scholarly journals Utilising the perspectives of patients with lower-limb osteoarthritis on prescribed physical activity to develop a theoretically informed physiotherapy intervention

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Matthew Willett ◽  
Carolyn Greig ◽  
Sally Fenton ◽  
David Rogers ◽  
Joan Duda ◽  
...  
Keyword(s):  
Physical Activity ◽  
Lower Limb ◽  
Theoretical Domains Framework ◽  
Barriers And Facilitators ◽  
Physical Factors ◽  
Behaviour Change Techniques ◽  
Personal Factors ◽  
Post Discharge ◽  
Access To Resources ◽  
Physiotherapy Intervention

Abstract Background Lower-limb osteoarthritis (OA) causes high levels of pain and disability. Physiotherapists are the primary healthcare provider of non-pharmacological treatments, and incorporate strategies to optimise physical activity (PA) to aid patients with lower-limb OA to moderate their clinical symptoms. However, patients with lower-limb OA have low adherence to PA recommendations both during treatment and after discharge. This study aimed to use knowledge of identified barriers and facilitators to physiotherapy prescribed PA (during treatment and post-discharge) to develop a theoretically informed intervention to optimise adherence to PA for patients with lower-limb OA during treatment and post-discharge. Methods 1) A purposive sample of 13 patients with lower-limb OA participated in semi-structured interviews following physiotherapy treatment. Inductive analysis identified themes/subthemes reflecting barriers and facilitators to physiotherapist prescribed PA, which were organised deductively according to personal factors, treatment and post-discharge phases. 2) Themes/subthemes were mapped onto the theoretical domains framework (TDF). 3) Behaviour change techniques (BCTs) were coded from the key identified domains and a theoretically informed physiotherapy intervention addressing barriers and using facilitators, was developed. Results Themes of patient confidence, mind-set, motivation, OA symptoms and PA experiences were primary personal factors that influenced PA adherence; with the TDF domain ‘Beliefs about capabilities’ most important to target. During treatment, the theme of routine formation was the major driver of personal factors; and primarily influenced by developing a positive physiotherapist-patient relationship. Post-discharge, physical factors, psychosocial factors and ongoing access to resources were important themes influencing PA maintenance. ‘Environmental context and resources’ and ‘social influences’ emerged as the key TDF domains to target during treatment and post-discharge. The proposed theoretically informed intervention included 26 BCTs delivered across conceptual phases of adoption, routine formation, and maintenance. Conclusion A theoretically informed physiotherapy intervention was proposed to optimise PA adherence in patients with lower-limb OA. The included BCTs primarily target patients’ perceived beliefs about their capabilities, by developing a PA routine during treatment and facilitating appropriate psychosocial support and access to resources for PA maintenance post-discharge. The feasibility of delivering the intervention in clinical practice will now be evaluated.

scholarly journals Barriers and facilitators to recommended physical activity in lower-limb osteoarthritis: protocol for a qualitative study exploring patients and physiotherapist perspectives using the theoretical domains framework and behaviour change taxonomy

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e029199
Author(s):  
Matthew James Willett ◽  
Carolyn Greig ◽  
David Rogers ◽  
Sally Fenton ◽  
Joan Duda ◽  
...  
Keyword(s):  
Behaviour Change ◽  
Lower Limb ◽  
Treatment Time ◽  
Change Theory ◽  
Theoretical Domains Framework ◽  
Post Treatment ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Behaviour Change Theory ◽  
Physiotherapy Intervention

