Development of a Culturally Relevant Physical Activity Intervention for Navajo Cancer Survivors

Abstract

Despite well-documented benefits of physical activity for cancer survivors, few interventions have been developed for Native American cancer survivors, the population with the poorest survival rates of any group. This paper describes the development and cultural adaptation of a physical activity intervention for Navajo cancer survivors using Intervention Mapping (IM). IM procedures were guided by the PEN-3 (Perceptions-Enablers-Nurturers) and Health Belief Models and informed by a qualitative study with 40 Navajo cancer survivors and family members. For each theoretical construct (perceived benefits, barriers, enablers of healthy behaviors, etc.), a measurable objective was identified. These objectives were then matched with intervention strategies. The IM process indicated the need for a highly culturally sensitive environment (site and providers), culturally acceptable measurements and materials, and integrating cultural and environmental activity preferences. Program objectives aligned directly with these areas. Intervention strategies included: (a) collaboration with providers sensitive to historical/cultural context and environmental barriers; (b) cultural adaptation of surveys, non-invasive physical measurements, no biospecimen storage; (c) materials, terminology and symbols embracing cultural values of return to harmony; (d) physical activities that are flexible and aligned with cultural preferences and environment/travel issues (e.g., outdoor walking; community and homebased options; portable, inexpensive resistance equipment; local resources; family/friends participation and more community cancer education); (e) clinical adaptations by site and symptoms. This study is the first to document the process of adaptation of a physical activity program for Navajo cancer survivors. Objectives and strategies incorporated via IM are expected to foster sustainability and enhance uptake, satisfaction, and adherence.

Health Behavior Change Intervention Preferences Expressed by American Indian Cancer Survivors From a Southwest Tribal Community: Semistructured Interview Study

“…The participants offered valuable insight on the specifics that would adapt published prehab models to their community. Such an intervention would attempt biochemical change using food as medicine and exercise as resilience, which is reflective of the wider momentum that American Indian/Alaska Native scholars are building in national discussions on the topics of Indigenous food sovereignty, decolonizing the diet, embracing traditional perspectives, and restoring balance [56][57][58][59].…”

Formative Evaluation and Adaptation of a Navajo Cancer Survivor Physical Activity Intervention to Serve a Broader Native American Cancer Survivor Community

“…Therefore, a cancer exercise intervention tailored to the Navajo people was developed and pilot-tested. The intervention, called Restoring Balance , was aligned with American College of Sports Medicine guidelines for cancer exercise and was culturally tailored based on focus groups and interviews with Navajo cancer survivors, family, and friends (Bea et al, 2018; Bea et al, 2019; de Heer et al, 2019).…”

“…The purpose of this article is to describe the process of consulting with cultural experts from different tribes to expand tribal inclusiveness of the Restoring Balance program and to serve a broader Native American cancer survivor community. Of note, the development of the original Restoring Balance program was guided by qualitative work utilizing the PEN-3 and Health Belief models, as well as Intervention Mapping (Bea et al, 2018; Bea et al, 2019; de Heer et al, 2019). These constructs consider perceptions, knowledge, attitudes, and beliefs, as well as community influences and cultural appropriateness and remained as guiding frameworks throughout the adaptation of the Restoring Balance program, in addition to the very practical elements of multicultural adaptation described herein.…”