{"paper_id":"10fe4ebf-ce40-4ee8-af22-658163d1bdab","body_text":"A Community Based Participatory Research Approach to Evaluate Barriers and Facilitators for Behavioral Weight Loss Intervention Implementation in a Predominantly Black Community | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Community Based Participatory Research Approach to Evaluate Barriers and Facilitators for Behavioral Weight Loss Intervention Implementation in a Predominantly Black Community Elizabeth De Jesus, Sean Woo, Robert S. Krouse, Carmen Guerra, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7104686/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Apr, 2026 Read the published version in Supportive Care in Cancer → Version 1 posted 9 You are reading this latest preprint version Abstract Purpose Breast cancer survivors who have overweight or obesity have worse breast cancer specific survival and outcomes as compared to those with average weight. [ 1 , 2 ] Our pilot G roup-bas E d T elehealth behavioral We ight L oss (GET-WEL) Program showed that fewer Black breast cancer survivors (BBCS) enrolled and lost less weight than White breast cancer survivors. [ 3 ] This study aims to use a community-based participatory research approach to assess barriers and facilitators of implementing a behavioral weight loss intervention among BBCS. Methods Eight BBCS from a predominantly Black community were invited to participate in semi-structured interviews that were voice recorded, transcribed, coded, and analyzed via comparative thematic analysis. Results Thematic analyses revealed multiple barriers within participants. These included lack of affordable healthy food access, safety concerns with regards to outdoor activities, lack of affordable fitness center memberships, time constraints related to competing work/life obligations, and steep learning curves with technology use. Most BBCS preferred an integrated community-based coach to guide their weight loss interventions via a combination of both virtual and in person sessions. Conclusion Our results indicate that a multimodal approach including nutrition education, reducing physical activity barriers, limiting time constraints by implementing both in person and virtual platforms and assisting with technology courses, are necessary to improve the equitable implementation of weight loss interventions. BBCS recommended utilizing established community facilities and leveraging known community members such as nutrition counselors and physical trainers, to increase successful implementation. breast cancer weight loss obesity healthcare disparity Introduction Breast cancer survivors with body mass indexes (BMI) that are categorized as overweight [BMI 25–29.9 kg/m 2 ] or obese (BMI > 30) have worse breast cancer specific survival and outcomes as compared to breast cancer survivors with average BMI (BMI of 18.5–24.9 kg/m 2 ). [ 1 , 2 ] Worse breast cancer specific survival includes higher recurrence rates, poorer responses to treatment, increased secondary and/or contralateral cancer rates and worse overall mortality. [ 1 , 2 ] Weight loss has been associated with a decreased risk of breast cancer specific mortality in breast cancer survivors [ 1 , 2 ] Therefore, we conducted a pilot study to determine the feasibility of a 20-week telehealth group-based weight loss intervention for management of obesity, the G roup-bas E d T elehealth behavioral WE ight L oss (GET-WEL) Program [ 3 ] , which was based on the validated Diabetes Prevention Program [ 4 ] . The GET-WEL Program was led by a behavioral weight loss trained psychologist who implemented virtual sessions focused on nutrition, exercise, stress, emotion management and lifestyle modification strategies. Participants were encouraged tBo attend weekly sessions that were offered at two times, allowing flexibility in choosing which session suited their schedule. Participants were provided with a digital scale to track their weight progress with access to MyFitnessPal.com for personal fitness and nutrition tracking. Twenty-one women enrolled in the pilot program [15 (71%) White, 5 (24%) Black, 1 Asian (5%)]. The results demonstrated lower weight loss efficacy in Black participants who on average ± SD lost 1.9% ± 6.6% of their baseline body weight compared to 7.5% ± 3.8% in White participants (p = 0.03). [ 3 ] We subsequently conducted a qualitative study of GET-WEL participants and non-participants (i.e, participants invited but who declined participation) to identify barriers, facilitators and perceptions of the telehealth weight loss intervention. [ 5 ] Among twenty-four total qualitative interviews, 9 were with GET-WEL participants (8 White and 1 Black BCS) and 15 with GET-WEL non-participants (8 White, 6 Black, and 1 Asian BCS). Participants reported not enrolling in GET-WEL due to lack of knowledge that the program was enrolling, need for access to healthy foods within their community and need for additional support to ease competing work/life priorities. [ 5 ] Given that our pilot GET-WEL study noted less overall weight loss among Black BCS, and our qualitative study listed some barriers to enrollment of White and Black participants, our current study aims to utilize a community based participatory research approach to assess barriers and facilitators of implementing a behavioral weight loss intervention in a predominantly Black Community. Methods This study utilized principles of community based participatory research (CBPR) to conduct qualitative semi-structured interviews. CBPR is a collaborative research framework which implements community driven research approaches involving stakeholders, community members and researchers to drive social change. [ 6 ] Utilizing principles of CBPR which mandate community access via endorsement from a trusted community leader with constituents, we partnered with the Director of Community Health Education Services for Chester City, PA. [ 6 ] Chester City, PA was chosen because it is a city in Pennsylvania with a high breast cancer age adjusted incidence rate of 136 per 100,000 females as reported between 2017–2021 by the Pennsylvania Department of Health. [ 7 ] In addition, the population is predominately Black at 71.7%, has a significant obesity rate at 27%, and the U.S Census recorded a poverty rate of 30.8% that is significantly greater than the national average of 11.5%. [ 8 ] Therefore, successful implementation of the GET-WEL program would address an unmet need to reduce obesity and breast cancer risk in this at-risk community and potentially serve as a model for implementation in other