Integrating and adapting three evidence-based interventions to enhance physical activity and reduce psychosocial distress among rural breast cancer survivors: The Mind Your BEAT study

Background: Rural cancer survivors are less likely to meet physical activity (PA) recommendations and report higher psychosocial distress than urban cancer survivors due to social, financial, and geographical barriers. Previous PA interventions have been largely unsuccessful because they do not consider unique barriers to PA present in rural communities. Purpose: Mind Your BEAT (MYB) used a community-engaged approach to adapt an evidence-based intervention for implementation in rural communities and to address psychosocial distress alongside PA. This study describes the information gathering and adaptation process and the study protocol for the feasibility trial of the adapted MYB intervention. Methods and Results: First, interviews with rural breast cancer survivors and community partners (N = 7) were completed to adapt core components from three evidence-based interventions. Themes from interviews with rural breast cancer survivors and community partners focused on making the program accessible, partnering with trusted community organizations and leaders, and ensuring PA is tailored to physical and emotional needs of cancer survivors. Adaptations were integrated into the MYB intervention. Next, we conducted a feedback session with community scientists to refine intervention protocols prior to implementation of the feasibility trial. Once adaptations were made, we worked with Kourage Health, an existing community- and evidence-based exercise program, to test the feasibility, acceptability, and effects of the intervention. The adapted MYB intervention combined aerobic exercise, group education, and mind-body strategies to increase PA and reduce distress in rural breast cancer survivors. Participants were recruited through Kourage Health and randomized to participate in MYB or usual care. Study evaluation was guided by the RE-AIM framework and the consolidated framework for implementation research (CFIR). Conclusions: This study underscores the importance of community input in the adaptation of evidence-based interventions to improve reach and implementation in rural community settings and aims to accelerate the translation of evidence-based programs to underserved communities to reduce the research-practice gap.