Find your BEAT: Toolkit to increase physical activity in rural cancer survivors

 描述（由申请人提供）：体力活动（PA）可以改善许多长期副作用和原发性癌症复发的风险增加（即，结肠和乳腺）、继发性肿瘤和癌症幸存者经历的慢性非癌症医学合并症。由于大多数癌症幸存者不参与常规PA，因此增加有效的PA行为改变干预措施（BCI）从研究到癌症幸存者护理的转化至关重要，特别是对于身体和精神健康状况较差的农村癌症幸存者。在一项多中心随机对照疗效试验中，我们的BEAT Cancer（癌症治疗后更好的运动依从性）PA BCI用于乳腺癌幸存者显著改善了PA行为，达到PA建议的几率是迄今为止癌症幸存者中任何先前BCI报告的两倍。BEAT癌症干预的下一个转化步骤是准备在癌症社区网络（CCN）内实施。在提交R 01申请之前，需要一个实施工具包，该工具包整合了针对乳腺癌和农村CCN研究中心以外的癌症类型的计划适应性调整，以提出有效性-实施混合1型试验（即，在诸如CCN的真实的世界环境中测试临床有效性，同时还提高了对实施环境的理解）。这样的试验预计将在伯明翰的亚拉巴马大学（UAB）CCN内进行，其中包括多个社区医院和癌症中心，包括农村地区的医院和癌症中心。因此，我们提出了以下具体目标，总体目标是改善BEAT Cancer PA BCI在CCN中的实施：1）开发一个实施工具包，使干预措施适应农村CCN站点和乳腺癌以外的癌症类型，2）测试实施工具包的可行性，以及3）评估工具包的可接受性，采用性，适当性，保真度，成本，以及对服务和客户结果的影响。我们的建议是基于实施研究的综合框架和罗杰斯的创新扩散理论。将从目标农村亚拉巴马县的三个组织级别获得定性和定量输入（即，潜在干预 参与者、社区一级的利益攸关方和潜在的干预提供工作人员）。定性 数据（即，焦点小组、名义小组技术小组、照片语音和地面宣誓）将用于有计划的调整和创建执行工具包。开发完成后，该工具包将在全国癌症中心对20名女性癌症幸存者进行试点测试。可行性措施将通过调查和行政数据获得。可接受性、采用性、适当性和实施成本将通过调查、焦点小组和管理数据进行评估。将通过直接观察和调查来评估保真度。结果（即，服务和客户）重要的利益相关者和PA（自我报告和加速计）也将进行评估。在为农村人口服务的CCN内改善这种有效的PA BCI的实施将增加干预的范围及其对PA和健康的有益影响。

 DESCRIPTION (provided by applicant): 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.