IntroductionOsteoarthritis (OA) is the leading cause of disability and pain in older adults. Although increasing physical activity (PA) can help reduce symptoms, patients with lower-limb OA are less active than the general public. Although physiotherapists commonly deliver PA programmes, they lack knowledge of key barriers and facilitators to adherence to prescribed PA that patients with lower-limb OA experience while attending physiotherapy appointments (treatment period) and after discharge (post-treatment period). This study aims to explore the perspectives of patients with lower-limb OA of barriers and facilitators to adherence to physiotherapy prescribed PA in the treatment and post-treatment time periods to inform the development of intervention underpinned by behaviour change theory.Methods and analysisA qualitative study, based on phenomenology, will purposively recruit patients with lower-limb OA who have had physiotherapy. In-depth semi-structured interviews will be undertaken following discharge from physiotherapy at a single time point. Participants’ perspectives of physiotherapy interventions, including barriers and facilitators to prescribed PA and techniques that they felt optimised adherence to physiotherapist PA prescription will be explored (phase I). The acceptability and feasibility of delivering a physiotherapy intervention incorporating the techniques identified in the semi-structured interviews will then be explored through focus groups conducted with physiotherapists (phase II). Data will be coded following thematic analysis, with barriers and facilitators mapped to the constructs on the theoretical domains framework, and behaviour change techniques identified following definitions from Michie’s V1 taxonomy.Ethics and disseminationFindings from this study will inform development of a physiotherapy intervention underpinned by behaviour change theory aiming to optimise adherence to PA prescription in patients with lower-limb OA during the treatment and post-treatment time periods. This study has ethical approval (IRAS 247904) and results will be disseminated through publications in peer-reviewed journals and presentations at conferences and to study participants.

scholarly journals Barriers and facilitators to utilisation of rehabilitation services amongst persons with lower-limb amputations in a rural community in South Africa

2018 ◽  
Vol 43 (1) ◽  
pp. 95-103 ◽  
Author(s):  
Ugendrie Naidoo ◽  
Liezel Ennion
Keyword(s):  
South Africa ◽  
Lower Limb ◽  
Rural Areas ◽  
Lower Limb Amputation ◽  
Barriers And Facilitators ◽  
Rural Setting ◽  
Limb Amputation ◽  
Rehabilitation Services ◽  
Personal Factors ◽  
Persons With Disabilities

Background: Persons with disabilities who reside in rural areas experience challenges accessing and utilising health services and rehabilitation. Due to the high prevalence of diabetes mellitus in rural regions, the risk of having a lower-limb amputation is increasing. Comprehensive rehabilitation is vital to mitigate the negative impact that a lower-limb amputation has on a person. Objective: To explore the barriers and facilitators to accessing rehabilitation experienced by persons with lower-limb amputations in a rural setting. Study Design: A qualitative descriptive approach was used to collect and analyse data. Methods: Data were collected from 11 conveniently sampled participants from three sub-district hospitals in the rural iLembe district, Kwa-Zulu Natal, South Africa. Data were collected using semi-structured interviews to explore the barriers and facilitators perceived by persons with lower-limb amputations in a rural region. Results: The three main barriers identified in this study were environmental factors, financial constraints and impairments. These barriers negatively impacted the participant’s utilisation of rehabilitation. The two main facilitators identified were environmental facilitators and personal factors which aided participant’s utilisation of rehabilitation. Conclusion: Access to rehabilitation was mainly hindered by the challenges utilising transport to the hospital, while self-motivation to improve was the strongest facilitator to utilising rehabilitation. Clinical relevance Rehabilitation is essential in preparation for prosthetic fitting. If a person cannot access rehabilitation services, they will remain dependent on caregivers. Highlighting the challenges to utilisation of rehabilitation in rural areas can assist to reduce these barriers and improve the functional status of persons with lower-limb amputations.

scholarly journals Perceived Barriers and Facilitators to Breaking Up Sitting Time among Desk-Based Office Workers: A Qualitative Investigation Using the TDF and COM-B

2019 ◽  
Vol 16 (16) ◽  
pp. 2903 ◽  
Author(s):  
Samson O. Ojo ◽  
Daniel P. Bailey ◽  
David J. Hewson ◽  
Angel M. Chater
Keyword(s):  
Behaviour Change ◽  
Theoretical Domains Framework ◽  
Perceived Barriers ◽  
Barriers And Facilitators ◽  
Office Workers ◽  
Sitting Time ◽  
Future Research ◽  
Behaviour Change Techniques ◽  
Organisational Support ◽  
Sitting Behaviour

