Adopting and implementing an efficacious peer-delivered physical activity program for web platform delivery in survivors of breast cancer: organizational readiness and perspectives

Abstract

Background

The Moving forward together (MFT) program is a 3-month, peer-led, physical activity (PA) program for survivors of breast cancer and has shown effectiveness in increasing survivors’ moderate-to-vigorous PA. We adapted an existing web-based platform to the MFT program, created webMFT, and partnered with four cancer care organizations to implement webMFT.

Purpose

To understand factors that influence adoption, implementation, and potential for maintenance of webMFT at the organizational level.

Methods

We used mixed methods to assess organizational readiness and facilitators/barriers for the organizational adoption and implementation of webMFT. In the preimplementation phase, eight representatives completed the organizational readiness for implementing change (ORIC) measure [2 subscales: commitment to change (CC) and efficacy for change (EC), score range = 1–5]. After implementation, four representatives also participated in a semistructured interview. Interviews were coded by two researchers using content analysis. Quantitative and qualitative results were integrated.

Results

ORIC scores showed high readiness: CC (mean ± SD; 4.42 ± 0.65) and EC (3.98 ± 0.64). Qualitative categories aligned with quantitative results and included: (i) Strong alignment of mission between webMFT and organizations; (ii) Motivation to adopt webMFT to support their communities; (iii) Lower organizational capacity to recruit participants to receive webMFT than capacity to recruit peer mentors to deliver webMFT; (iv) Resource needs—to scale out and sustain webMFT requires dedicated organizational staff time; and (v) Organizational members found webMFT staff helpful, professional, and communicative, which made partnering a positive experience.

Conclusions

Organizational perspectives provided insights into challenges and opportunities for the scalability of evidence-based programs for cancer survivors.

Clinical Trial information

The Clinical Trials Registration #: NCT05409664.

Cancer care organizations were committed to implementing a physical activity program for survivors of breast cancer because it aligned with their mission to support the needs of their communities. Organizational staff were confident in their ability to implement the program but also had concerns about capacity to help with participant recruitment.

Implications.

Practice: Partners interested in working with cancer care organizations to implement evidence-based programs for survivors of cancer should consider how the program aligns with the organization’s mission and understand the resources (staff time, capacity) needed for program implementation.

Policy: To enhance broader delivery of evidence-based physical activity programs for survivors of breast cancer, policymakers could consider incentives to encourage insurance companies to work with cancer care organizations to cover the cost of these programs.

Research: To improve access to evidence-based programs for survivors of cancer, researchers should consider partnering with cancer care organizations to support program implementation.

Introduction

Aerobic physical activity (PA) has been shown to alleviate the sequelae of cancer treatments [1–5], and current guidelines recommend that survivors participate in aerobic exercise at moderate-to-vigorous intensity (MVPA) for at least 150 min/week [6, 7]. However, only 24%–44% of survivors meet these guidelines [8]. Specifically for female breast cancer, there has been a large increase in 5-year survival rates, increasing from 63% in the 1960’s to 91% currently with >4 million breast cancer survivors in the United States today [9]. Thus, there is a critical need for PA programs that target improvements in PA for the many female survivors of breast cancer.

Moving forward together (MFT) is a 3-month, evidence-based, peer-delivered intervention to assist previously inactive survivors with increasing MVPA; this program has previously demonstrated effectiveness for adoption of MVPA [10]. Briefly, peer mentors who served as coaches were trained and supervised to provide MVPA counseling via telephone calls to other breast cancer survivor participants (i.e. recipients). The counseling calls effectively helped participants significantly increase their MVPA to a mean of 129 min/week at 12 weeks (P < 0.05) [10]. With the growing evidence of the key role that PA can play in cancer recovery, we are one of the first teams to extend these research findings into the “real world” by training community volunteers to encourage survivors to adopt MVPA [10–12]. In prior work, we interviewed 10 partners from the community-based organizations to understand key elements that influenced the potential for the decision to collaborate, facilitators and barriers during the trial, and recruitment recommendations [13]. Five themes were identified including (i) a match with the organization’s mission and goals, (ii) benefits to participating (health improvements for survivors of breast cancer, mentors learning how to better assist their peer survivors), (iii) cost considerations (staff time, resources), (iv) the importance of clear communication, and (iv) an overall satisfaction with the partnership [13]. These findings informed our approach for partnering with cancer care organizations in the present study.