at-risk communities. Eight BBCS approached a member of the research team to participate and were subsequently enrolled in our study at a Chester Community Engagement event for Breast Cancer Awareness in Chester City, PA. Inclusion criteria included English speaking, non-Hispanic Black females greater than 18 years of age, interested in a weight loss intervention and currently residing in Chester City, Pennsylvania. Participation was voluntary; participants had the option to opt out at any time and no compensation was provided for qualitative interviews. Prospective interviewees were identified as eligible by the study team at the event and were contacted subsequently by phone call and/or text messaging, based on participant preference. Interview questions were designed using The Health Belief Model and Preventive Health Behavior . [ 9 ] Interviews were conducted between October and November of 2024 using a semi-structured interview guide focused on perceptions, facilitators and barriers to weight (Appendix 1 ). The interviews were 45 mins in duration, not including the 15 min pre-interview demographic questionnaire which was not audio recorded. Interviews were voice recorded and professionally transcribed verbatim. All information was de-identified prior to transcription. The quality of the transcriptions was confirmed by members of the study team. The information was subsequently coded and analyzed by two members of the study team (EDJ and SW). The analysis utilized an integrated approach including mixed methods research principles for coding and thematic analysis which is an iterative process of determining theories of themes and patterns that are present in the data. The two coders independently coded 100% of the transcripts, meeting to resolve inter-coder differences and ensuring reliability. The framework, codes and thematic analysis were categorized utilizing NVivo software. After coding, thematic reports were reviewed and compared for consistency. Examples of responses are included within each theme. Information was subsequently coded and analyzed via comparative thematic analysis. [ 10 ] This research was determined to be exempt by the University of Pennsylvania Internal Review Board (IRB) and conducted in accordance with the ethical standards (IRB #857096). Each participant received an overview of the study and provided verbal consent prior to enrollment. Results Participant Demographics Deidentified demographic questions were obtained prior to the interviews via a short survey which was collected and coded. The demographic questions comprise of age, racial identity, marital status, and employment status. Of the eight participants, the ages ranged from 35-75 years, all were female BBCS. Regarding marital status, 3 identified as currently married, 3 divorced, 1 single and 1 widowed (Table 1). All noted an interest in weight loss interventions. Themes Themes are presented in order of discussion and list an example quote from participants for each theme. Theme 1: Perception of Community Nutrition and Physical Education When participants were asked about their current perception of nutrition and physical activity in their community, they emphasized their belief that education about nutrition will have an impact. \"Once they learn what to eat and how to eat, I think it'll make a big difference.” Theme 2: Constant Visibility and Integration in the Community Participants described the need for ensuring programs with resources for the community are widely disseminated throughout to improve visibility. Participants also emphasized the need for sustainability, emphasizing the need for resources to persist in the community. There's a need for people to know what programs that are being offered and how they can become part of those programs” Theme 3: Healthy Eating Barriers When discussing perceptions of nutrition and physical barriers that community members face, participants reported the importance of financial, environmental and time barriers and access. Regarding incorporating seafood into a balanced diet one participant stated “I used to buy them, but they’re so expensive now” “I think you have to think about the economy too. You have people who may not wanna be unhealthy, but based on their situation, environment, financial situation, um, their economics, they can’t” Another participant noted the difficulty in eating a balanced healthy meal each day due to limitations in her work schedule, “So I’m really only getting like one meal in a day because I’m working.” Theme 4: Physical Activity Barriers Physical activity barriers in the community included financial barriers such as expensive gym memberships and the need to make those more accessible. The alternative for most participants includes walking, however the community has public safety concerns which pose a significant barrier. \"It would be to our advantage to get into programs that are free.” “I used to go for walks years ago but now you don’t feel safe because of the crime.” Theme 5: Perceptions of Technology Incorporation When participants were prompted about their use of technology and their perceptions about its incorporation to facilitate healthy lifestyles, there was some initial resistance related to the learning curve required to implement technology into everyday lives. “Everybody don’t know how to do that. Only the young people know how to do that.” “I'm not learning it quickly.” “We do need training. I have to do things at least two or three thing,-- two or three times in order for me to understand or, you know, to understand what I'm doing.” However, some participants did note that they utilize smart watches or pedometers on their telephone and find them relatively easy to use. Some participants also cited financial barriers with updating devices, apps and models. Theme 6: Peer Influence An emphasis on the positive reinforcement that a group model offers to an intervention program both among participants as well as influencing additional community members to incorporate healthy habits. \"So, you have to be a model to influence other people--Then once you start, maybe they'll join on with you.” Recommendation for Ideal Program When prompted about ideal program recommendations, participants reported the need for this ideal program to be inexpensive and integrated into community facilities, as well as the need for diverse exercise/course offerings which included aerobics or yoga. Participants voiced a strong emphasis or desire for nutritional support such as cooking classes and examples of healthy food options to generate engagement