Abstract
Background: Although physical activity (PA) offers substantial physical and psychosocial benefits, engagement remains suboptimal among cancer survivors. A theory-informed understanding of survivors' perceived barriers, facilitators, and recommendations is needed to inform patient-centered PA about survivorship interventions. Objective: This study aimed to explore perceived barriers, facilitators, and recommendations for PA engagement among adult cancer survivors using the Theoretical Domains Framework (TDF). Methods: A phenomenological qualitative design was used. Eighteen cancer survivors from Nebraska participated in semi-structured interviews via Zoom or telephone. Semi-structured interviews (guided by open-ended questions with flexibility for probing) were transcribed verbatim, imported into MAXQDA 2024, and analyzed using TDF to identify themes and subthemes. Results: Three overarching themes emerged: barriers, facilitators, and recommendations related to PA engagement. Barriers included individual factors (low motivation and self-efficacy, limited awareness of PA guidelines, time constraints, and physical limitations due to treatment and comorbidities), social factors (limited support from family, friends), clinical factors (limited PA guidance from healthcare providers), and environmental factors (restricted access to resources and unfavorable weather). Facilitators included individual factors (PA knowledge, motivation, goals, and health benefits), social factors (support from family, friends), and clinical factors (encouragement from healthcare providers), and environmental factors (favorable weather and available community PA resources). Recommendations emphasized the need for tailored education, supportive counseling, and structured PA programs within survivorship care. Conclusions: Cancer survivors described multilevel determinants of PA engagement across individual, social, and environmental contexts. Findings highlight the importance of theory-informed, patient-centered strategies that enhance PA guideline awareness, strengthen social and clinical support, and improve access to community resources to promote sustained PA during cancer survivorship.