Physical activity (PA) can ameliorate many long term side effects and the increased risk of primary cancer recurrence (i.e., colon and breast), second neoplasm, and chronic non-cancer medical comorbidities experienced by cancer survivors. Because the majority of cancer survivors do not engage in regular PA, it is critical to increase the translation of efficacious PA behavior change interventions (BCIs) from research into cancer survivorship care, especially for rural cancer survivors who suffer poorer physical and mental health compared with urban counterparts. Our BEAT Cancer (Better Exercise Adherence after Treatment for Cancer) PA BCI for breast cancer survivors significantly improved PA behavior in a multicenter randomized controlled efficacy trial with the odds of meeting PA recommendations being double that reported by any previous BCI in cancer survivors, to date. A next translational step for the BEAT Cancer intervention is preparation for implementation within a Cancer Community Network (CCN). An implementation toolkit integrating planned adaptations for cancer types other than breast and a rural CCN site is needed before submitting an R01 application proposing an effectiveness-implementation hybrid type 1 trial (i.e., tests clinical effectiveness in a real world setting such as the CCN while also improving understanding of the implementation context). Such a trial is anticipated to occur within the University of Alabama at Birmingham (UAB) CCN which includes multiple community hospitals and cancer centers including those in rural settings. Therefore, we propose the following specific aims with the overall objective of improving implementation of the BEAT Cancer PA BCI within a CCN: 1) develop an implementation toolkit that adapts the intervention to a rural CCN site and cancer types other than breast, 2) test feasibility of implementing the toolkit, and 3) evaluate the toolkit's acceptability, adoption, appropriateness, fidelity, cost, and impact on service and clien outcomes. Our proposal is based on the Consolidated Framework for Implementation Research and Rogers' Diffusion of Innovations theory. Qualitative and quantitative input will be obtained from three organizational levels in the targeted rural Alabama County (i.e., potential intervention participants, community-level stakeholders, and potential intervention delivery staff). Qualitative data (i.e., focus groups, nominal group technique groups, photo voice, and ground trothing) will be used for planned adaptation and creation of the implementation toolkit. After development, the implementation toolkit will be pilot tested at the CCN site with 20 women cancer survivors. Feasibility measures will be obtained by survey and administrative data. Acceptability, adoption, appropriateness, and implementation cost will be assessed by survey, focus groups, and administrative data. Fidelity will be assessed with direct observation and survey. Outcomes (i.e., service and client) important to stakeholders and PA (self-report and accelerometer) will also be assessed. Improving the implementation of this efficacious PA BCI within a CCN serving rural populations will increase the reach of the intervention and its beneficial effects on PA and health.
Because cancer survivors living in rural communities experience poorer health and quality of life, it is important to provide rural cancer survivors wit the tools they need to exercise more regularly as one way to help improve their physical and mental well-being. We have designed the BEAT Cancer intervention which has been shown to increase the amount of exercise done by breast cancer survivors during and after the intervention. This proposal will collect the information needed to make the intervention available and successful in rural cancer care settings and among women of any cancer type.
