Fidelity of primary care nurses’ delivery of a behaviour change intervention to enhance physical activity in chronic patients

Abstract Background The effectiveness of a nurse-led intervention to enhance physical activity, the Activate intervention, was evaluated in primary care patients at risk for cardiovascular diseases in a cluster-randomised controlled trial (n = 195 patients, 31 general practices). To contribute to an accurate interpretation of the trial results, understanding of how the intervention works and enabling reproducibility, this study aimed to evaluate the fidelity of delivery of the Activate intervention by assessing: 1. self-reported fidelity of delivery; 2. observed fidelity of delivery; 3. quality of nurses’ delivery of the Activate intervention and 4. nurses’ beliefs about their capability, motivation, confidence and effectiveness towards delivering the Activate intervention, including behaviour change techniques. Methods An observational study was conducted. Nurses’ self-reported fidelity was evaluated using checklists (n = 279), and the observed fidelity and quality of delivery were examined using audio-recordings of intervention consultations (n = 44). Nurses’ beliefs towards delivering the intervention were assessed using questionnaires (n = 72). Results The self-reported fidelity was 87.6% and observed fidelity was 85.6%, representing high fidelity. The observed fidelity of applied behaviour change techniques was moderate (76.8%). The observed quality of delivery was sufficient and varied among nurses (mean 2.9; SD 4.4; range 0–4). Nurses’ beliefs about their capability, motivation, confidence and effectiveness towards delivering the intervention increased during the trial. Conclusions Nurses delivered most intervention components as intended with sufficient quality. Nurses believed they were capable, motivated and confident to deliver the intervention. They believed the intervention was effective to increase patients’ physical activity level. Despite the high fidelity and moderate fidelity of applied behaviour change techniques, the varying quality of delivery within and across nurses might have diluted the effectiveness of the Activate intervention. Trial registration: ClinicalTrials.gov NCT02725203 registered 31 March, 2016, https://clinicaltrials.gov/ct2/show/NCT02725203.

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Individualised behaviour change strategies for physical activity in multiple sclerosis (IPAC-MS): protocol for a randomised controlled trial

Trials ◽

10.1186/s13063-019-3768-7 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Farren L. Goulding ◽

Charity D. Evans ◽

Katherine B. Knox ◽

Hyun J. Lim ◽

Michael C. Levin ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Multiple Sclerosis ◽

Randomised Controlled Trial ◽

Behaviour Change ◽

Controlled Trial ◽

Activity Level ◽

Change Strategies ◽

Randomised Controlled

Abstract Background Multiple sclerosis (MS) is a chronic, degenerative disease of the central nervous system. Because of the long-term and unpredictable nature of the disease, the burden of MS is significant from both a patient and societal perspective. Despite a recent influx of disease-modifying therapies to treat MS, many individuals continue to experience disability that negatively affects productivity and quality of life. Previous research indicates that physical activity has a positive impact on walking function in individuals with MS, in addition to the usual beneficial effects on overall health. However, most people with MS are not active enough to gain these benefits, and a lack of support to initiate and maintain physical activity has been identified as a major barrier. This study will evaluate the impact of a novel intervention involving individualised behaviour change strategies delivered by neurophysiotherapists on increasing physical activity levels in individuals with MS who are currently inactive. Methods/design This single-blind, parallel-group, randomised controlled trial will be conducted in Saskatchewan, Canada. Eligible participants include individuals with MS who are ambulatory but identified as currently inactive by the self-reported Godin Leisure-Time Exercise Questionnaire (GLTEQ). The intervention will be delivered by neurophysiotherapists and includes individualised behaviour change strategies aimed at increasing physical activity over a 12-month period. The control group will receive usual care during the 12-month study period. The primary outcome is the change in physical activity level, as measured by the change in the GLTEQ score from baseline to 12 months. Secondary outcomes include the change in patient-reported outcome measures assessing MS-specific symptoms, confidence and quality of life. Discussion Physical activity has been identified as a top research priority by the MS community. Findings from this novel study may result in new knowledge that could significantly impact the management and overall health of individuals with MS. Trial registration ClinicalTrials.gov, NCT04027114. Registered on 10 July 2019.