and excitement. Also highlighted was the critical importance of a hybrid schedule offering flexibility to incorporate sessions into daily routine, particularly among many of the participants with busy employment and home lives. “Need for an affordable fitness center” “More aerobics, yoga or dance” “What about a cooking class?” “Nutritionist -focused on creating healthy meals, like grilled chicken or how to make vegetables soups.” “Available for me. And, you know, I can’t make it at 4 o'clock, but I can make it at 7. Or I can even make it later when, uh, when everything is done.” Discussion Recent studies focused on BBCS and behavioral weight loss as an intervention to reduce cancer mortality have cited mild to moderate weight loss with weight gain post intervention. [ 3 , 11 – 13 ] Although weight loss intervention programs are currently being studied and are gaining traction, such as the Breast Cancer WEight Loss (BWEL) trial, an ongoing randomized, controlled trial designed to determine whether weight loss after breast cancer diagnosis can reduce the risk of cancer recurrence in women with overweight or obesity, there remains a paucity of literature focused on specific barriers and facilitators needed to improve weight loss among BBCS. [ 15 ] We demonstrated in our pilot GET WEL study that BBCS were less likely to enroll and only 20% of Black participants lost a clinically significant amount of weight as compared to White participants, therefore we focused on understanding these barriers. [ 3 ] Our results indicate that a multimodal approach which includes delivery of nutrition education, encouraging physical activity by reducing financial barriers and use of basic technology are desired to improve equitable implementation of our weight loss intervention among BBCS. Resources that could address these barriers include providing healthy food options near the community, access to farmers markets as well as lower cost healthy alternatives. To reduce physical activity barriers, identifying subsidized gym memberships and/or developing group-or peer-based programs to utilize local safe walking paths may be needed to decrease financial burdens to exercise and ameliorate safety concerns. Offering courses focused on the use of technology-based platforms and devices, such as activity trackers for weight management, may help overcome learning curves and could also be of great yield as participants are eager to learn but noted they require more time to understand how to use new technology. In describing the ideal weight loss program, participants requested exercise programs with diverse exercise offerings. Participants were interested in various physical activities including yoga and tai chi. Community members strongly emphasized the need for nutritional support with integration of nutritional education. Cooking classes were recommended as a method to easily integrate nutrition into daily meals. The importance of a hybrid schedule comprising both in-person and virtual class options was recommended. Offering class time flexibility, accessibility and improved access to sessions in community was viewed as particularly important given community members felt increased daily living demands can be inflexible. Preference for a prerecorded video of an exercise class allowed for easy daily integration. Importantly there were several limitations of this study. The study comprised of a small sample size of eight participants. In addition, all interviewees were recruited from one location, Chester City, Pennsylvania, which may affect generalizability of the study. Participants were not asked to validate their weight or BMI with a scale; therefore, some participants may not meet the clinical criteria of overweight or obesity. Specifying BMI as an inclusion criterion may have limited our sample size further as many participants also noted that they were unaware if they were considered to have overweight vs obesity by standard clinical metrics. Future studies should focus on increased sample size and confirm individual BMI with clinical metrics. In addition, for the purposes of this study and resource limitations, we only included English speakers, which inherently limits diversity in the participant population, however we feel it is important to also make this intervention accessible for non-English speakers as well. In addition, responses from the participants may lean toward more exaggerated, positive comments, as they may be subjected to the Hawthorne effect when in a group setting. [ 14 ] Regardless of the following limitations, strengths of this study include our ability to delineate important barriers to equitable implementation of our weight loss program among BBCS utilizing principals of Community Based Participatory Research by leveraging access to the constituents the Director of Community Health Education Services for Chester, PA, a trusted official within the community [ 6 ] . These discussions and results will help inform the design, recruitment, implementation, sustainability and scaling of future inclusive weight loss programs, such as future iterations of GET-WEL by incorporating factors that improve diversity and efficacy among Black breast cancer survivors. Declarations Funding Source: This study was funded through a pilot grant by the Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, as well as philanthropic funds to Dr. Tchou. Author Contribution All authors contributed to the study conception and design. The main manuscript was written by E.D. and all authors commented on previous versions of the manuscript. E.D prepared all appendix figures. All authors read and approved of the final manuscript. References Yung, R.L. and J.A. Ligibel, Obesity and breast cancer: risk, outcomes, and future considerations . Clin Adv Hematol Oncol, 2016. 14(10): p. 790–797. Druesne-Pecollo, N., Touvier M, Barrandon E, Chan DS, Norat T, Zelek L, Hercberg S, Latino-Martel P. Excess body weight and second primary cancer risk after breast cancer: a systematic review and meta-analysis of prospective studies . Breast Cancer Res Treat. 2012;135(3):647–54. doi: 10.1007/s10549-012-2187-1 . Epub 2012 Aug 5. PMID: 22864804. Allison, K.C., McCuen-Wurst C, Raevsky A, Holmes N, Goldbach M, Guerra CE, Rendle KA, Cadet TJ, Krouse RS, Tchou J. The Group-basEd Telehealth behavioral WEight Loss Program Among Breast Cancer Survivors: A Pilot and Feasibility Study . Obes Sci Pract. 2024;10(6):e70023. doi: 10.1002/osp4.70023 . PMID: 39713088; PMCID: PMC11662970. The Diabetes Prevention Program: baseline characteristics of the randomized cohort. The Diabetes Prevention Program Research Group . Diabetes Care, 2000. 