# Mixed-methods organizational evaluation of a physical activity programme for cancer survivors in primary care

## TL;DR

This study evaluates how well a physical activity program for cancer survivors can be implemented in primary care settings in the Netherlands.

## Contribution

The study provides a mixed-methods evaluation of a physical activity program's feasibility in general practice using the RE-AIM framework.

## Key findings

- 9% of general practices adopted the program, showing high representativeness.
- Adherence to the program protocol was 77%, and training was rated highly.
- 69% of practitioners continued using program elements after the study.

## Abstract

Physical activity (PA) has proven health benefits for cancer survivors, yet PA programmes are not routinely available in general practice.

This mixed-methods study used the RE-AIM framework to evaluate the Adoption, Implementation, and Maintenance of a PA programme at an organisational level for cancer survivors in Dutch general practice.

Primary care practitioners (practice nurses, dieticians, and doctor’s assistants) delivering a PA programme aimed at increasing PA in daily activities, and general practitioners (GPs) in whose practices it was performed, completed questionnaires and interviews. Quantitative and qualitative data were analysed descriptively or by thematic analysis, respectively.

Concerning Adoption, 9% of general practices (n = 14) took part and showed high representativeness. Primary care practitioners coached a median of seven patients over 18.5 months, with barriers and facilitators emerging mainly related to organizational support, programme alignment, and patient health benefits. Concerning Implementation, adherence to the protocol was 77%, and the training was evaluated as 8 out of 10. Concerning Maintenance, 11 primary care practitioners (69%) used programme elements outside the study context.

We conclude that our PA programme seems feasible in general practice provided there is sufficient organizational capacity. Designating a lead-motivated practitioner, providing sufficient training, and aligning and integrating PA counselling in routine care are key to providing appropriate and targeted support for cancer survivors in general practice.

Physical activity programmes for survivors of cancer can be feasibly offered in primary care as a proof of principle, provided they align with regular care, are led by a motivated trained primary care practitioner, and have adequate time, budget, and personnel.

Graphical Abstract