Abstract
Purpose
To qualitatively explore exercise barriers and facilitators experienced by rural female cancer survivors from the program interventionist and recipient perspective for the purpose of enhancing exercise program implementation and uptake in rural settings.
Methods
A descriptive qualitative study design was utilized. Focus groups were conducted prior to implementation of an evidence-based exercise program by a rural non-research cancer clinical site. Nineteen rural female cancer survivors (mean age = 61.7 ± 10.9 years) and 11 potential interventionists (mean age = 42.3 ± 15.3 years) completed focus groups (stratified by participant role). Focus groups were audio recorded, transcribed, coded, and analyzed using inductive thematic analysis with NVivo 11.
Results
Cancer survivors identified 12 barrier themes (cancer specific adverse effects, lack of support, lack of knowledge, perceived negative aspects of exercise, cost, lack of resources, motivation, inconvenience, lack of program flexibility, time, weather, safety) and eight facilitator themes (knowledge, ease of access, resources, awareness, cost, options, organized, fun) related to exercise. Interventionists identified seven barrier themes (cost, transportation, lack of cancer survivor and interventionist knowledge, fear, motivation, lack of support, lack of resources) and four facilitator themes (resources, support, knowledge, motivation). Narratives revealed differing role-specific perspectives on shared themes between survivors and interventionists as well as potential implementation strategies for enhancing exercise participation and exercise program uptake among rural female cancer survivors.
Conclusion
Exploring multi-level stakeholder perspectives on cancer survivors’ exercise needs and related strategies yields important information for organizations to consider when implementing exercise programs in rural contexts.
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Data availability
Data and materials available upon request from the corresponding author.
References
Campbell KL, Winters-Stone KM, Wiskemann J et al (2019) Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc 51(11):2375–2390. https://doi.org/10.1249/mss.0000000000002116
Spence RR, Heesch KC, Brown WJ (2010) Exercise and cancer rehabilitation: a systematic review. Cancer Treat Rev 36(2):185–194. https://doi.org/10.1016/j.ctrv.2009.11.003
Speck RM, Courneya KS, Mâsse LC, Duval S, Schmitz KH (2010) An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 4(2):87–100. https://doi.org/10.1007/s11764-009-0110-5
Troeschel AN, Leach CR, Shuval K, Stein KD, Patel AV (2018) Physical activity in cancer survivors during “re-entry” following cancer treatment. Prev Chronic Dis 15:170277. https://doi.org/10.5888/pcd15.170277
Blanchard CM, Courneya KS, Stein K (2008) Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society's SCS-II. J Clin Oncol 26(13):2198–2204. https://doi.org/10.1200/JCO.2007.14.6217
Weaver KE, Palmer N, Lu L, Case LD, Geiger AM (2013) Rural-urban differences in health behaviors and implications for health status among US cancer survivors. Cancer Causes Control 24(8):1481–1490. https://doi.org/10.1007/s10552-013-0225-x
Singh GK, Williams SD, Siahpush M, Mulhollen A (2011) Socioeconomic, rural-urban, and racial inequalities in US cancer mortality: part I—all cancers and lung cancer and part II—colorectal, prostate, breast, and cervical cancers. J Cancer Epidemiol 2011:107497–107427. https://doi.org/10.1155/2011/107497
Reid-Arndt SA, Cox CR (2010) Does rurality affect quality of life following treatment for breast cancer? J Rural Health 26(4):402–405. https://doi.org/10.1111/j.1748-0361.2010.00295.x
Burris JL, Andrykowski M (2010) Disparities in mental health between rural and nonrural cancer survivors: a preliminary study. Psycho-Oncology. 19(6):637–645. https://doi.org/10.1002/pon.1600
Phillips SM, Alfano CM, Perna FM, Glasgow RE (2014) Accelerating translation of physical activity and cancer survivorship research into practice: recommendations for a more integrated and collaborative approach. Cancer Epidemiol Biomark Prev 23(5):687–699. https://doi.org/10.1158/1055-9965.EPI-13-1355
Cadmus-Bertram LA, Gorzelitz JS, Dorn DC, Malecki KMC (2020) Understanding the physical activity needs and interests of inactive and active rural women: a cross-sectional study of barriers, opportunities, and intervention preferences. J Behav Med 43(4):638–647. https://doi.org/10.1007/s10865-019-00070-z