23(11): p. 1619–29. Liu, Y., De Jesus E, Goldbach M, Krouse RS, Guerra CE, Rendle KA, Cadet TJ, Allison KC, Tchou J. Perceptions, facilitators, and barriers of participation for a behavioral weight loss group-based telehealth program for breast cancer survivors: a qualitative study. Support Care Cancer. 2024;32(12):808. doi : 10.1007/s00520-024-08999-x . PMID: 39567374; PMCID: PMC11579159. Collins, S.E., et al., Community-based participatory research (CBPR): Towards equitable involvement of community in psychology research . Am Psychol, 2018. 73(7): p. 884–898. Informatics, P.D.o.H.D.o.H. Pennsylvania County Health Profiles . 2025. Bureau, U.S.C. QuickFacts Chester city, Pennsylvania . 2025. Rosenstock, I.M., The health belief model and preventive health behavior . Health education monographs, 1974. 2(4): p. 354–386. Herzog, C. and P. Kelly, Applying thematic analysis to analyse press coverage in cross-country comparative research: A qualitative study protocol . International Journal of Qualitative Methods, 2023. 22: p. 16094069231179433. Lake, B., S. Damery, and K. Jolly, Effectiveness of weight loss interventions in breast cancer survivors: a systematic review of reviews . BMJ Open, 2022. 12(10): p. e062288. Greenlee, H.A., et al., A pilot randomized controlled trial of a commercial diet and exercise weight loss program in minority breast cancer survivors . Obesity (Silver Spring), 2013. 21(1): p. 65–76. Agurs-Collins, T., S.A. Ross, and B.K. Dunn, The Many Faces of Obesity and Its Influence on Breast Cancer Risk . Front Oncol, 2019. 9: p. 765. McCambridge, J., J. Witton, and D.R. Elbourne, Systematic review of the Hawthorne effect: new concepts are needed to study research participation effects . J Clin Epidemiol, 2014. 67(3): p. 267-77.15. Delahanty LM, Wadden TA, Goodwin PJ, Alfano CM, Thomson CA, Irwin ML, Neuhouser ML, Crane TE, Frank E, Spears PA, Gillis BP, Hershman DL, Paskett ED, Hopkins J, Bernstein V, Stearns V, White J, Hudis C, Winer EP, A Carey L, Partridge AH, Ligibel JA. The Breast Cancer Weight Loss trial (Alliance A011401): A description and evidence for the lifestyle intervention . Obesity (Silver Spring). 2022;30(1):28–38. doi: 10.1002/oby.23287 . PMID: 34932888; PMCID: PMC9186690. Tables Table 1: Socio-demographics and participant characteristics Variable N or as noted Sample Size 8 Mean Age Range (years) 55-64 Female 8 Black Race 8 Marital Status Single 1 Married 3 Divorced 3 Widowed 1 Education Less than High School 1 Completed High School or GED 2 Completed College 4 Masters/Doctorate 1 Employment Unemployed 0 Part-time Employment 2 Full-time Employment 4 Retired 2 Additional Declarations No competing interests reported. Supplementary Files Appendix.docx Cite Share Download PDF Status: Published Journal Publication published 06 Apr, 2026 Read the published version in Supportive Care in Cancer → Version 1 posted Editorial decision: Revision requested 04 Nov, 2025 Reviews received at journal 04 Nov, 2025 Reviews received at journal 18 Oct, 2025 Reviewers agreed at journal 27 Sep, 2025 Reviewers agreed at journal 08 Sep, 2025 Reviewers invited by journal 08 Sep, 2025 Editor assigned by journal 08 Sep, 2025 Submission checks completed at journal 06 Aug, 2025 First submitted to journal 11 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-7104686\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":515188311,\"identity\":\"6a133fe6-f805-4949-ba85-75c6d2e1d8a8\",\"order_by\":0,\"name\":\"Elizabeth De Jesus\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Pennsylvania\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Elizabeth\",\"middleName\":\"\",\"lastName\":\"De Jesus\",\"suffix\":\"\"},{\"id\":515188313,\"identity\":\"4f75b23d-c3cd-44b1-96a4-4287fb23183f\",\"order_by\":1,\"name\":\"Sean Woo\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Pennsylvania\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Sean\",\"middleName\":\"\",\"lastName\":\"Woo\",\"suffix\":\"\"},{\"id\":515188315,\"identity\":\"580ee5a4-a222-453d-989a-b6d5d7d7d9e3\",\"order_by\":2,\"name\":\"Robert S. 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class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]\\u003c/sup\\u003eTherefore, we conducted a pilot study to determine the feasibility of a 20-week telehealth group-based weight loss intervention for management of obesity, the \\u003cspan type=\\\"BoldUnderline\\\" class=\\\"BoldUnderline\\\" name=\\\"Emphasis\\\"\\u003eG\\u003c/span\\u003eroup-bas\\u003cspan type=\\\"BoldUnderline\\\" class=\\\"BoldUnderline\\\" name=\\\"Emphasis\\\"\\u003eE\\u003c/span\\u003ed \\u003cspan type=\\\"BoldUnderline\\\" class=\\\"BoldUnderline\\\" name=\\\"Emphasis\\\"\\u003eT\\u003c/span\\u003eelehealth behavioral \\u003cspan type=\\\"BoldUnderline\\\" class=\\\"BoldUnderline\\\" name=\\\"Emphasis\\\"\\u003eWE\\u003c/span\\u003eight \\u003cspan type=\\\"BoldUnderline\\\" class=\\\"BoldUnderline\\\" name=\\\"Emphasis\\\"\\u003eL\\u003c/span\\u003eoss (GET-WEL) Program\\u003csup\\u003e[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]\\u003c/sup\\u003e, which was based on the validated Diabetes Prevention Program \\u003csup\\u003e[\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]\\u003c/sup\\u003e. The GET-WEL Program was led by a behavioral weight loss trained psychologist who implemented virtual sessions focused on nutrition, exercise, stress, emotion management and lifestyle modification strategies. Participants were encouraged tBo attend weekly sessions that were offered at two times, allowing flexibility in choosing which session suited their schedule. Participants were provided with a digital scale to track their weight progress with access to MyFitnessPal.com for personal fitness and nutrition tracking. Twenty-one women enrolled in the pilot program [15 (71%) White, 5 (24%) Black, 1 Asian (5%)]. The results demonstrated lower weight loss efficacy in Black participants who on average\\u0026thinsp;\\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e\\u0026plusmn;\\u003c/span\\u003e\\u0026thinsp;SD lost 1.9% \\u0026plusmn; 6.6% of their baseline body weight compared to 7.5% \\u0026plusmn; 3.8% in White participants (p\\u0026thinsp;=\\u0026thinsp;0.03). \\u003csup\\u003e[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]\\u003c/sup\\u003e\\u003c/p\\u003e\\u003cp\\u003eWe subsequently conducted a qualitative study of GET-WEL participants and non-participants (i.e, participants invited but who declined participation) to identify barriers, facilitators and perceptions of the telehealth weight loss intervention. