432MO - Barriers and facilitators of home-based exercise intervention participation in Indonesian breast cancer patients: A nested qualitative study using COM-B model

Background

The benefits of home-based exercise for breast cancer (BC) are evident. However, little is known about its feasibility in Indonesia, with likely more challenging participation barriers compared to high-income countries (HIC). We aimed to assess intervention feasibility and understand patients’ barriers and facilitators to enhance participation.

Methods

This is a nested qualitative approach to a study assessing the benefit of a 12-week home-based exercise intervention in BC patients, consisting of walking and resistance training. Descriptive statistics were used to assess feasibility. After 12 weeks, 25 patients were purposively sampled. Semi-structured interviews on barriers and facilitators were conducted in Dr. Sardjito General Hospital, Indonesia. All interviews were individual, face-to-face, lasting 25-40 minutes, audiotaped, and transcribed verbatim. A deductive thematic approach was used to analyse the data, and the themes generated were mapped onto the Capability, Opportunity, Motivation, and Behaviour (COM-B) model.

Results

From 48 eligible patients, 36 patients consented (recruitment rate 75%) and 32 patients completed 12-week intervention (retention rate 89%). Barriers that hampered participation were categorized into: physical capability (pain upon exercising, feeling ill), psychological capability (laziness), physical opportunity (‘too busy’, bad weather), and social opportunity (no companion, judgment in society). It was unusual or taboo for women to exercise alone in the neighborhood. Facilitators of intervention participation were: physical opportunity (goal-setting, exercise recommendations from oncologists), social opportunity (reassurance from regular contact with research team), automatic motivation (accountability), and reflective motivation (improved physical fitness and psychological well-being).

Conclusions

Our findings indicate that home-based intervention is feasible. Among identified factors that affect participation in Indonesian BC patients, judgment in society is a unique social barrier and has not been observed in previous studies in HIC. Addressing barrier factors is needed to enhance participation.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

University of Leeds (2021), The Indonesian Ministry of Research, Technology and Higher Education (2022), Faculty of Medicine, Public Health, and Nursing (2022), and Universitas Gadjah Mada (2022).

Disclosure

All authors have declared no conflicts of interest.