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Beyond efficacy: a qualitative organizational perspective on key implementation science constructs important to physical activity intervention translation to rural community cancer care sites

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Abstract

Purpose

To identify constructs relevant to implementation of evidence-based physical activity (PA) behavior change interventions for rural women cancer survivors from an organizational perspective.

Methods

During the development of a PA intervention implementation toolkit, 11 potential interventionists and 19 community and organizational stakeholders completed focus groups stratified by role. Narratives were audio recorded, transcribed, and coded for Consolidated Framework for Implementation Research (CFIR) constructs.

Results

Multiple CFIR constructs were identified: Implementation Process (i.e., Engaging, Reflecting and Evaluating), Intervention Characteristics (i.e., Design Quality and Packaging, Cost, Evidence Strength and Quality, Adaptability, Complexity), Inner Setting (i.e., Implementation Readiness, Implementation Climate, Structural Characteristics), Outer Setting (i.e., Patient Needs and Resources, Cosmopolitanism), and Characteristics of Individuals (i.e., Knowledge and Beliefs, Stage of Change). Narratives identified rural implementation barriers (e.g., transportation) and facilitators (e.g., community-oriented). Unique needs of the cancer survivor (e.g., coping during cancer treatment and long-term effects on physical abilities) were emphasized as important barriers potentially addressed through Adaptability and Readiness implementation strategies. Narratives identified multi-level (i.e., individual-, organizational-, and community-level) strategies for targeting the identified constructs.

Conclusions

Fourteen CFIR constructs emerged as potentially important for organizations to consider when implementing PA interventions. Constructs were integrated into our implementation toolkit and research testing their potential mechanisms of action when implementing PA interventions in rural settings is warranted.

Implications

Strategies that target the identified constructs may enhance the implementation of PA programs for rural cancer survivors. Cancer survivors can facilitate these efforts by partnering with their health care providers and community organizations.

Implications for Cancer Survivors

Organizations promoting physical activity programs for cancer survivors must overcome implementation barriers including but not limited to cost, necessary expertise, and lack of awareness. Cancer survivors can facilitate these efforts by partnering with their health care providers, cancer center, and local community organizations to raise awareness and champion these efforts. It will “take a village”, with cancer survivors being their own best advocate, to bring physical activity promotion to a broad range of cancer survivors.

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Funding

This project was supported by the National Cancer Institute (R21CA182601 and R25CA76023). Dr. Baumann is supported by 3U01HL133994-02S1, R01HG009351, U24HL136790, and UL1TR00234.

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Authors and Affiliations

  1. School of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35294-4410, USA

    Laura Q. Rogers, Maria Pisu & Robert A. Oster

  2. School of Health Professions, Department of Nutrition Sciences, University of Alabama at Birmingham, 1675 University Blvd, Birmingham, AL, 35294, USA

    Latoya Goncalves, Danielle Hessong & Fatima Iqbal

  3. Department of Preventive Medicine and Center for Innovation in Health Equity Research, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN, 38163, USA

    Michelle Y. Martin

  4. School of Public Health, Department of Epidemiology, University of Alabama at Birmingham, 1720 2nd Ave S, RPHB 430, Birmingham, AL, 35294-0022, USA

    Tamika L. Smith

  5. School of Health Professions, Department of Health Services Administration, University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL, 35294, USA

    Haiyan Qu & Richard Shewchuk

  6. Russell Medical Center, 3316 US-280, Alexander City, AL, 35010, USA

    Mary E. Sheffield & Alex Minter

  7. Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO, 63130, USA

    Ana A. Baumann

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  1. Laura Q. Rogers
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  2. Latoya Goncalves
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Corresponding author

Correspondence to Laura Q. Rogers.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Rogers, L.Q., Goncalves, L., Martin, M.Y. et al. Beyond efficacy: a qualitative organizational perspective on key implementation science constructs important to physical activity intervention translation to rural community cancer care sites. J Cancer Surviv 13, 537–546 (2019). https://doi.org/10.1007/s11764-019-00773-x

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