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Fidelity of primary care nurses’ delivery of a behavioural change intervention enhancing physical activity in patients at risk of cardiovascular disease: an observational study

BMJ Open ◽

10.1136/bmjopen-2020-046551 ◽

2021 ◽

Vol 11 (3) ◽

pp. e046551

Author(s):

Heleen Westland ◽

Jaap C A Trappenburg ◽

Marieke J Schuurmans ◽

Michelle H Zonneveld ◽

Carin D Schröder

Keyword(s):

Physical Activity ◽

Primary Care ◽

Observational Study ◽

Behavioural Change ◽

High Fidelity ◽

Primary Care Nurses ◽

Quality Of Delivery ◽

Patients At Risk ◽

General Practices

ObjectiveTo evaluate the fidelity of delivery of a nurse-led intervention to enhance physical activity in patients at risk for cardiovascular diseases, the Activate intervention, by assessing: (1) self-reported fidelity of delivery; (2) observed fidelity of delivery; (3) quality of delivery of the Activate intervention and (4) nurses’ beliefs about their capability, motivation, confidence and effectiveness towards delivering the Activate intervention, including behavioural change techniques.DesignAn observational study.SettingGeneral practices in the Netherlands.ParticipantsPrimary care nurses (n=20) from 16 general practices.Primary and secondary outcome measuresNurses’ self-reported fidelity was evaluated using checklists (n=282), and the observed fidelity and quality of delivery were examined using audiorecordings of consultations of the delivery of the Activate intervention (n=42). Nurses’ beliefs towards delivering the intervention were assessed using questionnaires (n=72).ResultsThe self-reported fidelity was 88.1% and observed fidelity was 85.4%, representing high fidelity. The observed fidelity of applied behavioural change techniques was moderate (75.0%). The observed quality of delivery was sufficient and varied among nurses (mean 2.9; SD 4.4; range 0–4). Nurses’ beliefs about their capability, motivation, confidence and effectiveness towards delivering the intervention increased over time.ConclusionsNurses delivered most intervention components as intended with sufficient quality. Nurses believed they were capable, motivated and confident to deliver the intervention. They believed the intervention was effective to increase patients’ physical activity level. Despite the high fidelity and moderate fidelity of applied behavioural change techniques, the varying quality of delivery within and across nurses might have diluted the effectiveness of the Activate intervention.Trial registration numberNCT02725203.

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‘No one ever asked us’: a feasibility study assessing the co-creation of a physical activity programme with adolescent girls

Global Health Promotion ◽

10.1177/1757975919853784 ◽

2019 ◽

Vol 27 (3) ◽

pp. 34-43

Author(s):

Méabh Corr ◽

Elaine Murtagh

Keyword(s):

Physical Activity ◽

Data Collection ◽

Behaviour Change ◽

Adolescent Girls ◽

Retention Rate ◽

Controlled Trial ◽

Activity Level ◽

Health Concern ◽

Post Intervention ◽

Behaviour Change Wheel

Background: Globally, the poor activity level of adolescent girls is a public health concern. Little research has involved adolescents in the design of interventions. This study assessed the feasibility of involving girls in the co-creation of an activity programme. Methods: Thirty-one students (15–17 years old) were recruited from a post-primary school. The Behaviour Change Wheel guided intervention design, providing insights into participants’ capability, opportunity and motivation for change. Step counts and self-reported physical activity levels were recorded pre- and post-intervention. Feasibility benchmarks assessed recruitment, data collection, acceptability and adherence. Results: Activity and educational sessions were delivered for six weeks during physical education class. Average attendance was 87% (benchmark = 80%). Eligibility was 61% (benchmark = 60%). There was a 100% retention rate (benchmark = 90%). All participants ( n = 31) completed baseline measures and 71% ( n = 22) completed post-measures. 54% ( n = 17) of students completed pedometer measurements, with 32% ( n = 10) having complete data. Average daily steps were 13,121 pre-intervention and 14,128 post-intervention ( p > 0.05). Data collection was feasible, receiving a mean score > 4/5 (benchmark > 3.5/5). Conclusions: The Behaviour Change Wheel can be used to co-create an activity programme with adolescent girls. Predetermined benchmarks, except for pedometer recordings, were reached or exceeded, providing evidence for the need of a randomised controlled trial to test effectiveness.

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Primary Care implementation of Germ Defence, a digital behaviour change intervention to improve household infection control during the COVID-19 pandemic: A structured summary of a study protocol for a randomised controlled trial

Trials ◽

10.1186/s13063-021-05188-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Jeremy Horwood ◽

Melanie Chalder ◽

Ben Ainsworth ◽

James Denison-Day ◽

Frank de Vocht ◽

...

