Walking Juntos: Developing and Testing a Culturally Tailored Mobile Health and Social Media Physical Activity Intervention Among Adolescent and Young Adult Childhood Cancer Survivors

Latinx adolescent and young adult (AYA) survivors have a disproportionately high health burden of cardiometabolic conditions, yet have low rates of physical activity (PA) and are markedly understudied in survivorship research. There is currently no culturally tailored PA intervention in Latinx AYA survivors. We have a unique opportunity to address this critical gap by leveraging the infrastructure built for our ongoing StepByStep Study (a multilevel mHealth intervention restricted to English speakers). We seek to culturally adapt this intervention for Latinx patients who speak either Spanish and/or English through a rigorous iterative process and then test our novel intervention for short term efficacy using a randomized control trial (RCT) design. The ultimate goal is to inform a future, large, fully powered, longer term RCT in Children’s Oncology Group (COG) focused on the underrepresented Latinx AYA survivor population.

The overall goals of this study will be to (1) Use an iterative approach to develop a culturally tailored multilevel remote-based physical activity intervention using the StepByStep intervention as a starting point, and (2) conduct initial short term efficacy testing using a RCT design. These two steps adhere to the ORBIT model for intervention development and will provide substantial findings to support a planned fully powered, long term efficacy RCT among Latinx AYA survivors to estimate efficacy of the culturally tailored intervention. Study staff who will engage participants will be bicultural and bilingual (English/Spanish), a staffing strategy that we have successfully used in multiple previous and ongoing studies involving Latinx populations.

The original intervention in the StepByStep trial consists of an “intensive phase” of 6 months, which is directed largely by staff, followed by a “maintenance phase” of 6 months, which differs generally in having a lower frequency of staff contact/support as participants are encouraged to develop greater independence with the 3 components of the intervention. We have chosen to focus the cultural tailoring and most of the RCT on the “intensive” phase of the original StepByStep intervention (shortened to 12 weeks, a sufficient duration in general physical activity studies), given its importance in producing behavior change. Moreover, cultural tailoring of the “intensive phase” will greatly inform the “maintenance phase,” which will be incorporated into the future long term efficacy RCT. The maintenance phase will be conducted over a shortened 4-week period immediately following the intensive phase. Assessment of the maintenance phase will be conducted by a process evaluation and post-intervention qualitative interviews.

Our aim is to develop a culturally-tailored online physical activity program to best meet the unique language and cultural preferences of Hispanic or Latino/a adolescent and young adult survivors of cancer.​ We are doing this study because we want to find out what works best to encourage Hispanic or Latino/a survivors stay physically active after receiving cancer treatment.