To further scale out MFT, we adapted an existing web-based platform for MFT, created webMFT, and partnered with cancer care organizations to implement webMFT [14]. Consistent with dissemination and implementation science, we applied the expanded RE-AIM framework (reach, efficacy/effectiveness, adoption, implementation, and maintenance) of implementation outcome dimensions that includes a model of key contextual determinants of successful implementation: the practical, robust implementation and sustainability model (PRISM) [15]. RE-AIM has been in use since 1999 and has been applied widely to plan and evaluate the translation of many interventions in primary care and community settings, including smoking cessation intervention, diabetes management, and MVPA promotion [see www.re-aim.org; [16]]. As PRISM operationalizes the organizational, staff and survivor domains that influence implementation success, we sought to use PRISM to identify contextual factors at the cancer care organizational level that influence RE-AIM outcomes [17]. PRISM is a recommended framework for use in PA intervention and cancer survivorship research [18, 19] and has been applied in the context of evaluation of PA interventions [20, 21] as well as cancer survivorship interventions [22]. While one prior study has applied PRISM to evaluate a program delivering PA electronic referrals for cancer survivors [23], this is the first known study to apply PRISM to a PA intervention for breast cancer survivors specifically. The objective of this manuscript is to describe factors that influence adoption, implementation, and the potential for maintenance of webMFT at the cancer care organizational level using mixed methods.

Methods

This was a mixed methods organizational-level implementation study that complemented a larger randomized controlled trial [24]. Results of the larger trial have been previously published [24]. In brief, we partnered with four cancer care organizations to identify peer mentors to receive training to deliver webMFT during the preimplementation stage and the subsequent testing of webMFT using a randomized controlled trial design in the implementation stage. Survivors of breast cancer (i.e. participants) were randomized to receive either webMFT (assigned a trained peer mentor to deliver intervention via the web platform) or an MVPA Tracking group (independent MVPA tracking). Mentors were trained to deliver webMFT via recorded modules and synchronous platform training sessions with research staff. The trial is registered at Clinical Trials.gov (NCT05409664) and details of the trial protocol have been published previously [14]. Institutional Review Board (IRB) approval was obtained from the institution and written informed consent was obtained from study participants.

Description of webMFT

The webMFT intervention is a 3-month PA program where survivors of breast cancer (i.e. recipients) receive weekly phone calls from a trained, peer mentor. WebMFT involves a web-based platform for mentors to effectively deliver the PA intervention. Key components of webMFT include survivor enrollment; mentee-to-mentor matching; 1-on-1 remote mentor mentoring via phone, text messaging; automated MVPA tracking via Fitbit; and administrator oversight and support (www.inquisithealth.com, now PYX health). Additional details of the webMFT program have been published previously [14].

Recruitment of cancer care organizations

Cancer care organizations were approached to assist with the recruitment of peer mentors (to serve as a coach), and breast cancer survivors (to serve as participants and be randomized to either webMFT or the MVPA Tracking group). Organizations could be included in the study if they (i) had ongoing peer mentoring programs (which included peer mentoring for breast cancer survivors) and (ii) were located in the United States prior to agreeing to partner with the research study, the Principal Investigator and program manager met virtually with the leaders of the organization to review the components of webMFT, identify a timeline for their support, and expectations of the partnership (i.e. recruitment of mentors and recipients). Additionally, since recruitment was the primary ask of the research study, recruitment documents such as flyers and brochures were shared during this meeting. Following the meeting, organizations agreed or declined to partner with the research study. Organizations that agreed to partner were sent IRB-approved recruitment materials for mentor and/or recipient recruitment. Research staff routinely checked in with organizations via email throughout the recruitment processes.

