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 home-based 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.
Highlights
Cancer is the second leading cause of death among the Navajo people, one of the largest Native American nations in the United States (U.S.) (Navajo Epidemiology Center [NEC], 2013)
The process of Intervention Mapping (IM) in this study revealed areas of need in the Navajo cancer survivor community, a need for education on cancer and physical activity (PA) recommendations
Despite improving cancer survivorship rates throughout much of the U.S, significant disparities exist between Navajo and non-Hispanic White cancer survivors
Summary
Cancer is the second leading cause of death among the Navajo people, one of the largest Native American nations in the United States (U.S.) (Navajo Epidemiology Center [NEC], 2013). Native Americans, including Navajo, are diagnosed with cancer at more advanced stages compared to non-Hispanic Whites (NEC, 2018; Siegel, Ma, Zou, & Jemal, 2014) and have the poorest five-year cancer survival rate of any group in the country (Clegg, Li, Hankey, Chu, & Edwards, 2002; Siegel et al, 2014). Physical activity decreases fatigue and improves body composition, physical function, and overall quality of life among cancer survivors across multiple populations (Schmitz et al, 2010). Despite substantial disparities in survivorship outcomes among Native Americans, evidence-based physical activity programs have not been developed for any tribal nation including the Navajo Nation (Bea et al, 2018). The Native American Cancer Research Corporation does have a Physical Activity and Cancer Branch, providing information about national activity guidelines for cancer survivors and culturally tailored vignettes on emotional and spiritual benefits of physical activity (Native American Cancer Research Corporation, n.d.)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
