Use of Co-Design Approaches to Identify Barriers to Health-Promoting Behaviors among African American Breast Cancer Survivors with Comorbid Obesity

Abstract

Approximately 90% of African American patients with newly diagnosed breast cancer have multimorbidity - with obesity as one of the most common conditions. Obesity is related to negative impacts across all aspects of cancer care as well as more adverse side effects of cancer treatment. African American breast cancer survivors (BCS) show higher incidences of chronic conditions, like obesity, with barriers to body wellness. Lifestyle interventions can improve survivorship outcomes, but most have not been adapted to African American BCS needs. The purpose of this research is to explore and honor the lived experiences of breast cancer survivorship among African American women with obesity to better understand their experiences and perceptions of how their cancer journey intersects with other health behaviors and to identify barriers to health-promoting behaviors. A co-design approach with five participants was used to understand specific barriers to a healthy weight and lifestyle as well as potential solutions that would benefit African American or Black BCS entering an evidence-based lifestyle intervention that targeted weight and body wellness. Participants completed one co-design session for problem identification. This initial session identified the participants' most impactful cancer- and non-cancer-related barriers to building health behaviors. Cancer- and non-cancer-related barriers to a healthy lifestyle were identified from artifact creation and affinity diagramming for intensity and frequency. Top cancer-related barriers were pain and fatigue related to cancer treatment and its side effects. Non-cancer related barriers included time and responsibilities, lack of nutritional information and culturally, medically sensitive exercise resources, as well as restrictive definitions of health used by medical professionals. Both cancer-related and non-cancer-related barriers were identified as contributing to difficulty in maintaining health behaviors. Further research should examine how these barriers can be addressed in lifestyle interventions targeted to African American BCS.