Measures

In this manuscript, we collected quantitative survey data on organizational readiness for implementing change (ORIC [25], see details below) and qualitative interview data were analyzed with attention to PRISM contextual and organizational factors that influence the RE-AIM outcomes dimensions of adoption, implementation, and the potential for maintenance. While reach (which is assessed at the participant level) was also evaluated in the overall trial, the content analysis did not consider PRISM contextual influences on reach because the focus of this manuscript is at the organizational level. The PRISM domains assessed included: organizational perspective of the intervention, organizational characteristics, external environment, and implementation and sustainability infrastructure [15]. Methods of the trial have been described in detail previously and are described briefly below [14].

RE-AIM implementation outcomes

Adoption

Adoption includes the total number of eligible organizations out of the total number of potential organizations, the percentage of eligible organizations that agreed to participate in the study, as well as the percentage of eligible mentors who agreed to participate to deliver webMFT [17, 26]. In addition, organizational staff were asked about factors that influenced their decision to participate in the study during semistructured interviews.

Implementation

According to RE-AIM, the implementation dimension includes assessment of organizational readiness that relates to the feasibility of program delivery. We also collected several qualitative assessments of additional implementation outcomes based on PRISM domains (organization perspective of the intervention, organizational characteristics, external environment, and implementation infrastructure) [15] in semistructured interviews with organizational staff.

Potential for maintenance

Potential for sustainability and motivation to sustain webMFT after the grant funding period ended was assessed during the semistructured interviews with organizational staff.

Quantitative data collection

Organizational readiness surveys

During the preimplementation phase, we conducted brief surveys to assess demographics and prior experience with research collaborations. Two organizational members (a leader and staff member) from each potential organization were asked to complete the ORIC questionnaire [25] that includes two subscales [commitment to change (CC) and efficacy for change (EC)] of five items and seven items each, respectively. Respondents were asked to rate each item using a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree). Subscale scores represent the average of scores for each subscale. There are no specific cut-points for high versus low readiness, but our team determined that a mean score ≥4 indicated that an organization was ready to participate, as this score reflects that on average, respondents “somewhat agree” or “agree” across the 12 items assessing readiness.

Additional survey items

Four additional questions were added to obtain a more “summative measure” of organizational readiness and to capture reasons for choosing to participate or not in the webMFT study (and assess elements of adoption from RE-AIM). These questions were as follows: (i) “We recognize that organizational capacity to implement new interventions fluctuates with changing organizational demands. Right now, to what extent do you agree with this statement? Members from our organization are prepared to implement the webMFT intervention? (consider in your answer both elements of psychological and behavioral preparation): (1 = disagree, 5 = agree),” (ii) “Is your organization interested in participating in the webMFT intervention? (yes/no),” (iii) “If yes, why are you interested? (open-ended response),” and (iv) To what extent do you agree with the following statement: “The webMFT intervention aligns with the mission and vision of my organization” (1 = disagree, 4 = agree).

Qualitative data collection

Post-study implementation, we conducted semistructured interviews with organizational staff. Interviews lasted approximately 45–60 min, were audio-recorded via Microsoft Teams, and were conducted by a research team member using a semistructured interview guide to ensure that each interviewee was asked the same core questions, based on PRISM domains.

Data analyses

Analyses of quantitative data

Results from the brief surveys (including the ORIC survey) were analyzed using descriptive statistics.

Analyses of qualitative data

The audio-recorded interviews were transcribed verbatim into a Microsoft Word document using the Microsoft Teams auto-transcription function. Each transcript was reviewed by the Research Assistant and verified for accuracy. Data analysis was conducted using conventional content analysis [27] to identify and describe the relevant contextual factors at the cancer care organizational level and their respective PRISM domains as well as any of the prespecified RE-AIM outcomes that these may have influenced [17]. Two members of the research team examined each interview transcript independently to label words, phrases, or sentences that aligned with the predetermined RE-AIM and PRISM content areas (open coding, completed manually). Open codes were compared and sorted into categories by the two coders into a code book informed by RE-AIM and PRISM. Codes and categories were then discussed with the larger research team to gain their impressions, systematically classify the codes, identify patterns, and gain consensus on analytic decisions. The analysis was conducted using a rigorous process [28, 29] that included: (i) dual coding and reviewing of the data to provide credibility of the analysis, (ii) discussion of data coding, exemplars, and analytical decisions by the larger research team [30], and (iii) documentation of all interview data and analytic decisions to provide an audit trail of the analysis.

