Adaptation and implementation of a community-based intervention to reduce psychosocial distress and promote physical activity in rural breast cancer survivors

项目摘要/摘要 农村癌症幸存者比城市癌症幸存者更不可能达到体力活动建议， 导致与缺乏运动相关的癌症健康差距。循证干预措施，以减少 癌症幸存者的心理社会痛苦和增加的体力活动是在城市或临床上发展起来的 在农村社区环境中实施时，往往会失败。这份职业发展的目标是 该奖项是为了帮助Scherezade K.Mama博士实现成为一名独立调查员的长期目标 在包括农村癌症在内的服务不足人群中设计和实施体力活动干预措施 为改善健康状况和减少健康差距，联合国儿童基金会将继续为幸存者提供援助。Mama博士的短期目标包括 在使用心理社会干预方法、癌症存活率和干预措施方面获得专门知识 改进生存成果、密集的纵向方法以及传播和实施 研究。在与她的多学科导师和顾问团队的合作下，她制定了一个 通过课程作业、研讨会、科学会议、定向阅读和 有指导的研究项目。拟议研究项目的主要目标是利用一个社区- 制定和评估减少心理社会压力和增加心理社会压力的干预措施 宾夕法尼亚州中部农村乳腺癌幸存者的体力活动。焦点小组(n=6)与社区 将对利益攸关方和农村乳腺癌幸存者进行调查，以(A)确定如何最好地修改 为农村癌症幸存者提供循证干预并在社区环境中实施，以及(B) 反馈修改后的干预措施。农村乳腺癌幸存者(n=50)将通过现有的 社区伙伴关系，参加为期3个月的改编社区干预或接受通常 关心。干预包括面对面和基于家庭的会议，其中包括有氧运动和 减少心理社会痛苦和增加体力活动的身心策略。参与者完成 在四个时间点(基线、6周、干预后、6个月)进行评估，并完成每日日记 在3个月的干预期内评估日常痛苦和体力活动。深度访谈 将在6个月后与干预参与者(n=25)和社区利益相关者(n=10)进行 在研究期内探索实施成果。这项研究的发现将填补文献中的一个关键空白 关于将循证干预措施转化为社区环境中的持续做法，并将向 这项研究的下一阶段是对一个大规模社区的有效性-实施混合研究- 基于随机对照试验的减少农村乳房心理社会痛苦和增加体力活动 癌症幸存者。完成拟议的研究和培训目标将为Mama博士提供技能， 经验，以及启动成功的物理独立研究生涯所需的初步数据 活动促进、癌症预防和控制以及健康差距。

PROJECT SUMMARY / ABSTRACT 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.