Keyword(s):

Primary Care ◽

Usual Care ◽

Behaviour Change ◽

Controlled Trial ◽

Behaviour Change Techniques ◽

Current Standard ◽

Link Type ◽

Implementation Period ◽

Full Protocol ◽

Randomised Controlled

Abstract Objectives To examine the effectiveness of randomising dissemination of the Germ Defence behaviour change website via GP practices across England UK. Trial design A two-arm (1:1 ratio) cluster randomised controlled trial implementing Germ Defence via GP practices compared with usual care. Participants Setting: All Primary care GP practices in England. Participants: All patients aged 16 years and over who were granted access by participating GP practices. Intervention and comparator Intervention: We will ask staff at GP practices randomised to the intervention arm to share the weblink to Germ Defence with all adult patients registered at their practice during the 4-month trial implementation period and care will otherwise follow current standard management. Germ Defence is an interactive website (http://GermDefence.org/) employing behaviour change techniques and practical advice on how to reduce the spread of infection in the home. The coronavirus version of Germ Defence helps people understand what measures to take and when to take them to avoid infection. This includes hand washing, avoiding sharing rooms and surfaces, dealing with deliveries and ventilating rooms. Using behaviour change techniques, it helps users think through and adopt better home hygiene habits and find ways to solve any barriers, providing personalised goal setting and tailored advice that fits users’ personal circumstances and problem solving to overcome barriers. Comparator: Patients at GP practices randomised to the usual care arm will receive current standard management for the 4-month trial period after which we will ask staff to share the link to Germ Defence with all adult patients registered at their practice. Main outcomes The primary outcome is the effects of implementing Germ Defence on prevalence of all respiratory tract infection diagnoses during the 4-month trial implementation period. The secondary outcomes are: 1) incidence of COVID-19 diagnoses 2) incidence of COVID-19 symptom presentation 3) incidence of gastrointestinal infections 4) number of primary care consultations 5) antibiotic usage 6) hospital admissions 7) uptake of GP practices disseminating Germ Defence to their patients 8) usage of the Germ Defence website by individuals who were granted access by their GP practice Randomisation GP practices will be randomised on a 1:1 basis by the independent Bristol Randomised Trials Collaboration (BRTC). Clinical Commission Groups (CCGs) in England will be divided into blocks according to region, and equal numbers in each block will be randomly allocated to intervention or usual care. The randomisation schedule will be generated in Stata statistical software by a statistician not otherwise involved in the enrolment of general practices into the study. Blinding (masking) The principal investigators, the statistician and study collaborators will remain blinded from the identity of randomised practices until the end of the study. Numbers to be randomised (sample size) To detect planned effect size (based on PRIMIT trial, Little et al, 2015): 11.1 million respondents from 6822 active GP practices. Assuming 25% of these GP practices will engage, we will contact all GP practices in England spread across 135 Clinical Commissioning Groups. Trial status Protocol version 2.0, dated 13 January 2021. Implementation is ongoing. The implementation period started on 10 November 2020 and will end on 10 March 2021. Trial registration This trial was registered in the ISRCTN registry (isrctn.com/ISRCTN14602359) on 12 August 2020. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.

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Moving from intention to behaviour: a randomised controlled trial protocol for an app-based physical activity intervention (i2be)

BMJ Open ◽

10.1136/bmjopen-2021-053711 ◽

2022 ◽

Vol 12 (1) ◽

pp. e053711

Author(s):

Lili L Kókai ◽

Diarmaid T Ó Ceallaigh ◽

Anne I Wijtzes ◽

Jeanine E Roeters van Lennep ◽

Martin S Hagger ◽

...

Keyword(s):

Physical Activity ◽

Randomised Controlled Trial ◽

Behaviour Change ◽

Controlled Trial ◽

Vigorous Physical Activity ◽

Well Being ◽

Behaviour Change Techniques ◽

Automatic Processes ◽

Post Intervention ◽

Randomised Controlled

IntroductionEfficacy tests of physical activity interventions indicate that many have limited or short-term efficacy, principally because they do not sufficiently build on theory-based processes that determine behaviour. The current study aims to address this limitation.Methods and analysisThe efficacy of the 8-week intervention will be tested using a three-condition randomised controlled trial delivered through an app, in women with a prior hypertensive pregnancy disorder. The intervention is based on the integrated behaviour change model, which outlines the motivational, volitional and automatic processes that lead to physical activity. The mechanisms by which the behaviour change techniques lead to physical activity will be tested.Following stratification on baseline factors, participants will be randomly allocated in-app to one of three conditions (1:1:1). The information condition will receive information, replicating usual care. Additionally to what the information condition receives, the motivation condition will receive content targeting motivational processes. Additionally to what the motivation condition receives, the action condition will receive content targeting volitional and automatic processes.The primary outcome is weekly minutes of moderate-to-vigorous physical activity, as measured by an activity tracker (Fitbit Inspire 2). Secondary outcomes include weekly average of Fitbit-measured daily resting heart rate, and self-reported body mass index, waist-hip ratio, cardiorespiratory fitness and subjective well-being. Tertiary outcomes include self-reported variables representing motivational, volitional, and automatic processes. Outcome measures will be assessed at baseline, immediately post-intervention, and at 3 and 12 months post-intervention. Physical activity will also be investigated at intervention midpoint. Efficacy will be determined by available case analysis. A process evaluation will be performed based on programme fidelity and acceptability measures.Ethics and disseminationThe Medical Ethics Committee of the Erasmus MC has approved this study (MEC-2020-0981). Results will be published in peer reviewed scientific journals and presented at scientific conferences.Trial registration numberNetherlands trial register, NL9329.