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]\\u003c/sup\\u003e Among twenty-four total qualitative interviews, 9 were with GET-WEL participants (8 White and 1 Black BCS) and 15 with GET-WEL non-participants (8 White, 6 Black, and 1 Asian BCS). Participants reported not enrolling in GET-WEL due to lack of knowledge that the program was enrolling, need for access to healthy foods within their community and need for additional support to ease competing work/life priorities.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]\\u003c/sup\\u003e Given that our pilot GET-WEL study noted less overall weight loss among Black BCS, and our qualitative study listed some barriers to enrollment of White and Black participants, our current study aims to utilize a community based participatory research approach to assess barriers and facilitators of implementing a behavioral weight loss intervention in a predominantly Black Community.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cp\\u003e This study utilized principles of community based participatory research (CBPR) to conduct qualitative semi-structured interviews. CBPR is a collaborative research framework which implements community driven research approaches involving stakeholders, community members and researchers to drive social change.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]\\u003c/sup\\u003e Utilizing principles of CBPR which mandate community access via endorsement from a trusted community leader with constituents, we partnered with the Director of Community Health Education Services for Chester City, PA.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]\\u003c/sup\\u003e Chester City, PA was chosen because it is a city in Pennsylvania with a high breast cancer age adjusted incidence rate of 136 per 100,000 females as reported between 2017\\u0026ndash;2021 by the Pennsylvania Department of Health.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]\\u003c/sup\\u003e In addition, the population is predominately Black at 71.7%, has a significant obesity rate at 27%, and the U.S Census recorded a poverty rate of 30.8% that is significantly greater than the national average of 11.5%.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]\\u003c/sup\\u003e Therefore, successful implementation of the GET-WEL program would address an unmet need to reduce obesity and breast cancer risk in this at-risk community and potentially serve as a model for implementation in other at-risk communities. Eight BBCS approached a member of the research team to participate and were subsequently enrolled in our study at a Chester Community Engagement event for Breast Cancer Awareness in Chester City, PA.\\u003c/p\\u003e\\u003cp\\u003eInclusion criteria included English speaking, non-Hispanic Black females greater than 18 years of age, interested in a weight loss intervention and currently residing in Chester City, Pennsylvania. Participation was voluntary; participants had the option to opt out at any time and no compensation was provided for qualitative interviews.\\u003c/p\\u003e\\u003cp\\u003e Prospective interviewees were identified as eligible by the study team at the event and were contacted subsequently by phone call and/or text messaging, based on participant preference. Interview questions were designed using \\u003cem\\u003eThe Health Belief Model and Preventive Health Behavior\\u003c/em\\u003e.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e]\\u003c/sup\\u003e Interviews were conducted between October and November of 2024 using a semi-structured interview guide focused on perceptions, facilitators and barriers to weight (Appendix \\u003cspan type=\\\"Underline\\\" class=\\\"Underline\\\" name=\\\"Emphasis\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003eThe interviews were 45 mins in duration, not including the 15 min pre-interview demographic questionnaire which was not audio recorded. Interviews were voice recorded and professionally transcribed verbatim. All information was de-identified prior to transcription. The quality of the transcriptions was confirmed by members of the study team. The information was subsequently coded and analyzed by two members of the study team (EDJ and SW). The analysis utilized an integrated approach including mixed methods research principles for coding and thematic analysis which is an iterative process of determining theories of themes and patterns that are present in the data. The two coders independently coded 100% of the transcripts, meeting to resolve inter-coder differences and ensuring reliability. The framework, codes and thematic analysis were categorized utilizing NVivo software. After coding, thematic reports were reviewed and compared for consistency. Examples of responses are included within each theme. Information was subsequently coded and analyzed via comparative thematic analysis.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]\\u003c/sup\\u003e This research was determined to be exempt by the University of Pennsylvania Internal Review Board (IRB) and conducted in accordance with the ethical standards (IRB #857096). Each participant received an overview of the study and provided verbal consent prior to enrollment.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eParticipant Demographics\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eDeidentified demographic questions were obtained prior to the interviews via a short survey which was collected and coded. The demographic questions comprise of age, racial identity, marital status, and employment status. Of the eight participants, the ages ranged from 35-75 years, all were female BBCS. Regarding marital status, 3 identified as currently married, 3 divorced, 1 single and 1 widowed (Table 1). All noted an interest in weight loss interventions.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eThemes\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThemes are presented in order of discussion and list an example quote from participants for each theme.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTheme 1: Perception of Community Nutrition and Physical Education\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWhen participants were asked about their current perception of nutrition and physical activity in their community, they emphasized their belief that education about nutrition will have an impact.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\\"Once they learn what to eat and how to eat, I think it'll make a big difference.”