Seguin R, Connor L, Nelson M, LaCroix A, Eldridge G (2014) Understanding barriers and facilitators to healthy eating and active living in rural communities. J Nutr Metab 2014(2):146502–146508. https://doi.org/10.1155/2014/146502
Olsen JM (2013) An integrative review of literature on the determinants of physical activity among rural women. Public Health Nurs 30(4):288–311. https://doi.org/10.1111/phn.12023
Clifford BK, Mizrahi D, Sandler CX, Barry BK, Simar D, Wakefield CE, Goldstein D (2018) Barriers and facilitators of exercise experienced by cancer survivors: a mixed methods systematic review. Support Care Cancer 26(3):685–700. https://doi.org/10.1007/s00520-017-3964-5
Rogers LQ, Markwell SJ, Courneya KS, McAuley E, Verhulst S (2009) Exercise preference patterns, resources, and environment among rural breast cancer survivors. J Rural Health 25(4):388–391. https://doi.org/10.1111/j.1748-0361.2009.00249.x
Vallance J, Lavallee C, Culos-Reed NS, Trudeau M (2013) Rural and small town breast cancer survivors’ preferences for physical activity. Int J Behav Med 20(4):522–528. https://doi.org/10.1007/s12529-012-9264-z
Economic Research Service (2013) Rural-urban continuum codes. United States Department of Agriculture. https://www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx. Accessed 5 July 2019.
Krueger RA, Casey MA (2015) Focus groups : a practical guide for applied research, 5th edn. Sage Publications, Thousand Oaks
Morgan DL (1997) Focus groups as qualitative research. 2nd ed. Qualitative research methods series, vol 16. Sage Publications, Thousand Oaks
Rogers LQ, McAuley E, Anton PM, Courneya KS, Vicari S, Hopkins-Price P, Verhulst S, Mocharnuk R, Hoelzer K (2012) Better exercise adherence after treatment for cancer (BEAT Cancer) study: rationale, design, and methods. Contemp Clin Trials 33(1):124–137. https://doi.org/10.1016/j.cct.2011.09.004
Krippendorff K (2003) Content analysis: an introduction to its methodology, 2nd edn. Sage Publications, Newbury Park
Milne HM, Gordon S, Guilfoyle A, Wallman KE, Courneya KS (2007) Association between physical activity and quality of life among Western Australian breast cancer survivors. Psychooncology. 16(12):1059–1068. https://doi.org/10.1002/pon.1211
Olson EA, Mullen SP, Rogers LQ, Courneya KS, Verhulst S, McAuley E (2014) Meeting physical activity guidelines in rural breast cancer survivors. Am J Health Behav 38(6):890–899. https://doi.org/10.5993/ajhb.38.6.11
Vallance JK, Lavallee CM, Culos-Reed NS, Trudeau MG (2012) Physical activity is associated with clinically important differences in health-related quality of life among rural and small-town breast cancer survivors. Support Care Cancer 20:1079–1087. https://doi.org/10.1007/s00520-011-1188-7
Rogers LQ, Markwell SJ, Verhulst S, McAuley E, Courneya KS (2009) Rural breast cancer survivors: exercise preferences and their determinants. Psycho-Oncology. 18(4):412–421. https://doi.org/10.1002/pon.1497
Funding
This work was supported by the National Institutes of Health (R21CA182601, R25CA76023, 5R25MH080916, 3U01 HL133994-02S1, UL1 TR002345, and R01HG009351).
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All authors, excluding Mary E. Sheffield and Alex Minter, contributed to the study conception and design. All authors, excluding Ana A. Baumann, contributed to material preparation, data collection, or analysis. The first draft of the manuscript was written by Jessica L. Adams, and all authors commented on subsequent versions of the manuscript. All authors approved the final manuscript.
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All study procedures involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its amendments or comparable ethical standards. The proposal was approved by the UAB Institutional Review Boards for Human Use.
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Adams, J.L., Martin, M.Y., Pisu, M. et al. Determining patient needs to enhance exercise program implementation and uptake in rural settings for women after a cancer diagnosis. Support Care Cancer 29, 4641–4649 (2021). https://doi.org/10.1007/s00520-021-05990-8
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DOI: https://doi.org/10.1007/s00520-021-05990-8