Results

Of the eight potential organizations that were contacted, five attended an informational meeting with the research team, and four agreed to participate in the study. Two organizations did not respond to the initial request, one declined due to limited bandwidth due to COVD-19, and one declined after attending the initial informational meeting, stating limited capacity—see Fig. 1 and Supplementary Table S1 for additional details. Among the four participating organizations, organization size varied from small (<50 employees, n = 3) to large (>100 employees, n = 1) (Table 1). One of the four organizations reported having a paid employee within their existing organizational peer mentoring program. The number of peer support volunteers associated with each cancer care organization varied (1–50 volunteers, n = 1; 51–200 volunteers, n = 1; 201–499 volunteers, n = 1; ≥500 volunteers, n = 1). Within the four cancer care organizations, two organizational members (one staff member, one leader) responded to questions about readiness to participate (n = 8 organizational members total, 100% response rate). All organizational members’ responses to our survey questions indicated agreement that members were prepared to implement the webMFT intervention (50% indicated “somewhat agree”; 50% indicated “agree”), and 100% of organizational members indicated they were interested in participating in the webMFT intervention.

Figure 1.

Adoption at the organizational level.

Table 1.

Characteristics of participating cancer care organizations

Characteristics	Cancer care organizations (n  =  4)
Number of paid employees in organization (n, %)
1–49	3 (75)
50–99	0 (0)
≥100	1 (25)
Is there a paid employee within the organization’s peer mentoring program? (n, %)
Yes	1 (25)
No	3 (75)
Approximate number of peer support volunteers affiliated with the organization (n, %)
1–50	1 (25)
51–200	1 (25)
201–499	1 (25)
≥500	1 (25)

Quantitative results organizational readiness

A total of eight organizational members (n = 1 staff member and n = 1 leader from each of the four participating organizations) completed the ORIC. Overall, there was high CC and EC based on the ORIC data (Fig. 2). In general, scores for CC and EC were slightly higher amongst organizational staff, as compared to organizational leaders (Fig. 2). In addition, all members expressed agreement that the webMFT intervention aligned with the mission and vision of their organizations (25% somewhat agree and 75% agree).

Figure 2.

Organizational readiness.

Qualitative results

When asked why they were interested in participating in webMFT, qualitative responses of the cancer care organizations indicated strong CC, “We are passionate about providing support to the cancer community” but mentioned concerns about EC, stating, “beyond the help with referrals for the study, we don’t have the capacity to manage the back end” (Table 2).

Table 2.

Pre-implementation motivation for organizations to participate in the study

PRISM domain	ORIC domain	When asked why they were interested in participating, organizational members responded with
Organizational perspective of intervention	Commitment to change	“We are passionate about providing support to the cancer community, and feel physical activity is an important factor throughout cancer treatment and recovery. We have dedicated, committed volunteers who jump at any chance to help support others. We are grateful to be a part of this project.”
		“As an organization committed to encouraging mental health and wellness in cancer survivors and their loved ones, [web]MFT is aligned well with the [our] mission. Only wish the program could be offered to cancer survivors of ALL cancer types as think we’d see positive correlation between [mentors] and exercise/weight loss.”
		“It provides value add to our mentor experience. It is important for science. And it elevates [our organization’s] work with more evidence and to be part of a true research process. It is one more thing to manage but we are trying to keep everything going despite our small team.”
		“We are excited about the opportunity. We’re excited to give our mentors the opportunity to give back in a unique way. We’d love to see some of the data after the study concludes.”
		“[We have obtained] IRB approval and I have sent the approved email and brochure to 125 experienced breast cancer peer mentors, as agreed.”
Implementation and sustainability infrastructure	Change efficacy	“We experience unprecedented staff shortages, and there is no end in sight to end it. Everyone agrees that [web]MFT is a great intervention and would like to facilitate access to it for our patients, but beyond the help with referrals for the study, we don’t have the capacity to manage the back end of it. I hope it changes soon.”
Organizational characteristics	Change efficacy	“We have mentors that are candidates to participate and may have interest. It is difficult to predict what actual interest/participation will be.”