High amounts of sedentary behaviour, such as sitting, can lead to adverse health consequences. Interventions to break up prolonged sitting in the workplace have used active workstations, although few studies have used behaviour change theory. This study aimed to combine the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation to Behaviour system (COM-B) to investigate perceived barriers and facilitators to breaking up sitting in desk-based office workers. Semi-structured interviews with 25 desk-based employees investigated barriers and facilitators to breaking up sitting in the workplace. Seven core inductive themes were identified: ‘Knowledge-deficit sitting behaviour’, ‘Willingness to change’, ‘Tied to the desk’, ‘Organisational support and interpersonal influences’, ‘Competing motivations’, ‘Emotional influences’, and ‘Inadequate cognitive resources for action’. These themes were then deductively mapped to 11 of the 14 TDF domains and five of the six COM-B constructs. Participants believed that high amounts of sitting had adverse consequences but lacked knowledge regarding recommendations and were at times unmotivated to change. Physical and social opportunities were identified as key influences, including organisational support and height-adjustable desks. Future research should identify intervention functions, policy categories and behaviour change techniques to inform tailored interventions to change sitting behaviour of office workers.

Similar barriers and facilitators to physical activity across different clinical groups experiencing lower limb spasticity

2016 ◽  
Vol 38 (14) ◽  
pp. 1370-1381 ◽  
Author(s):  
Sandra Hundza ◽  
Caroline Quartly ◽  
Jasmine M. Kim ◽  
James Dunnett ◽  
Jill Dobrinsky ◽  
...  
Keyword(s):  
Physical Activity ◽  
Lower Limb ◽  
Barriers And Facilitators ◽  
Limb Spasticity ◽  
Lower Limb Spasticity

scholarly journals PARIS: protocol for a prospective single arm, theory-based, group-based feasibility intervention study to increase Physical Activity and reduce sedentary behaviouR after barIatric Surgery

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e051638
Author(s):  
Jennifer James ◽  
Wendy Hardeman ◽  
Helen Eborall ◽  
Mark Goodall ◽  
John Wilding
Keyword(s):  
Physical Activity ◽  
Bariatric Surgery ◽  
Sedentary Behaviour ◽  
Behaviour Change ◽  
Feasibility Study ◽  
Theoretical Domains Framework ◽  
Comparative Approach ◽  
Service Research ◽  
Behaviour Change Techniques ◽  
Behaviour Change Intervention

IntroductionIncreased physical activity and reduced sedentary behaviour can encourage favourable outcomes after bariatric surgery. However, there is a lack of evidence as to how to support patients with behaviour change. The aim of this study is to assess the feasibility of a physiotherapist led, online group-based behaviour change intervention to increase physical activity and reduce sedentary behaviour following bariatric surgery.Methods and analysisSingle arm feasibility study of a theory and evidence-based group behaviour change intervention based on the Behaviour Change Wheel and Theoretical Domains Framework using behaviour change techniques from the Behaviour Change Technique Taxonomy v1. The intervention has eight objectives and specifies behaviour change techniques that will be used to address each of these. Groups of up to eight participants who have had surgery within the previous 5 years will meet weekly over 6 weeks for up to 1½ hours. Groups will be held online led by a physiotherapist and supported by an intervention handbook. Feasibility study outcomes include: rate of recruitment, retention, intervention fidelity, participant engagement and acceptability. Secondary outcomes include: physical activity, sedentary behaviour, body composition, self-reported health status and will be analysed descriptively. Change in these outcomes will be used to calculate the sample size for a future evaluation study. Qualitative interviews will explore participants’ views of the intervention including its acceptability. Data will be analysed according to the constant comparative approach of grounded theory.Ethics and disseminationThis study has National Health Service Research Ethics Committee approval; Haydock 20/NW/0472. All participants will provide informed consent and can withdraw at any point. Findings will be disseminated through peer-reviewed journals, conference and clinical service presentations.Trial registration numberISRCTN31524689.

scholarly journals Implementation strategies, and barriers and facilitators for implementation of physical activity at work: a scoping review

