Table 3.

Intervention strategies informed by facilitators and barriers to physical activity components of a lifestyle intervention identified by breast cancer survivors in Guam and Hawai’i, organized by social ecological model (SEM) level.

SEM Level	Intervention Components for Physical Activity Components	Perspectives and Illustrative Quotes
Individual	Guam Personal goal setting, achievements, and incentives Hawai’i Activity performed individually because of lifestyle and career and at most convenient place for individual (e.g., home or at gym) Being kept accountable with apps and devices (i.e., Fitbit)	“What’s my goal? Maybe it was never to change my diet. So that’s why it’s not important for me. But if we all had a common goal. Like, “Look guys. Little by little, we’re changing whatever”. Then how we get there is up to us”. —Guam Participant #6 “…have some kind of measuring to where we would log it to you or on a log sheet or whatever we do in terms of an activity a day and for the week. What I see is that accountability for myself to make sure that I do this thing, because sometimes they’re like, ‘Okay,’ then we eat our sweets. We don’t know if it is the sweets or not, but to be accountable and say, ‘Hey, you know what? I want to be a part of this? Do I want to go walking 30 min a day so I can log it in.’ To me, that’s accountability and I would love to be a part of that”. —Hawai’i Participant #6
Interpersonal	Guam Exercise with a support system (e.g., family, partner, or other individuals for accountability) Hawai’i Being in a supportive group	“Motivation. I need consistency and motivation...A core group of people who I can do it with. They depend on me and then I depend on them... So if you have someone that [is] relying on you to meet them there and then you feel obligated to be there, and then it works both ways”. —Guam Participant #1 “But in the group exercise that we do, it’s good because you have other people that are exercising with you, so it motivates you to come to class, because I know that our group has gotten pretty close. And so, if somebody is not going to be there, we have to answer to why that is. That part. That part of it is good”. —Hawai’i Participant #12
Organizational	Hawai’i Indoor (preferred) location with childcare Utilizing or partnering with existing community resources/programs for nutrition education or counseling, physical activity, mental health, or stress management	“We would go there (community center) like 9:30 in morning, twice a week or two times a week. But that all stopped during the pandemic. So that community helped me a lot. Socializing with people”. —Hawai’i Participant #8
Community	Guam Family-friendly environment (e.g., park, hotel, hotel pool, beach)	“walking by the beach or at the complex…a cemented path… even here at Ypao…or at the complex…up in Dededo, we go five rounds and then when we’re so late in the morning, we just walk in the neighborhood because we have a very quiet neighborhood, no dogs… no everything. So it’s, really, not much cars”. —Guam Participant #5
Policy	Guam Safe environment (e.g., address stray dogs and crime at physical activity spaces)	“I used to walk in Asan, but then we had those reports of people breaking into cars”. —Guam Participant #3 “And it goes back to the sidewalks. Our physical setup of the island or the city isn’t conducive to walking...so even for our younger kids to walk to the store, it’s right there, but it’s not safe because the road and the puddles so if we’re not setting our island up to live that healthy lifestyle…” —Guam Participant #6
Sociocultural (across all levels)	Guam Family-centered: family can be a support system to perform physical activity together Active transport (e.g., walking to commute) not normalized Hawai’i Family-centered: family can be a support system to perform physical activity together Group activities with similar cultural backgrounds Sharing and exchanging stories with other survivors	“Obligatory events. If you have something that’s planned by the family, you better go to that and forget your exercising. And I do that, I honor that because my family does come first”. —Guam Participant #7 “And so having avenues like this in-person or online, I think is very helpful for survivors, because then it creates that type of community that we’re not alone. We’re all walking through this together. And we might not have had the same treatments or the same different things that happen to us, but we do understand the strength it takes to continue to survive and stay hopeful”. —Hawai’i Participant #1