Conditions for adherence to videoconference-based programs promoting adapted physical activity in cancer patients: a realist evaluation

Abstract

Background Although moderate physical activity (PA) during cancer treatment has been associated with improved quality of life, reduced side effects, and even lower mortality, many barriers to successful implementation remain. Digital technology has been perceived as an effective lever for overcoming access and motivational issues – the exponential use of videoconferencing during the Covid-19 pandemic has reinforced this promise – but few studies have been performed to confirm this assumption. The "VISIO-AJUST" study explored the factors affecting the conditions of adherence to video-conference-based PA programs in patients undergoing cancer treatment. Methods The VISIO-AJUST study was based on a qualitative successive case approach, guided by the principles of the realist evaluation, and applied to two French programs of PA, following three main steps: 1) Identification of factors likely to influence conditions of patients’ adherence; 2) Elaboration and testing of explanatory “Context-Mechanism-Outcome (CMO)” configurations; 3) Refinement of CMO configurations, in order to understand what, how, for whom, and under what circumstances video-conference-based PA programs work. Results Five main CMO configurations were found to be associated with adherence to video-conferencing-based PA programs, promoting (i) Accessibility and a supportive environment for adapted physical activity, (ii) A setting conducive to sociability despite distance, (iii) Confidence and security of practice, (iv) A combination of several motivational levers in favor of continuity of effort and progress, (v) Regularity of the sessions, progressiveness in the effort and evaluation of progress as a basis for the adoption of a regular physical practice. Conclusion This study provides original insights into the use of videoconferencing to enable patients to improve their PA during cancer treatment. Future research with long-term follow-up would allow for a better understanding of the key conditions promoting sustainable behavior change.