A total of four interviews were completed in the post-study implementation phase, representing three of the four participating organizations (three staff members and one leader). Qualitative categories included: (i) Mission—there was strong alignment between webMFT and each organization’s mission (PRISM organizational perspective of webMFT); (ii) CC/motivation—organizations wanted to adopt webMFT to support their communities (PRISM organizational characteristics and perspective); (iii) Different organizational capacity for certain activities/EC—organizational staff felt confident in adopting webMFT, however, they reported greater capacity to recruit peer mentors to deliver webMFT than to recruit participants to receive webMFT (PRISM organizational characteristics, implementation and sustainability infrastructure); (iv) Resources—several resources were identified that are needed to scale out and sustain webMFT, such as protected staff time (PRISM implementation and sustainability infrastructure); and (v) Organizational members found webMFT staff interactions to be helpful, professional, and communicative—these qualities made partnering a positive experience (PRISM organizational perspective of webMFT). Each of these categories are described in detail below and in Table 3. Qualitative codes are displayed in Supplementary Table S2.

Table 3.

Qualitative categories and exemplars from organizational interviews post-implementation

PRISM domain	Category		Exemplars
	ORIC change commitment
Organizational perspective of the intervention	Organizational staff are… committed, will do whatever it takes, want to, determined and motivated to implement the webMFT intervention	Community protection Mentors are survivors too	“It was an opportunity to offer our mentors to even be involved in something that’s a little new and different.” “I take, you know, our volunteer’s privacy, really personally, it’s a high priority for me to make sure we’re protecting our community. So I felt very comfortable kind of sharing this study with them and having them communicate with you directly.” “I see it [webMFT] providing our volunteers an additional opportunity to help support, you know their clients in an additional capacity.”
	ORIC change efficacy
Organizational perspective of the intervention and implementation and sustainability infrastructure	Staff are confident … organization can get people invested, keep track of progress, support, keep momentum going, handle challenges, coordinate tasks, manage politics to implement the webMFT study	Clear communication Engagement Organizational capacity (time, staffing, recruitment)	“They become peer mentors, but then they’re ready to move on themselves and kind of forget about their breast cancer and…just get on with normal life. And not forget about it, because you can never forget about it, but, you know, after a while there, it’s many of them feel it’s time for them just to move on…” “So, it kind of took them out of the ability to do both the study and uh mentor other mentees that were requesting from our website. So, I mean it’s not negative at all. It just was something that we didn’t really expect, I guess.” “I thought it was great that the mentors had the opportunity to participate in the study and there was such an interest and I think it’s a really great experience for them to have such great guidance and information to provide. But I think that maybe some of them didn’t realize the amount of time commitment.”
	Mission
Organizational perspective of the intervention	Mission of organization aligns with webMFT	webMFT aligns well with organizational missions. Providing hope Mind-body-spirit	“…There was just some really very strong alignment with your mentor peer coach model that you know we’ve got a cadre of breast cancer survivors- you know trained breast cancer survivor peers, it was a really interesting fit. It [the research study] caught out attention and not that it took so many resources that we need board approval.” “It fits really all of our missions because it’s providing training to our mentors that an then educate other participants in our programs. I think that it supports those mentors as well and giving them additional resources not only as a mentor but also as a survivor and empowerment too.” “[The study] definitely aligns with where our focus is on the clients. And then with our volunteers as well, using their skills and their knowledge and their expertise in certain aspects to help support other people. I definitely see parallels and that’s I think why we wanted to really be a part of it, because we saw it aligning really well with our mission and our program.”
	Resources
Implementation and sustainability infrastructure	Resources needed to implement webMFT.	Organizational capacity/resources (time, staffing, recruitment, having enough clients who would have interest) Champions (mentors, administrators, clients, board of directors or council/trustees support) Incentives to organizations for resources Technology resources for recruitment and streamlining other organizational processes webMFT study staff/CON/NIH grant	“Programmatically, we had a little bit of capacity, free capacity to do something new and different, and I will just say that the concept of research around exercise you know for breast cancer patients partly caught our attention.” “[A staff member] in particular had some bandwidth and some interest to take it on, you know…she had all the relationships with our mentors to actually do the work that you needed her to do.” “It’s always just going to be a constant, you know resource, you know do we have enough staff bandwidth to do one more thing.” “Participants of our programs are coming to us for resources and this is just another resource.”
	Interactions with webMFT staff
Organizational perspective of the intervention	webMFT program and staff		“I didn’t have a problem at all with trusting you all. Let me that- it never really never occurred to me, I guess not to trust you.” “I felt it was very clear throughout from the beginning. We kind of knew what you needed from us and then the communication with the team was always really quick, really responsive.”

