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

• Published in: Journal of cancer survivorship Vol. 13; no. 4; pp. 537 - 546
• Main Authors: Rogers, Laura Q., Goncalves, Latoya, Martin, Michelle Y., Pisu, Maria, Smith, Tamika L., Hessong, Danielle, Oster, Robert A., Qu, Haiyan, Shewchuk, Richard, Iqbal, Fatima, Sheffield, Mary E., Minter, Alex, Baumann, Ana A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-08-2019; Springer Nature B.V
• Subjects: Adaptability; Cancer; Community; Community organizations; Exercise; Health care; Health Informatics; Health Promotion and Disease Prevention; Intervention; Long-term effects; Medicine; Medicine & Public Health; Oncology; Organizations; Packaging; Packaging design; Physical activity; Primary Care Medicine; Public Health; Quality of Life Research; Rural areas; Rural communities; Survival; Oncology; Supportive care; Exercise; Qualitative; Implementation
• ISSN: 1932-2259; 1932-2267
• DOI: 10.1007/s11764-019-00773-x

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.