Chang Alison, Boyd Alisa, Leung Ivan, Trejo Evelin, Dixit Niharika, Mallidi Jaya, Win Sithu, Beatty Alexis L
School of Medicine, University of California, San Francisco, USA.
Department of Epidemiology and Biostatistics, University of California, San Francisco, USA.
Cardiooncology. 2024 May 17;10(1):28. doi: 10.1186/s40959-024-00228-y.
Breast cancer survivors are disproportionately at risk for cardiovascular disease; exercise-based interventions may improve cardiovascular health. The objective of this formative research is to better understand the needs of patients and barriers to participation in an adapted cardiac rehabilitation program for diverse breast cancer survivors in an urban safety net setting.
We recruited 30 participants (10 English-speaking, 10 Spanish-speaking, and 10 Cantonese-speaking) who had received treatment with curative intent for breast cancer from an urban safety net hospital between November 9, 2021, to August 30, 2022. Participants completed surveys and interviews about perspectives on health behaviors and participating in an adapted cardiac rehabilitation program. Interviews were qualitatively analyzed using rapid template analysis with pre-selected constructs from the Theory of Planned Behavior, Unified Theory of Acceptance and Use of Technology, and Consolidated Framework for Implementation Research, as well as emergent codes. We developed a Participant User Journey for a program based on responses and conducted human-centered design sessions with 8 participants to iteratively revise the Participant User Journey.
Among 30 participants, mean age was 56.7 years (standard deviation [SD] 10.2) with 100% female sex assigned at birth; 1 participant withdrew before completing study procedures. Most participants had limited health literacy (18/29, 62%). Mean body mass index was 31.4 (SD 8.3), 21/29 (72%) had blood pressure below 140/90 mmHg, and 12/29 (41%) had blood pressure below 130/80. Mean 6-minute walk distance was 384.9 meters (SD 78.3). The desired benefits of a program included healthy living and prevention of cancer recurrence. Barriers to participation included motivation, social support, transportation, and concerns about exercise safety. Participants emphasized the need for practicality, such as fitting physical activity into daily life and nutrition support, including recipes and shopping lists. Trusted experts and cultural and language concordance were viewed as important aspects of the program.
Through participant interviews and human-centered design sessions, we developed the HEART-ACT program, a 12-week multi-disciplinary program addressing physical activity, nutrition, emotional well-being, cardiovascular risk, survivorship, and other components if indicated (e.g., tobacco cessation). Future research will test the effects of this program on patient-centered outcomes.
乳腺癌幸存者患心血管疾病的风险不成比例地高；基于运动的干预措施可能会改善心血管健康。这项形成性研究的目的是更好地了解患者的需求以及在城市安全网环境中参与针对不同乳腺癌幸存者的适应性心脏康复计划的障碍。
我们招募了30名参与者（10名说英语的、10名说西班牙语的和10名说粤语的），他们于2021年11月9日至2022年8月30日期间在一家城市安全网医院接受了乳腺癌根治性治疗。参与者完成了关于健康行为观点和参与适应性心脏康复计划的调查与访谈。访谈采用快速模板分析法进行定性分析，使用了计划行为理论、技术接受与使用统一理论以及实施研究综合框架中的预选结构，以及新出现的编码。我们根据反馈为一个项目制定了参与者用户旅程，并与8名参与者进行了以用户为中心的设计会议，以迭代修订参与者用户旅程。
在30名参与者中，平均年龄为56.7岁（标准差[SD]为10.2），出生时指定性别均为女性；1名参与者在完成研究程序前退出。大多数参与者的健康素养有限（18/29，62%）。平均体重指数为31.4（SD为8.3），21/29（72%）的血压低于140/90 mmHg，12/29（41%）的血压低于130/80。平均6分钟步行距离为384.9米（SD为78.3）。一个项目期望的益处包括健康生活和预防癌症复发。参与的障碍包括动力、社会支持、交通以及对运动安全的担忧。参与者强调了实用性的必要性，比如将体育活动融入日常生活以及营养支持，包括食谱和购物清单。值得信赖的专家以及文化和语言一致性被视为该项目的重要方面。
通过参与者访谈和以用户为中心的设计会议，我们开发了HEART-ACT项目，这是一个为期12周的多学科项目，涉及体育活动、营养、情绪健康、心血管风险、生存以及其他如有需要的组成部分（如戒烟）。未来的研究将测试该项目对以患者为中心的结果的影响。