Alignment with organizational mission

Organizational members indicated strong alignment between the webMFT intervention and their organizational missions (Table 3). They felt that the program provides hope and empowerment while also easing fears and doubts for survivors of cancer. They appreciated how much webMFT supported the mentors and mentioned the beneficial training and education.

CC/motivation

Organizational members indicated high commitment to implementing webMFT. One member stated, “staff are … committed, will do whatever it takes, want to, determined and motivated to implement the [web]MFT intervention.” Another stated,

We pride ourselves on providing really client-focused, custom peer support … meaning, we listen to our clients to really get a sense of where their needs are in that moment and kind of meeting them where they are. And for many people that’s physical activity and that piece of it is really big.

Organizational members were motivated to implement webMFT because they wanted to protect their fellow community of survivors of cancer, and they liked that mentors for the program were survivors too. One organizational leader who was interviewed indicated she was also a survivor of breast cancer which added to her motivation for committing to implementing webMFT. Organizational members also indicated that the description of the study and the process for participating was very clear. This program was supported by funding from the National Institutes of Health (NIH) and received approval from the IRB, which supported the legitimacy of the program and was a contributing factor influencing organizational members’ motivation to participate.

Differential organizational capacity for certain activities/EC

Organizational members felt confident in their role for implementation of the webMFT intervention. They felt that there was clear communication regarding the expectations of mentors. Organizational members stated that it was easier to recruit mentors (a survivor of breast cancer who is already meeting PA guidelines) to deliver the webMFT intervention due to the recurring contact they had with the organization. Alternatively, it was difficult to recruit recipients (a survivor of breast cancer who is not meeting PA guidelines) to participate in the study and receive webMFT, likely because of the other competing activities offered by their organization. In general, organizational members felt that mentors from their organizations seem very interested and engaged in the webMFT intervention. Several organizational members mentioned that they never saw how many mentors participated in the study and it would have been helpful to know which of their mentors opted into the study. Lastly, some mentioned that the fall was a busy time of year (due to increased events around breast cancer awareness month), making it difficult to implement the webMFT intervention.

Resources

Several comments were made regarding the resources needed to implement webMFT in terms of recruitment of mentors and recipients, which aligned with the implementation and sustainability infrastructure domain from PRISM. Organizational members mentioned that webMFT is more regimented than other walking programs and resources. They also mentioned issues of bandwidth (especially for smaller teams), time, and feelings of “being maxed out as far as staff.” The idea of having an organizational champion (mentors, administrators, board of directors or council/trustees) was raised to help support implementation of webMFT. In terms of incentives, organizations received $250 for assistance with recruitment of mentors, an additional $250 for assistance with recruitment of recipients and $100 if they completed the end-of-study interview. Interviewees expressed that these incentives were “fantastic.” Issues around technology were also mentioned—some indicated that their customer resource management platform they used to track survivors in their organization was chronically challenging and they expressed a need for resources to help with recruitment of mentors and recipients and to help streamline other organizational processes.