\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTheme 2: Constant Visibility and Integration in the Community\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eParticipants described the need for ensuring programs with resources for the community are widely disseminated throughout to improve visibility. Participants also emphasized the need for sustainability, emphasizing the need for resources to persist in the community.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eThere's a need for people to know what programs that are being offered and how they can become part of those programs”\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTheme 3: Healthy Eating Barriers\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWhen discussing perceptions of nutrition and physical barriers that community members face, participants reported the importance of financial, environmental and time barriers and access.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eRegarding incorporating seafood into a balanced diet one participant stated \\u003cem\\u003e“I used to buy them, but they’re so expensive now” \\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e“I think you have to think about the economy too. You have people who may not wanna be unhealthy, but based on their situation, environment, financial situation, um, their economics, they can’t”\\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAnother participant noted the difficulty in eating a balanced healthy meal each day due to limitations in her work schedule,\\u003cem\\u003e\\u0026nbsp;“So I’m really only getting like one meal in a day because I’m working.” \\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTheme 4: Physical Activity Barriers\\u003c/strong\\u003e \\u003c/p\\u003e\\n\\u003cp\\u003ePhysical activity barriers in the community included financial barriers such as expensive gym memberships and the need to make those more accessible. The alternative for most participants includes walking, however the community has public safety concerns which pose a significant barrier.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\\"It would be to our advantage to get into programs that are free.”\\u003c/em\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e“I used to go for walks years ago but now you don’t feel safe because of the crime.”\\u003c/em\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTheme 5: Perceptions of Technology Incorporation\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWhen participants were prompted about their use of technology and their perceptions about its incorporation to facilitate healthy lifestyles, there was some initial resistance related to the learning curve required to implement technology into everyday lives.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e“Everybody don’t know how to do that. Only the young people know how to do that.” \\u0026nbsp;\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e“I'm not learning it quickly.”\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\u0026nbsp;“We do need training. I have to do things at least two or three thing,-- two or three times in order for me to understand or, you know, to understand what I'm doing.”\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eHowever, some participants did note that they utilize smart watches or pedometers on their telephone and find them relatively easy to use. Some participants also cited financial barriers with updating devices, apps and models.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTheme 6: Peer Influence\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAn emphasis on the positive reinforcement that a group model offers to an intervention program both among participants as well as influencing additional community members to incorporate healthy habits.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e\\\"So, you have to be a model to influence other people--Then once you start, maybe they'll join on with you.”\\u003c/em\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eRecommendation for Ideal Program\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWhen prompted about ideal program recommendations, participants reported the need for this ideal program to be inexpensive and integrated into community facilities, as well as the need for diverse exercise/course offerings which included aerobics or yoga. Participants voiced a strong emphasis or desire for nutritional support such as cooking classes and examples of healthy food options to generate engagement and excitement. Also highlighted was the critical importance of a hybrid schedule offering flexibility to incorporate sessions into daily routine, particularly among many of the participants with busy employment and home lives.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e“Need for an affordable fitness center”\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e“More aerobics, yoga or dance”\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e“What about a cooking class?”\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e“Nutritionist -focused on creating healthy meals, like grilled chicken or how to make vegetables soups.”\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003e“Available for me. And, you know, I can’t make it at 4 o'clock, but I can make it at 7. Or I can even make it later when, uh, when everything is done.”\\u003c/em\\u003e\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eRecent studies focused on BBCS and behavioral weight loss as an intervention to reduce cancer mortality have cited mild to moderate weight loss with weight gain post intervention. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR12\\\" citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]\\u003c/sup\\u003e Although weight loss intervention programs are currently being studied and are gaining traction, such as the Breast Cancer WEight Loss (BWEL) trial, an ongoing randomized, controlled trial designed to determine whether weight loss after breast cancer diagnosis can reduce the risk of cancer recurrence in women with overweight or obesity, there remains a paucity of literature focused on specific barriers and facilitators needed to improve weight loss among BBCS.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]\\u003c/sup\\u003e We demonstrated in our pilot GET WEL study that BBCS were less likely to enroll and only 20% of Black participants lost a clinically significant amount of weight as compared to White participants, therefore we focused on understanding these barriers. