1 3 J Immigrant Minority Health DOI 10.1007/s10903-016-0520-1 ORIGINAL PAPER Stage Validity of the Health Action Process Approach in African American Breast Cancer Survivors Rachel Meadows 1  · Raheem J. Paxton 2   © Springer Science+Business Media New York 2016 stage- or phase-based interventions can be designed for this population. Keywords Breast cancer · African American · Health behavior · Physical activity · Cancer survivorship · Validity · Stage of change Introduction Physical activity (PA) is associated with several benefits for cancer survivors including improvements in cancer- related fatigue, emotional well-being, sleep disturbances, pain, physical functioning, cardio-respiratory fitness, and reductions in body mass index [1–6]. Despite the benefits, many cancer survivors do not meet current PA guidelines and African Americans report the lowest compliance rates among cancer survivors [7–9]. Inactivity among African American cancer survivors contributes significantly to the cancer-related disparities that exist among African Ameri- can and non-Hispanic White survivor populations [10]. Literature documenting the correlates of PA in breast cancer survivors has focused almost exclusively on non- Hispanic White survivor samples, while fewer studies have addressed the correlates of PA in minority cancer survivors [5, 11–15]. African American breast cancer survivors are in desperate need of studies that document the correlates of PA as well as effective behavior change strategies. The limited data that exist on effective behavior change strate- gies in minority cancer survivors suggests a need for more theory research in this population [16, 17]. Prior studies in cancer survivors have focused on frame- works such as the Social Cognitive Theory, Health Belief Model, and Theory of Planned Behavior [18–20]. Recently, the Health Action Process Approach (HAPA) was shown to Abstract The Health Action Process Approach (HAPA) has been applied in a number of populations because it proposes to overcome limitations from previous health behavior theories. However, it has yet to be applied to can- cer survivors or racial/ethnic minorities. In this study, we examined the construct validity of the HAPA phase and stage algorithms in a sample of African American breast cancer survivors. A total of 259 African American breast cancer survivors (mean age = 54 years) participated in a Web-based survey that assessed sociodemographic and medical characteristics, physical activity, and HAPA con- structs. Analysis of covariance was used to compare mean differences between HAPA phase/stage. Statistical signifi- cance was determined at p < 0.017 due to multiple com- parisons. Phase and stage inconsistencies were observed for most constructs. However, adequate distinctions were made for motivational self-efficacy and intentions (i.e., P = I < A) by phase, and both action and coping planning (i.e., P < I < A) by stage. Our data indicate partial sup- port of the HAPA algorithm to classify African American breast cancer survivors according to stage or phase. Modi- fying the staging algorithm or constructs are needed if * Rachel Meadows meadows.262@osu.edu Raheem J. Paxton Raheem.Paxton@unthsc.edu 1 Comprehensive Cancer Center, Center for Population Health and Health Disparities and the College of Public Health, The Ohio State University, 1590 N. High Street, Suite 525, Columbus, OH 43201, USA 2 Institute of Healthy Aging and the School of Public Health, The University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA