Supportive Care in Cancer

, Volume 26, Issue 1, pp 231–240 | Cite as

Perceived barriers and preferred components for physical activity interventions in African-American survivors of breast or endometrial cancer with type 2 diabetes: the S.U.C.C.E.S.S. framework

  • Kristin Z. Black
  • La-Shell Johnson
  • Carmen D. Samuel-Hodge
  • Lavanya Gupta
  • Aditi Sundaresan
  • Wanda K. NicholsonEmail author
Original Article



African-American (AA) female cancer survivors share a disproportionate burden of diabetes compared to their white counterparts. Our objectives were to explore the perspectives of AA survivors with type 2 diabetes on perceived barriers to physical activity (PA) and preferences for a PA intervention and develop a framework for a PA program after cancer treatment.


Trained interviewers conducted semi-structured interviews with AA survivors of breast or endometrial cancer with diabetes (total n = 20; 16 breast, 4 endometrial). Thirteen open-ended questions were posed to stimulate discussions, which were audio recorded and transcribed verbatim. Two investigators independently reviewed transcriptions and extracted coded quotations to identify major themes.


Median age of participants was 63 years. Nine themes were identified that focused on post-treatment physical symptoms (e.g., lymphedema, bone/joint pain, depression symptoms and self-motivation as barriers to PA, exercise routines tailored to physical limitations and peer partners and program leaders who understand their emotional health needs). The S.U.C.C.E.S.S. framework summarizes the survivors’ preferences for an effective lifestyle intervention: Support efforts to maintain PA, Understand physical and depression symptoms, Collaborate with multi-disciplinary provider, Coordinate in-person intervention activities, Encourage partnerships among survivors for comorbidity risk reduction, develop Sustainable coping strategies for side effects of treatment, and Share local community resources.


Survivors verbalized the need for a multi-disciplinary team to assist with their psychosocial needs and physical limitations to achieve their PA goals, as integrated into the S.U.C.C.E.S.S. framework.

Implications for cancer survivors

The S.U.C.C.E.S.S. framework reflects the perspectives of survivors with type 2 diabetes and may help to inform post-treatment programs.


African American women Cancer survivors Type 2 diabetes Physical activity Breast cancer Endometrial cancer 


Compliance with ethical standards


Dr. Nicholson was funded in part by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK P30DK093002) and the Agency for Health Care Research and Quality (1P50H502341801).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in our study involving human participants were in accordance with the ethical standards of the University of North Carolina at Chapel Hill and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The University of North Carolina at Chapel Hill Institutional Review Board (#15-0162) approved the study.

Informed consent

Written or verbal informed consent was obtained from all individual participants included in the study.

Supplementary material

520_2017_3839_MOESM1_ESM.docx (16 kb)
ESM 1 (DOCX 15 kb)


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Health Behavior, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Lineberger Comprehensive Cancer CenterUniversity of North Carolina at Chapel HillChapel HillUSA
  3. 3.Center for Health Promotion and Disease PreventionUniversity of North Carolina at Chapel HillChapel HillUSA
  4. 4.Department of Nutrition, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  5. 5.Division of Public Health, Cancer Prevention and Control BranchNorth Carolina Department of Health and Human ServicesChapel HillUSA
  6. 6.Patient-Centered Program on Women’s Endocrine and Reproductive Health (PoWER)University of North Carolina at Chapel HillChapel HillUSA
  7. 7.Department of Obstetrics and Gynecology Center for Women’s Health ResearchUniversity of North Carolina at Chapel HillChapel HillUSA

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