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Anne Garne-Dalgaard ◽  
Stephanie Mann ◽  
Thomas Viskum Gjelstrup Bredahl ◽  
Mette Jensen Stochkendahl
Keyword(s):  
Physical Activity ◽  
Scoping Review ◽  
Social Influences ◽  
Theoretical Domains Framework ◽  
Implementation Strategies ◽  
Professional Role ◽  
Environmental Context ◽  
Barriers And Facilitators ◽  
Factors Affecting ◽  
Study Characteristics

Abstract Background Inactivity and sedentary lifestyle have led experts to recommend an increase in structured, workplace-based physical activity (PA) initiatives. Previous studies on workplace-based PA have only shown moderate and short-term effects. This has been attributed to the lack of clear implementation strategies and understanding of factors that may hinder or enable uptake of PA. To ensure long-term, sustainable outcomes, there is a need for a better understanding of implementation strategies, and barriers and facilitators to workplace-based PA. Method A scoping review of studies investigating implementation approaches and factors affecting uptake of workplace-based PA was conducted. Qualitative and quantitative articles published in MEDLINE, Embase, Scopus, or PsycINFO between 2008 and 2018 evaluating the implementation of PA were included. Data on study characteristics, evaluation, and implementation methods applied were systematically extracted. Two reviewers extracted, coded, and organised factors affecting uptake using the Theoretical Domains Framework (TDF). Results After dual, blinded screening of titles and abstracts, 16 articles reporting on eight studies were included in the review. Several different methods of implementation were applied, including information meeting, kick-off events, and “change agents” as the most common. A total of 109 factors influencing implementation were identified, consisting of 57 barriers and 52 facilitators. Barriers most often related to the TDF domains Environmental Context and Resources (n = 34, 36.2%), Social influences (n = 13, 13.8%), and Social/Professional Role and Identity (n = 8, 8.5%). Likewise, facilitators most often related to the TDF domains Social influences (n = 17, 19.5%), Environmental Context and Resources (n = 16, 18.4%), and Social/Professional Role and Identity (n = 9, 10.3%). Conclusion Our review has highlighted the multilevel factors affecting the uptake of workplace-based PA and underpins the complexities in implementation of such initiatives. The published literature predominantly provides details from the employees’ perspectives on factors that need to be addressed and a lack of attention to these factors will cause them to hamper uptake of PA. The analysis of barriers and facilitators provides a theoretical foundation to guide future intervention design. However, further research is needed to fully understand the success or failure of implementation processes.

scholarly journals Identifying Barriers and Facilitators to Diet and Physical Activity Behaviour Change in Type 2 Diabetes Using a Design Probe Methodology

2021 ◽  
Vol 11 (2) ◽  
pp. 72
Author(s):  
Kevin A. Cradock ◽  
Leo R. Quinlan ◽  
Francis M. Finucane ◽  
Heather L. Gainforth ◽  
Kathleen A. Martin Ginis ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 2 Diabetes ◽  
Behaviour Change ◽  
Design Research ◽  
Extended Period ◽  
Barriers And Facilitators ◽  
Behavioural Intervention ◽  
Behaviour Change Techniques ◽  
Diet And Physical Activity

Treatment of Type 2 Diabetes (T2D) typically involves pharmacological methods and adjunct behavioural modifications, focused on changing diet and physical activity (PA) behaviours. Changing diet and physical activity behaviours is complex and any behavioural intervention in T2D, to be successful, must use an appropriate suite of behaviour change techniques (BCTs). In this study, we sought to understand the perceived barriers and facilitators to diet and PA behaviour change in persons with T2D, with a view to creating artefacts to facilitate the required behaviour changes. The Design Probe was chosen as the most appropriate design research instrument to capture the required data, as it enabled participants to reflect and self-document, over an extended period of time, on their daily lived experiences and, following this reflection, to identify their barriers and facilitators to diet and PA behaviour change. Design Probes were sent to 21 participants and 13 were fully completed. A reflective thematic analysis was carried out on the data, which identified themes of food environment, mental health, work schedule, planning, social support, cravings, economic circumstances and energy associated with diet behaviour. Similar themes were identified for PA as well as themes of physical health, weather, motivation and the physical environment.

