Physical Activity and Breast Cancer: A Qualitative Study on the Barriers to and Facilitators of Exercise Promotion from the Perspective of Health Care Professionals

Abstract

We determined the barriers to and facilitators of exercise promotion by health care professionals (HCPs) for women with breast cancer (BC). The study was a qualitative descriptive study. Semi-structured interviews were conducted with HCPs who treat individuals with BC in Ontario. The interviews were recorded and transcribed. Two reviewers independently used content analysis to determine codes and themes developed in the interviews. NVivo 10 was used during the coding process. A total of 24 HCPs participated in this study. The data from the interviews were grouped into five main categories: (1) institutional barriers, (2) HCP barriers, (3) perceived patient barriers, (4) facilitators (resource and service needs), and (5) patient characteristics. A graphic depiction of the interaction was created for these categories and how they affect the promotion of exercise for women with BC. Participants in this study identified several barriers to exercise promotion at the institutional, professional, and patient levels and suggested several strategies to facilitate exercise promotion. These findings can inform future exercise interventions to increase exercise adherence and engagement in this population.

What hinders healthcare professionals in promoting physical activity towards cancer patients? The influencing role of healthcare professionals’ concerns, perceived patient characteristics and perceived structural factors

“…To increase levels of PA promotion towards patients with cancer, several studies tried to identify factors that influence HCPs in their PA promotion (Jones, Courneya, Peddle, & Mackey, ; Karvinen et al., , ; O'Hanlon & Kennedy, ; Park et al., ; Smith‐Turchyn, Richardson, Tozer, McNeely, & Thabane, ; Spellman et al., ; Williams et al., ). They detected factors belonging to three categories: attitudes of HCPs (both, perceived benefits and concerns), perceived patient characteristics and structural factors.…”

“…Perceived patient characteristics have been studied almost exclusively in terms of patients’ interest in PA (Karvinen et al., , ; Park et al., ; Spellman et al., ; Williams et al., ), although other patient characteristics could influence HCPs’ PA promotion likewise. Structural factors analysed to date involved various aspects including HCPs’ working environment, their education and characteristics of the healthcare system (Karvinen et al., , ; O'Hanlon & Kennedy, ; Park et al., ; Smith‐Turchyn et al., ; Spellman et al., ; Williams et al., ). However, it needs further clarification how these structural factors affect the PA promotion to outline ways to overcome structural barriers.…”

Physical activity and breast cancer: Results of a focus group to devise novel exercise interventions for women with breast cancer

“…However, recent research in Ontario has found that barriers at the institutional level, HCP level, and patient level may all contribute to a lack of exercise promotion. [22] For example, institutionally a lack of time with each patient, a lack of defined role for who should be discussing exercise, and a lack of funding for the inclusion of rehabilitation professionals and exercise programs were stated barriers to exercise promotion. [22] Professionally, HCPs commonly described a lack of their own specific exercise knowledge and a vast number of competing priorities needed to discuss with their patients as barriers to exercise promotion.…”

“…[22] For example, institutionally a lack of time with each patient, a lack of defined role for who should be discussing exercise, and a lack of funding for the inclusion of rehabilitation professionals and exercise programs were stated barriers to exercise promotion. [22] Professionally, HCPs commonly described a lack of their own specific exercise knowledge and a vast number of competing priorities needed to discuss with their patients as barriers to exercise promotion. [22] Finally, professionals also perceived patients with BC as having poor attitudes towards exercise, lacking accessibility to exercise resources, and having complex medical needs as patient barriers to promoting the recommended levels of exercise.…”

“…[22] Professionally, HCPs commonly described a lack of their own specific exercise knowledge and a vast number of competing priorities needed to discuss with their patients as barriers to exercise promotion. [22] Finally, professionals also perceived patients with BC as having poor attitudes towards exercise, lacking accessibility to exercise resources, and having complex medical needs as patient barriers to promoting the recommended levels of exercise. [22] Both the patient and the HCP reported that barriers to exercise participation and promotion respectively have limited the implementation of this effective, low-cost, low-risk management strategy.…”