![]() Despite increasing awareness that exercise has critical implications for the CS and should be integrated into the survivorship care plan, many challenges remain and most women CSs are insufficiently physically active. For instance, women with a history of breast cancer who participate in exercise were at a 44% lower risk of mortality compared to those who did not engage in exercise. Also, a large body of research supports that exercise is associated with reduced cancer mortality risk in CSs. Strong evidence has been found that exercise positively influences quality of life in women living with a history of cancer, such as beneficial effects on physical function, cognitive function, fatigue, anxiety, depression, insomnia, sexuality, and cardiorespiratory fitness. With technical advances in cancer diagnosis and treatment, cancer survivors (CSs) can live longer, and the number of female CSs is estimated to reach over 10 million in the USA by 2026. Findings also reinforced the importance of multilevel implementation strategies for increasing exercise in an underserved, at-risk population. Multilevel input yielded diversity in type, relative priority, and conceptualization of implementation facilitators suggesting foci for future implementation strategy development and testing. How the three participant levels conceptualized the CFIR constructs demonstrated both similarities and differences. 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). 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). 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. Responses were shared, discussed to clarify meaning, and prioritized by group vote. 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. We conducted three nominal group technique meetings with rural women CSs, three with community/organizational stakeholders, and one with potential interventionists. ![]() 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). ![]() Such factors can be used to design implementation strategies. 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. ![]()
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