Perceptions, facilitators, and barriers of participation for a behavioral weight loss group-based telehealth program for breast cancer survivors: a qualitative study

Purpose: Results from the pilot Group-basEd Telehealth behavioral Weight Loss (GET-WEL) Program (NCT04855552) showed that fewer Black breast cancer survivors (BCS) enrolled than White BCS. Black participants also lost less weight than White participants. Little is known about mitigating factors or how best to implement such programs equitably. In this study, we explored facilitators and barriers in Black and White BCS who did or did not participate in GET-WEL.

Methods: BCS who are overweight or obese (body mass index (BMI) ≥ 25 kg/m²) and who had previously been assessed for their willingness to participate in GET-WEL were invited to participate in a semi-structured telephone interview conducted from June to August 2023. Interviewees were purposefully sampled from those who did (participants) and did not (non-participants) enroll in GET-WEL. Interviews were coded and analyzed via comparative thematic analysis.

Results: Of the 24 interviewees, 9 (8 White, 1 Black) were GET-WEL participants, and 15 (8 White, 6 Black, 1 Asian) were non-participants. There were no thematic differences between Black and White BCS. Most non-participants lacked awareness that the Program was recruiting. Program accountability, session flexibility, and pre-existing exercise routines emerged as facilitators while inability to identify enjoyable physical activities, difficulty accessing healthy foods, and competing work/life priorities emerged as barriers.

Conclusion: Our results suggest that enhancing Program awareness and outreach may increase enrollment in minoritized BCS. Resources providing healthy foods and support to ease competing work/life priorities may help BCS maintain healthy lifestyles during and after GET-WEL. These results may help inform future large-scale GET-WEL implementation.