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]\\u003c/sup\\u003e Our results indicate that a multimodal approach which includes delivery of nutrition education, encouraging physical activity by reducing financial barriers and use of basic technology are desired to improve equitable implementation of our weight loss intervention among BBCS.\\u003c/p\\u003e\\u003cp\\u003eResources that could address these barriers include providing healthy food options near the community, access to farmers markets as well as lower cost healthy alternatives. To reduce physical activity barriers, identifying subsidized gym memberships and/or developing group-or peer-based programs to utilize local safe walking paths may be needed to decrease financial burdens to exercise and ameliorate safety concerns. Offering courses focused on the use of technology-based platforms and devices, such as activity trackers for weight management, may help overcome learning curves and could also be of great yield as participants are eager to learn but noted they require more time to understand how to use new technology. In describing the ideal weight loss program, participants requested exercise programs with diverse exercise offerings. Participants were interested in various physical activities including yoga and tai chi. Community members strongly emphasized the need for nutritional support with integration of nutritional education. Cooking classes were recommended as a method to easily integrate nutrition into daily meals. The importance of a hybrid schedule comprising both in-person and virtual class options was recommended. Offering class time flexibility, accessibility and improved access to sessions in community was viewed as particularly important given community members felt increased daily living demands can be inflexible. Preference for a prerecorded video of an exercise class allowed for easy daily integration.\\u003c/p\\u003e\\u003cp\\u003eImportantly there were several limitations of this study. The study comprised of a small sample size of eight participants. In addition, all interviewees were recruited from one location, Chester City, Pennsylvania, which may affect generalizability of the study. Participants were not asked to validate their weight or BMI with a scale; therefore, some participants may not meet the clinical criteria of overweight or obesity. Specifying BMI as an inclusion criterion may have limited our sample size further as many participants also noted that they were unaware if they were considered to have overweight vs obesity by standard clinical metrics. Future studies should focus on increased sample size and confirm individual BMI with clinical metrics. In addition, for the purposes of this study and resource limitations, we only included English speakers, which inherently limits diversity in the participant population, however we feel it is important to also make this intervention accessible for non-English speakers as well. In addition, responses from the participants may lean toward more exaggerated, positive comments, as they may be subjected to the Hawthorne effect when in a group setting. \\u003csup\\u003e[\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]\\u003c/sup\\u003e Regardless of the following limitations, strengths of this study include our ability to delineate important barriers to equitable implementation of our weight loss program among BBCS utilizing principals of Community Based Participatory Research by leveraging access to the constituents the Director of Community Health Education Services for Chester, PA, a trusted official within the community \\u003csup\\u003e[\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]\\u003c/sup\\u003e. These discussions and results will help inform the design, recruitment, implementation, sustainability and scaling of future inclusive weight loss programs, such as future iterations of GET-WEL by incorporating factors that improve diversity and efficacy among Black breast cancer survivors.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003eFunding Source:\\u003c/h2\\u003e\\u003cp\\u003eThis study was funded through a pilot grant by the Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, as well as philanthropic funds to Dr. Tchou.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eAll authors contributed to the study conception and design. The main manuscript was written by E.D. and all authors commented on previous versions of the manuscript. E.D prepared all appendix figures. All authors read and approved of the final manuscript.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eYung, R.L. and J.A. Ligibel, \\u003cem\\u003eObesity and breast cancer: risk, outcomes, and future considerations\\u003c/em\\u003e. 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Witton, and D.R. Elbourne, \\u003cem\\u003eSystematic review of the Hawthorne effect: new concepts are needed to study research participation effects\\u003c/em\\u003e. J Clin Epidemiol, 2014. 67(3): p. 267-77.15.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eDelahanty LM, Wadden TA, Goodwin PJ, Alfano CM, Thomson CA, Irwin ML, Neuhouser ML, Crane TE, Frank E, Spears PA, Gillis BP, Hershman DL, Paskett ED, Hopkins J, Bernstein V, Stearns V, White J, Hudis C, Winer EP, A Carey L, Partridge AH, Ligibel JA. \\u003cem\\u003eThe Breast Cancer Weight Loss trial (Alliance A011401): A description and evidence for the lifestyle intervention\\u003c/em\\u003e. Obesity (Silver Spring). 2022;30(1):28\\u0026ndash;38. doi: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1002/oby.23287\\u003c/span\\u003e\\u003cspan address=\\\"10.1002/oby.23287\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. PMID: 34932888; PMCID: PMC9186690.