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

 描述(申请人提供)：体力活动(PA)可以改善许多长期副作用，并增加癌症幸存者经历的原发癌症复发(即结肠癌和乳房)、继发肿瘤和慢性非癌症内科合并症的风险。由于大多数癌症幸存者没有定期参与PA，因此关键是增加有效的PA行为改变干预措施(BCI)从研究到癌症幸存者护理的转化，特别是对于与城市癌症幸存者相比身心健康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，我们针对乳腺癌幸存者的BCI(癌症治疗后更好地坚持锻炼)PA BCI显著改善了PA的行为，到目前为止，符合PA建议的几率是任何癌症幸存者BCI报告的两倍。BEAT癌症干预的下一个翻译步骤是准备在癌症社区网络(CCN)内实施。在提交R01申请之前，需要一个实施工具包，该工具包集成了对乳腺癌和农村CCN站点以外的癌症类型的计划适应，该R01申请提出了有效性-实施混合类型1试验(即，在真实世界环境中测试临床有效性，例如CCN，同时也提高了对实施背景的理解)。这样的试验预计将在阿拉巴马大学伯明翰分校(UAB)CCN内进行，该中心包括多家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，我们提出以下具体目标和总体目标，以改进在CCN内实施BEAT癌症PA BCI：1)开发一个实施工具包，使其适应农村CCN地点和乳腺癌以外的癌症类型的干预，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、采用率、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综合框架和罗杰斯的创新扩散理论。将从目标阿拉巴马县农村的三个组织级别获得定性和定量投入(即潜在干预 参与者、社区一级的利益攸关方和潜在的干预交付人员)。定性的 数据(即重点小组、名义小组技术小组、照片语音和地面服务)将用于有计划的适应和创建实施工具包。开发完成后，该实施工具包将在CCN现场进行试点测试，有20名女性癌症幸存者参加。可行性措施将通过调查和行政数据来获得。可接受性、采用率、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。保真度将通过直接观察和调查进行评估。还将评估对利益相关者和PA(自我报告和加速计)重要的结果(即服务和客户)。在为农村人口服务的CCN中改进这一有效的PA BCI的实施将增加干预的覆盖范围及其对PA和健康的有利影响。

 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.