Abstract
PURPOSE OF THE STUDY: This study aimed to explore the contextual and multilevel challenges to promoting exercise engagement among prostate cancer survivors in a low-resource setting, with a focus on integrating exercise-based rehabilitation into routine care and survivorship care planning, using a qualitative approach grounded in interpretative description. METHODS: Sixteen prostate cancer survivors (aged 53-77 years) were purposively sampled from public and private healthcare facilities in Cape Town, South Africa. Semi-structured telephonic interviews were conducted using a topic guide informed by prior research. Interviews were audio-recorded, transcribed verbatim, and analysed thematically. RESULTS: Four major themes were identified. Findings highlighted stark contrasts in exercise engagement between men treated in private versus public healthcare settings. Exercise was essential to private patients, whereas most public patients showed limited interest. Factors influencing engagement included knowledge gaps, treatment complications, fear of worsening symptoms, and age-related comorbidities. Socio-environmental barriers-such as neighbourhood safety and poor work-life balance-reduced exercise opportunities. Facility-level issues included inconsistent messaging from providers, lack of exercise oncology pathways, and absent referral systems. CONCLUSION: Our study identified key multilevel influences surrounding exercise promotion and integration in routine care for prostate cancer survivors receiving treatment in private and public healthcare settings. While highlighting the opportunities/challenges surrounding integrating exercise programs in routine management, our findings offer program planners valuable insights for planning and developing interventions in resource-constrained settings.