scholarly journals Supporting medicines management for older people at care transitions – a theory-based analysis of a systematic review of 24 interventions

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Justine Tomlinson ◽  
Iuri Marques ◽  
Jonathan Silcock ◽  
Beth Fylan ◽  
Judith Dyson
Keyword(s):  
Older People ◽  
Behaviour Change ◽  
Complex Intervention ◽  
Care Transitions ◽  
Theoretical Domains Framework ◽  
Behaviour Change Techniques ◽  
Medicines Management ◽  
Post Discharge ◽  
Behaviour Change Technique ◽  
Randomised Controlled

Abstract Background Older patients are at severe risk of harm from medicines following a hospital to home transition. Interventions aiming to support successful care transitions by improving medicines management have been implemented. This study aimed to explore which behavioural constructs have previously been targeted by interventions, which individual behaviour change techniques have been included, and which are yet to be trialled. Method This study mapped the behaviour change techniques used in 24 randomised controlled trials to the Behaviour Change Technique Taxonomy. Once elicited, techniques were further mapped to the Theoretical Domains Framework to explore which determinants of behaviour change had been targeted, and what gaps, if any existed. Results Common behaviour change techniques used were: goals and planning; feedback and monitoring; social support; instruction on behaviour performance; and prompts/cues. These may be valuable when combined in a complex intervention. Interventions mostly mapped to between eight and 10 domains of the Theoretical Domains Framework. Environmental context and resources was an underrepresented domain, which should be considered within future interventions. Conclusion This study has identified behaviour change techniques that could be valuable when combined within a complex intervention aiming to support post-discharge medicines management for older people. Whilst many interventions mapped to eight or more determinants of behaviour change, as identified within the Theoretical Domains Framework, careful assessment of the barriers to behaviour change should be conducted prior to intervention design to ensure all appropriate domains are targeted.

scholarly journals Physical activity promotion in primary care: Health professional and patient views on connecting primary care patients with community-based physical activity opportunities

2020 ◽  
Author(s):  
Sharon Ann Carstairs ◽  
Rayna H Rogowsky ◽  
Kathryn B Cunningham ◽  
Frank Sullivan ◽  
Gozde Ozakinci
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health Professionals ◽  
Local Community ◽  
Theoretical Domains Framework ◽  
Barriers And Facilitators ◽  
Community Based ◽  
Activity Promotion ◽  
Primary Care Patients ◽  
Potential Methods

Abstract Background Inconclusive evidence in support of referrals from health professionals to gym-based exercise programmes has raised a concern for the roll-out of such schemes and highlights the importance of developing and maintaining links between primary care settings and community-based opportunities to improve physical activity levels. This study aimed to identify methods of connecting primary care patients to community-based physical activity opportunities, using the example of jog scotland , and to explore what factors can facilitate this connection. Methods We conducted a qualitative exploratory study utilising semi-structured interviews with primary care patients (n=14) and health professionals (HP) (n=14) from one UK National Health Service (NHS) board. We analysed the transcripts separately for patients and HPs using thematic analysis and synthesised them for potential methods of connection. Sub-themes for patients and HPs were mapped onto relevant components of the capability, opportunity, motivation behavioural (COM-B) model and theoretical domains framework (TDF) to identify barriers and facilitators for connecting primary care to community jog scotland groups. Results Three potential methods of connecting patients to community-based jog scotland groups were identified: informal passive signposting, informal active signposting, and formal referral or prescribing. Barriers and facilitators to connecting patients to jog scotland groups fell into five TDF domains for HPs and two COM-B model components for patients. Conclusions Our findings suggest that for patients, the acknowledgement and raising of the topic of physical activity improvement by their HP can help to justify as well as facilitate and motivate action to change. The workload associated with connecting patients to community-based opportunities is central to the implementation by HPs. Resource solutions (e.g. intermediary person or community information hub) and social support opportunities for patients (e.g. meet and greet) can provide patients with a greater variety of physical activity options and the vital information and support for connecting with local community-based opportunities, such as jog scotland .

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