Social ecological determinants of physical activity among adult survivors of childhood cancer

Abstract

Purpose: Adult survivors of childhood cancer (ASCCs) are at high risk for cardiovascular disease from chemotherapy and radiation therapy-related cardiotoxicity. Physical activity can reduce this risk, but most ASCCs do not engage in sufficient physical activity. The Ecological Model of Physical Activity (EMPA) is a theoretical framework which suggests multiple factors facilitate or hinder PA. These factors exist at the individual (e.g., motivation, genetics), micro- (e.g., parents, neighborhood parks), meso- (e.g., transportation), exo- (e.g., two microsystems working together), and macro- (e.g., societal values) system levels. The purpose of this study was to identify barriers and facilitators of physical activity among ASCCs using the EMPA framework. Methods: A concept elicitation survey was distributed to ASCCs (diagnosed with cancer before the age of 18, and currently 18-39 years old) and parent/legal guardians of an ASCC via Qualtrics. The survey consisted of open-ended questions asking about barriers, facilitators and resources for physical activity. Content analysis of open-ended questions categorized responses into levels of the EMPA, and identified key themes. Results: A total of 17 ASCCs, and 8 parents of ASCCs completed the survey. The majority of barriers were considered microsystem factors, and included proximity/access, social support and equipment. This study also identified financial resources as a macrosystem-level barrier to physical activity among ASCC. Seven themes emerged as factors impacting physical activity among ASCC: proximity/access, social support, equipment, time/schedule, none, finances, and health-related barriers. Conclusion: This is the first study to examine barriers and facilitators of physical activity among ASCC using the EMPA. Results from this study will provide a comprehensive understanding of physical activity determinants among ASCC to enhance future quantitative survey development.