The feasibility and acceptability of delivering and evaluating a physical activity intervention (ACCEPTANCE) for cervical cancer survivors

Abstract

Background: Cervical cancer treatment can be associated with long-term physical, psychological and emotional issues leading to compromised quality of life (QOL). Physical activity (PA) may improve QOL in cervical cancer survivors. Methods: A one arm pre/post- feasibility study with parallel process evaluation was conducted to test the feasibility and acceptability of a 12-week PA intervention (ACCEPTANCE). Feasibility was determined by using pre-established criteria relating to: inclusion criteria, recruitment and retention, compliance with intervention components and compliance with evaluation measures. The 12- week intervention consisted of: 1) an online education session on the benefits of PA and a barrier identification and problem-solving session; 2) a Fitbit monitor; 3) daily and weekly diary entries; 4) brief fortnightly online health coaching sessions; and 5) organising and participating in group walks 6) online social interaction via a messaging group. Measures included accelerometer assessed PA and sleep, quality-of-life and PA behaviour change questionnaires distributed at 4-time points (baseline, week-6, week-12 and week-24). Process evaluation measures were questionnaires on the acceptance of intervention components and semi-structured interviews with participants after completion. Results: 30 participants were recruited with a retention rate of 77% at week-24. The education session, health coaching and Fitbit PA monitor were deemed to be feasible based on compliance rates whilst the online messaging group, diary and group waking compliance suggested that modifications would be needed. Accelerometer and questionnaires were deemed to be feasible evaluation measures based on compliance rates. Process evaluation results suggest that the Fitbit and health coaching sessions were perceived to be the most beneficial aspects of the programme as they enabled self-monitoring of behaviour and goal setting. Unexpected mechanisms of behaviour change were the integration of a small change approach and formation of habits to facilitate PA, whilst barriers to behaviour change included the online, virtual nature of the programme, poor mental health, and environmental challenges. Physical activity levels were higher after the intervention, whilst QOL was seen to worsen throughout the study. Conclusions: The ACCEPTANCE study is deemed to be feasible based on criteria established a priori, and only minor modifications would be needed ready for a definitive randomised control trial. The intervention showed potential to increase PA, through hypothesised mechanisms of self-monitoring behaviour and problem solving and unexpected mechanisms such as habit formation. Trial registration: ISRCTN16349793, Registered 30 September 2020. Key words: Exercise Oncology, Feasibility trial, Process evaluation, Cervical cancer survivorship