Implementing physical activity counselling versus structured exercise for breast cancer survivors in the PAC-WOMAN trial: mapping TICD-based determinants to the behaviour change wheel

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Physical activity (PA) benefits breast cancer survivorship, yet translation into routine care faces multilevel barriers. This study examined implementation determinants of two group-based PA interventions within the PAC-WOMAN trial, brief PA counselling (PAC) and supervised structured exercise (ExG), using the Tailored Implementation for Chronic Diseases (TICD) checklist and the Behaviour Change Wheel (BCW). Process evaluation included six online focus groups with 24 participants, semi-structured interviews with three implementers and six stakeholders, and implementation monitoring logbook assessment. Content analysis followed a framework approach, mapping TICD determinants onto BCW COM-B elements, intervention functions, and policy categories. Fifty-one TICD determinants were identified across six domains. Facilitators were primarily individual and interpersonal, including participant motivation, implementer trust, and supportive group dynamics. Barriers were largely structural, encompassing time constraints, transport difficulties, limited financial coverage, and insufficient policy support. Both interventions demonstrated feasibility and acceptability, with comparable attrition and predominantly non-intervention-related adverse events. BCW-informed strategies highlighted education, modelling, enablement, environmental restructuring, and policy actions to address key barriers. Sustainable implementation of PA interventions in cancer care requires supportive systems beyond evidence alone. Key determinants included motivation, professional capability, organisational networks, and financial incentives. Future efforts should prioritise policy reform, multisectoral collaboration, professional training, and fiscal mechanisms to embed PA within standard breast cancer survivorship care, using BCW-guided strategies to enhance capability, opportunity, and motivation. April 20, 2023 – NCT05860621. April 21, 2023 – https://doi.org/10.17605/OSF.IO/ZAQ9N April 27, 2023 – UMIN000050945

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