| Theoretical Construct | Intervention Objectives | Strategies for Activity or Group Sessions | Strategies for Individual Activities |
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| Perceptions (PEN-3) | Reinforce accurate beliefs about cancer causes, environmental, and behavioral factors Reduce inaccurate beliefs about cancer Tap into resilience in culture and emphasis on tribal kinship, family, and community support Improve understanding of quantity and intensity of PA. during and after cancer treatment
| Promote health, fitness, and balance with cultural beliefs Health coaching to increase perceived control over health Provide education about cancer in Navajo and English and disseminate widely across community and partner agencies Facilitate recognition of strength in the community in general and with regard to treatment and health post-diagnosis
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| Enablers (PEN-3)/Perceived Barriers (HBM) | Decrease structural barriers to seeking treatment where possible (financial, logistic, and cultural) Support local organizations’ capacity to provide services Decrease fear about screening and finding out test results Promote knowledge regarding the U.S. healthcare system (what services are available and where to access services) Reinforce trust of community health representatives Improve skills to promote communication with healthcare providers about cancer among all family members as well as community members
| Discuss healthy changes that are possible within structural and environmental limitations at the family and individual level Disseminate information about screening recommendations (where to seek treatment and services for translation and patient navigation throughout the community and local organizations) Challenge negative beliefs about screening and learning about results with anecdotes and published data on screening benefits Practice communication with medical providers (role-playing) Practice goal setting and self-monitoring as effective techniques for improving diet and PA Highlight culminating event to facilitate behavioral strategies of (goal-setting/self-monitoring) aimed at engaging entire community Employ local, culturally sensitive partnership and support where possible Educate healthcare providers about Navajo culture and appropriate communication and activities Educate healthcare providers about our program as a resource for their patients
| Review individual and familial structural barriers and ways to address them Match patients with appropriate local site even if care is received in urban setting (expecting more sites in full project) Engage in personalized goal-setting based on individuals’ activity level with all family members Stepwise approach to reach ACSM cancer survivor exercise targets Be a resource on signs and symptoms for reducing activity/stopping activity/seeking consult with program and/or healthcare provider Review home-based program activities based on activity monitors Practice communication with health provider one-on-one for issues participants are not comfortable discussing in group setting Reinforce progress towards individual and family goals and ability to self-monitor progress Facilitate individuals identifying optimal program for them including: activity choices, group vs. solo activities, and home + center or another site
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| Nurturers (PEN-3) (Supportive and/or discouraging influences of families and friends including eating tradition, community and events, spirituality and soul, values of friends) | Reinforce the value of healthy traditional foods and PA in cancer prevention, prevention of other chronic disease, and overall quality of life Reinforce cultural beliefs of restoring balance and aerobic PA Emphasize importance of and provide skills needed to seek social support at the family and community level Reinforce the importance of information about cancer for family and community members, including appropriate PA recommendations for survivors
| Discuss cultural aspects of balance, health, physical activity, and dietary habits Share real-life examples of coping strategies gathered from the qualitative study in Navajo cancer survivors Facilitate social support of fellow participants due to shared experiences and success/learned lessons; draw on prior successes Reinforce the cultural value of gaining knowledge for dissemination to other family members (who are generally at elevated risk for cancer) and other members in the local community
| Reinforce ability and importance of seeking and providing support Provide individualized and family education based on cultural and clinical knowledge of cancer Review success in employing coping strategies
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| Perceived Susceptibility (HBM) | | Provide and discuss culturally and clinically relevant educational materials about susceptibility, screening, and PA recommendations for cancer survivors Disseminate materials throughout local community organizations and leadership as well as within the family
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| Perceived Benefits (HBM) | Improve knowledge on the role of PA for several different cancer types and in recurrence for several cancers Improve knowledge on the benefits of PA for fatigue and quality of life among family and community Improve knowledge on the importance of early detection and following treatment and screening recommendations for patient and family members Improve knowledge of adequate intensity required to achieve protective benefits
| Provide culturally appropriate education to survivors and family/community members on the importance of activity for cancer prevention, control, fatigue, and quality of life Group discussion on benefits of early detection Group discussion on health behaviors currently engaged in/successful changes made in the past
| Reinforce accurate individual and family beliefs Challenge inaccurate beliefs Review individual list of pros and cons and emphasize individual reason for engaging in healthy behaviors and personal control
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| Perceived Severity (HBM) | Increase knowledge on cancer survival rates, advances in treatment, and the importance of early diagnosis and therapy Provide information that although cancer is a serious condition, survival rates of many cancers have improved, particularly with early diagnosis and adequate treatment
| Participants develop a list of pros/cons of engaging in regular screening, PA, and healthy/traditional diet Discuss reasons and consequences of engaging in healthy behaviors
| Challenge inaccurate beliefs Reinforce accurate beliefs through education via teaching, one-on-one conversations, handing out fliers, and encouraging participants to ask questions
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| Self-Efficacy (HBM) | Increase self-efficacy for secondary cancer prevention among patients, family members, and at organizational/community level Increase self-efficacy to engage in behavioral strategies of PA and other health behaviors Increase sense of self-control and self-determination at the community level to improve quality of life and cancer fatigue Increase ability to seek and utilize resources, including social support of peers, family, and community members Empower participants to take control of their own and families’ health Reduce anxiety or discomfort associated with changes among patients, family members, and community members Emphasize opportunity for participants to improve experiences of other family/community members
| Provide information on baseline activity status and progress towards goals Share successes at the group level and among family/community Offer direct encouragement and positive verbal reinforcement during on-site sessions Draw upon the camaraderie of group sessions to motivate individuals Group discussion on successes achieved to overcome health challenges (e.g., treatment side effects) during and post-treatment Group discussion on influencing family and community members in a positive way with encouraging PA
| Positive reinforcement of healthy behaviors; draw upon strengths and successes Encourage open and honest communication about challenges, successes, and progress
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