Input from multiple stakeholder levels prioritizes targets for improving implementation of an exercise intervention for
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(2020) 1:97
Implementation Science Communications
RESEARCH
Open Access
Input from multiple stakeholder levels prioritizes targets for improving implementation of an exercise intervention for rural women cancer survivors Haiyan Qu1, Richard Shewchuk1, Xuejun Hu1, Ana A. Baumann2, Michelle Y. Martin3, Maria Pisu4, Robert A. Oster5 and Laura Q. Rogers6*
Abstract Background: Although evidence-based interventions for increasing exercise among cancer survivors (CSs) exist, little is known about factors (e.g., implementation facilitators) that increase effectiveness and reach of such interventions, especially in rural settings. Such factors can be used to design implementation strategies. Hence, our study purpose was to (1) obtain multilevel perspectives on improving participation in and implementation of a multicomponent exercise behavior change intervention for rural women CSs and (2) identify factors important for understanding the context using the Consolidated Framework for Implementation Research (CFIR) for comparison across three levels (CSs, potential interventionists, community/organizational stakeholders). Methods: We conducted three nominal group technique meetings with rural women CSs, three with community/ organizational stakeholders, and one with potential interventionists. During each meeting, participants were asked to respond silently to one question asking what would make a multicomponent exercise intervention doable from intervention participation (CSs) or implementation (potential interventionists, stakeholders) perspectives. Responses were shared, discussed to clarify meaning, and prioritized by group vote. Data was deductively coded using CFIR. Results: Mean age of CSs (n = 19) was 61.8 ± 11.1 years, community stakeholders (n = 16) was 45.9 ± 8.1 years, and potential interventionists (n = 7) was 41.7 ± 15.2 years. There was considerable consensus among CSs, potential interventionists, and stakeholders in terms of CFIR domains and constructs, e.g., “Design quality and packaging” (Innovation Characteristics), “Patients needs and resources” (Outer Setting), “Available resources” (Inner Setting), and “Engaging” (Process). However, participant-specific CFIR domains and constructs were also observed, e.g., CSs endorsed “Knowledge and beliefs about the intervention,” “Individual stage of change,” and “Self-efficacy” (Characteristics of Individuals); potential interventionists valued “Tension for change” (Inner Setting) and “Innovation participants” and “Key stakeholder” (Process); stakeholders emphasized “Goals and feedback” and “Network and communication” (Inner Setting), and “Planning” (Process). How the three participant levels conceptualized the CFIR constructs demonstrated both similarities and differences. (Continued on next page)
* Correspondence: [email protected] 6 School of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham, 1720 2nd Ave S, MT 614, Birmingham, AL 35294-4410, USA Full list of author information is available at the end of the article © The Author(s).
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