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"},{\"header\":\"Tables\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e\\u003cem\\u003e\\u003cu\\u003eTable \\u0026nbsp;1: Socio-demographics and participant characteristics\\u0026nbsp;\\u003c/u\\u003e\\u003c/em\\u003e\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" class=\\\"fr-table-selection-hover\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eVariable\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003eN or as noted\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eSample Size\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMean Age Range (years)\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e55-64\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eFemale\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eBlack Race\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eMarital Status\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003eSingle\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003eMarried\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003eDivorced\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003eWidowed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEducation\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003eLess than High School\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003eCompleted High School or GED\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003eCompleted College\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003eMasters/Doctorate\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e1\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eEmployment\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003eUnemployed\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003ePart-time Employment\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003eFull-time Employment\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e4\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003eRetired\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 208px;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"supportive-care-in-cancer\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"jscc\",\"sideBox\":\"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)\",\"snPcode\":\"520\",\"submissionUrl\":\"https://submission.nature.com/new-submission/520/3\",\"title\":\"Supportive Care in Cancer\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false},\"keywords\":\"breast cancer, weight loss, obesity, healthcare disparity\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7104686/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7104686/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003ePurpose\\u003c/h2\\u003e\\u003cp\\u003eBreast cancer survivors who have overweight or obesity have worse breast cancer specific survival and outcomes as compared to those with average weight.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]\\u003c/sup\\u003e Our pilot \\u003cem\\u003eG\\u003c/em\\u003eroup-bas\\u003cem\\u003eE\\u003c/em\\u003ed \\u003cem\\u003eT\\u003c/em\\u003eelehealth behavioral \\u003cem\\u003eWe\\u003c/em\\u003eight \\u003cem\\u003eL\\u003c/em\\u003eoss (GET-WEL) Program showed that fewer Black breast cancer survivors (BBCS) enrolled and lost less weight than White breast cancer survivors.\\u003csup\\u003e[\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]\\u003c/sup\\u003e This study aims to use a community-based participatory research approach to assess barriers and facilitators of implementing a behavioral weight loss intervention among BBCS.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e\\u003cp\\u003e Eight BBCS from a predominantly Black community were invited to participate in semi-structured interviews that were voice recorded, transcribed, coded, and analyzed via comparative thematic analysis.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e\\u003cp\\u003eThematic analyses revealed multiple barriers within participants. These included lack of affordable healthy food access, safety concerns with regards to outdoor activities, lack of affordable fitness center memberships, time constraints related to competing work/life obligations, and steep learning curves with technology use. Most BBCS preferred an integrated community-based coach to guide their weight loss interventions via a combination of both virtual and in person sessions.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e\\u003cp\\u003eOur results indicate that a multimodal approach including nutrition education, reducing physical activity barriers, limiting time constraints by implementing both in person and virtual platforms and assisting with technology courses, are necessary to improve the equitable implementation of weight loss interventions. BBCS recommended utilizing established community facilities and leveraging known community members such as nutrition counselors and physical trainers, to increase successful implementation.\\u003c/p\\u003e\",\"manuscriptTitle\":\"A Community Based Participatory Research Approach to Evaluate Barriers and Facilitators for Behavioral Weight Loss Intervention Implementation in a Predominantly Black Community\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-09-16 18:33:18\",\"doi\":\"10.21203/rs.3.rs-7104686/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-11-05T03:56:00+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-11-04T05:53:56+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-10-18T09:15:21+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"309849963846832093636185329502951999263\",\"date\":\"2025-09-27T15:09:09+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"244344927861154728099548992698089065590\",\"date\":\"2025-09-08T21:53:18+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-09-08T21:16:15+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-09-08T21:14:31+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-08-06T07:11:48+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Supportive Care in Cancer\",\"date\":\"2025-07-11T22:19:27+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"supportive-care-in-cancer\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"jscc\",\"sideBox\":\"Learn more about [Supportive Care in Cancer](https://www.springer.com/journal/520)\",\"snPcode\":\"520\",\"submissionUrl\":\"https://submission.nature.com/new-submission/520/3\",\"title\":\"Supportive Care in Cancer\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Springer Hybrid\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":false}}],\"origin\":\"\",\"ownerIdentity\":\"142b4bbb-3301-4e95-b83d-3c736be02f12\",\"owner\":[],\"postedDate\":\"September 16th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-04-13T16:05:25+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-7104686\",\"link\":\"https://doi.org/10.1007/s00520-026-10548-7\",\"journal\":{\"identity\":\"supportive-care-in-cancer\",\"isVorOnly\":false,\"title\":\"Supportive Care in Cancer\"},\"publishedOn\":\"2026-04-06 15:58:37\",\"publishedOnDateReadable\":\"April 6th, 2026\"},\"versionCreatedAt\":\"2025-09-16 18:33:18\",\"video\":\"\",\"vorDoi\":\"10.1007/s00520-026-10548-7\",\"vorDoiUrl\":\"https://doi.org/10.1007/s00520-026-10548-7\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7104686\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7104686\",\"identity\":\"rs-7104686\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}