Development of a physical activity promotion intervention for colorectal cancer survivors who are physically...

Physical activity (PA) confers multiple health and rehabilitation benefits for colorectal cancer (CRC) survivors; however, many CRC survivors do not meet recommended PA levels following curative-intent treatment. This study aimed to develop a comprehensive, evidence-based PA promotion intervention program for CRC survivors who are physically inactive.

A preliminary program was developed based on the COM-B model, a literature review, clinical practice guidelines, and a retrospective case analysis. Between August and October 2025, 15 experts with expertise in clinical nursing, clinical medicine, rehabilitation medicine, and nursing management participated in two rounds of Delphi consultation. Experts completed the questionnaires independently in each round, and aggregated feedback was used to refine the program through an iterative consensus process. The analytic hierarchy process (AHP) was used to derive indicator weights and establish a hierarchical framework.

Of the 20 experts invited, 15 completed Round 1 (response rate, 75%); all 15 Round 1 participants completed Round 2 (response rate, 100%). The expert authority coefficients were 0.840 and 0.857 in Rounds 1 and 2, respectively. The coefficients of variation for all indicators were below 0.25 in both rounds, and Kendall's coefficients of concordance were 0.188 and 0.228, respectively (both P < 0.001), indicating low but statistically significant inter-expert concordance. The finalized program comprised three first-level indicators, ten second-level indicators, and 25 third-level indicators, with AHP-derived weights of 0.49, 0.31, and 0.20 assigned to motivation, capability, and opportunity components, respectively.

The program developed in this study provides a theoretically grounded, expert-consensus-based framework for promoting PA among CRC survivors who are physically inactive. Its feasibility, acceptability, safety, and preliminary efficacy should be evaluated before clinical implementation.