi-level stakeholder interviews. Using newer technologies for enhanced intervention delivery, program management and automated data collection has the exciting promise of facilitating effective implementation by organizations with limited resources. Adapting evidence-based MFT to a customized web platform and collecting data at multiple-levels (coaches, survivors and organizations) along with costs will provide a strong foundation for a robust multi-site implementation trial to increase MVPA (and its benefits) among many more breast cancer survivors.
We have developed an efficacious intervention to promote physical activity adoption among breast cancer survivors. The intervention has been implemented successfully by peer mentors at the American Cancer Society. However, to reach more survivors and scale up the intervention so that it can be used by other cancer care organizations in the US that also have peer mentoring programs, we propose to adapt and modify our intervention (Moving Forward Together) using a web platform that has already shown success in supporting peer mentoring for medication adherence and dietary changes in other patient groups such as those with poorly-controlled diabetes.