Interactions with webMFT staff

Overall, organizational members felt that their experience was great, and they appreciated the clear content and communication they received from study staff. The study team used various types of communication with the organizations, and they were proactive with following up. Organizational members indicated that it was a good partnership that was handled very professionally. When asked if they felt like they could trust the webMFT study team, one member expressed, “I didn’t have a problem at all with trusting you all…it never really occurred to me, I guess not to trust you.”

Integrated quantitative and qualitative results

Qualitative categories related to CC aligned well with the quantitative results from the ORIC survey. Organizational members indicated strong alignment between the webMFT intervention and their mission as well as high motivation to protect their community of fellow survivors. These qualitative findings fit with ORIC scores, showing agreement for CC (mean ± SD; 4.42 ± 0.65). Qualitative categories related to EC included clear communication of expectations but some challenges with organizational capacity related to recruitment of participants (breast cancer survivors not meeting PA guidelines). These qualitative findings also aligned with ORIC scores for EC, as they were slightly lower (3.98 ± 0.64) compared to CC scores. Several organizational members mentioned a need for additional resources to help with recruitment of participants and other organizational processes (e.g. adequate staffing) which also aligns with the lower scores for EC.

Discussion

Overall, both quantitative and qualitative findings in the present study demonstrated high organizational readiness among the four cancer care organization partners. Scores were particularly high for the ORIC subscale of CC, indicating excitement to initiate change (i.e. implementation of webMFT) into their organization. Qualitative data aligned with the quantitative findings on commitment—for example, we learned that the organizations had a very positive perspective on webMFT which related to the alignment of webMFT with their mission and a desire to continue supporting their communities. Scores for EC were slightly lower, and qualitative findings aligned with quantitative data—for example, we learned that ease of recruitment of peer mentors for the study and clearly outlined objectives from research staff supported their positive experience of working as a partner with the webMFT research team and contributed to their confidence in ability to partner with the study. Organizations also recognized the challenges of implementing a PA study such as webMFT. Specific organizational challenges included some difficulty recruiting webMFT participants (recipients), and the lack of dedicated resources at the organizations, such as dedicated staff time to launch the program. These data provide useful insights when beginning to transition an evidence-based program, such as webMFT, into a cancer care organization and will aid in the next steps of the implementation process. To overcome some of the challenges, a guide for collaboration is being developed by the team to outline steps for partnering with cancer care organizations to deliver evidence-based PA programs. This guide will provide examples of study resources (e.g. sample meeting agenda to meet with cancer care organizations, and a visual timeline for coach commitment) as well as detailed estimates of the time commitment required to implement the intervention to help organizations make informed decisions about adopting the program.

Cancer care organizations are highly supportive of their communities and are dedicated to improving the health of their cancer survivors which aligns with their mission. Staff members were motivated to implement this program, which may be due to their ongoing relationship with survivors of breast cancer and listening to their needs for future implementation. Organizations support the peer mentoring approach which aligns well with their current mentoring model; in fact, implementing webMFT would provide their mentors with additional skills relating to encouraging PA adoption. Importantly, learning new skills has previously been cited as a benefit that mentors have accrued when delivering the webMFT intervention [13].

In terms of influences of cancer care organizations committing to partner with new programs, our results are similar to a prior study indicating that alignment with the culture and values of the implementation setting as well as collaboration of organizational members are needed for successful implementation of interventions [31]. As we expected, the present qualitative categories in this manuscript are similar to our prior qualitative work that also highlighted the importance of mission alignment, the challenges for the required resources to implement the program, and the importance of clear communication regarding the “ask” when it comes to partnering with a community-based organization [13]. In our prior qualitative work, the program delivery was telephone-based, whereas in the present study, the intervention was delivered using a web-based platform. Unsurprisingly, the mode of program delivery did not have a large impact on the major factors that influenced organizational readiness to adopt the program because the organizational staff did not need to use the web platform in the present study. All of the coaches and participants lived in urban areas. Thus, for cancer care organizations that serve diverse survivor populations in rural settings, web delivery of the program could pose challenges due to participants’ limited access to Wi-Fi, cellular service, and/or safe places to be active. Furthermore, organizational staff members in the current study worked directly with the research staff when recruiting mentors and participants. In the interviews for the present study, organizational staff members noted the clear objectives, requirements, and time commitment of the research study. These interactions with research staff may have increased their efficacy for implementing the program.

Lack of resources and appropriate staffing were marked as the main challenges when considering implementing a new PA program. During the interviews, organizations stated the need for technology resources to assist with streamlining recruitment processes (e.g. having the ability to send mass emails for recruitment of participants), which influences the RE-AIM dimension of implementation. While we did not assess Reach in the present manuscript, the ability of organizations to easily recruit recipients likely has a strong influence on this RE-AIM dimension. Furthermore, organizational staff members noted the importance of a dedicated staff member who has experience with PA to assist with implementation. These findings likely influenced the lower scores observed for the ORIC EC. These challenges were cited previously by our group [13] and have also been seen among 12 cancer services (organizations) in Australia [32]. In the Australian study, the ORIC was used to determine the level of readiness when implementing an anxiety care program into routine care [32]. Faris et al. also noted the importance of supporting staff in addition to using the proper resources to implement change [32], as noted in this current study.

As noted in the Results section, four out of eight cancer care organizations that were approached agreed to participate in the study. Of the four organizations that declined, two declined due to limited capacity/bandwidth (one stating that was specifically due to COVID-19), and the lack of response from two organizations leaves their motives open to interpretation. We take these results as a “glass half full” as even during a global pandemic, half of the organizations approached agreed to adopt webMFT. Given that organizations were approached during COVID-19, it is possible that adoption of webMFT or similar programs to promote PA in breast cancer survivors may be higher post-pandemic. However, we were unable to collect additional data from the organizations to have a deeper understanding of their reasons for not participating, which is a study limitation.

There are additional limitations to this study which include a small sample size (four interviews, eight ORIC responses). Thus, we likely did not achieve saturation in qualitative findings. Furthermore, as suggested by Faris et al., there may have been a sample bias, as those organizations who completed the ORIC assessment and interview had agreed to partner with the research study [32]. Generalizability of results are limited to similar, United States-based cancer care organizations, as we did not engage health systems whose mission is much broader than cancer care organizations. In addition, we did not assess Reach since that is at the level of the participant and the focus of this present manuscript was at the organizational level. The study did, however, have several strengths, including taking into consideration the perspectives of more than one organization and including organizations of various sizes. The organizations which partnered in this study were not clustered in one location of the United States, rather they were spread across the United States, which allows for a better representation of United States cancer care organizations. Additionally, research staff were able to collect quantitative and qualitative data from the organizations. Integrating the two methods gave the research team an opportunity to obtain a more comprehensive view of the organizations’ experiences implementing the webMFT intervention.

Conclusion

Overall, cancer care organizations were motivated to implement webMFT because the intervention aligned with their mission; however, there were logistical challenges with implementation and variations in organizational capacity. This is reflected by the high CC scores and the moderately lower EC scores. Findings can support future efforts to implement interventions for survivors of cancer that involve partnership with cancer care organizations.

Supplementary Data

Supplementary material is available at Translational Behavioral Medicine online.

Funding Source

This study was funded by the National Institutes of Health, National Cancer Institute (R01 CA 242745).

Conflicts of Interest

Drs. Ostendorf, Huebschmann, Wickersham, Kindred, and Pinto declare that they have no conflicts of interest.

Human Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study received approval from the Institutional Review Board (IRB).

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Welfare of Animals

This article does not contain any studies with animals performed by any of the authors.

Transparency Statement

Study registration

This study was registered after the study began. The study is registered at clinicaltrials.gov. https://clinicaltrials.gov/study/NCT05409664

Analytic plan preregistration

The plan for the analyses was not formally preregistered.

Analytic code availability

There is no analytic code associated with this manuscript.

Materials availability

Materials used to conduct the study are not publicly available.

Data Availability

De-identified data from this study are not available in a public archive. De-identified data from this study will be made available (as allowable according to institutional IRB standards) by emailing the corresponding author.