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Individualized behaviour change strategies for physical activity in multiple sclerosis (IPAC-MS): protocol for a randomized controlled trial

10.21203/rs.2.13365/v2 ◽

2019 ◽

Author(s):

Farren L. Goulding ◽

Charity D. Evans ◽

Katherine B. Knox ◽

Hyun J. Lim ◽

Michael C. Levin ◽

...

Keyword(s):

Physical Activity ◽

Multiple Sclerosis ◽

Controlled Trial ◽

Behavioural Change ◽

Activity Level ◽

Change Strategies ◽

Major Barrier ◽

Patient Reported ◽

The Impact

Abstract Background Multiple sclerosis (MS) is a chronic, degenerative disease of the central nervous system. Because of the long-term and unpredictable nature of the disease, the burden of MS is significant from both a patient and societal perspective. Despite a recent influx of disease-modifying therapies to treat MS, many individuals continue to experience disability that negatively affects productivity and quality of life. Previous research indicates that physical activity has a positive impact on walking function in individuals with MS, in addition to the usual beneficial effects on overall health. However, most people with MS are not active enough to gain these benefits, and a lack of support to initiate and maintain physical activity has been identified as a major barrier. This study will evaluate the impact of a novel intervention involving individualized behavioural change strategies delivered by neurophysiotherapists on increasing physical activity levels in individuals with MS who are currently inactive.Methods/Design This single-blinded, parallel-group, randomised controlled trial will be conducted in Saskatchewan, Canada. Eligible participants include individuals with MS who are ambulatory, but identified as currently inactive by the self-reported Godin Leisure-time Exercise Questionnaire (GLTEQ). The intervention will be delivered by neurophysiotherapists and includes individualised behavioural change strategies aimed at increasing physical activity over a 12-month period. The control group will receive usual care during the 12-month study period. The primary outcome is the change in physical activity level, as measured by the change in the GLTEQ score from baseline to 12 months. Secondary outcomes include the change in patient-reported outcome measures assessing MS-specific symptoms, confidence and quality of life.Discussion Physical activity has been identified as a top research priority by the MS community. Findings from this novel study may result in new knowledge that could significantly impact the management and overall health of individuals with MS.

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A systematic review of the characteristics of interventions that promote physical activity in adults with asthma

Journal of Health Psychology ◽

10.1177/13591053211059386 ◽

2021 ◽

pp. 135910532110593

Author(s):

Leanne Tyson ◽

Wendy Hardeman ◽

Malcolm Marquette ◽

Joanna Semlyen ◽

Gareth Stratton ◽

...

Keyword(s):

Physical Activity ◽

Behaviour Change ◽

Pulmonary Rehabilitation ◽

Behaviour Change Techniques ◽

Inclusion Criteria ◽

Control Groups ◽

Asthma Symptoms ◽

And Control ◽

Positive Effect

Physical activity is promoted in the asthma population through pulmonary rehabilitation, but limited funding and facilities are available. This review aimed to examine the effectiveness of interventions that promote physical activity and identify the behaviour change techniques (BCTs) and other intervention components used. Five databases were searched, and 25 studies met the inclusion criteria. Interventions had a significant positive effect on physical activity, sedentary behaviour, quality of life and asthma symptoms. BCTs used across intervention and control groups were similar in studies that showed effects and those that did not. Future interventions should employ techniques that help to maintain behaviour change.

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Increasing physical activity by four legs rather than two: systematic review of dog-facilitated physical activity interventions

British Journal of Sports Medicine ◽

10.1136/bjsports-2019-101156 ◽

2020 ◽

Vol 54 (20) ◽

pp. 1202-1207 ◽

Cited By ~ 2

Author(s):

Ryan E Rhodes ◽

Maria Baranova ◽

Hayley Christian ◽

Carri Westgarth

Keyword(s):

Physical Activity ◽

Systematic Review ◽

Behaviour Change ◽

Controlled Trial ◽

Grey Literature ◽

Future Research ◽

Behaviour Change Techniques ◽

Eligibility Criteria ◽

Dog Owners

ObjectivesRegular walking is a critical target of physical activity (PA) promotion, and dog walking is a feasible PA intervention for a large segment of the population. The purpose of this paper was to review PA interventions that have involved canine interactions and to evaluate their effectiveness. A secondary aim of this review was to highlight the populations, settings, designs and intervention components that have been applied so as to inform future research.DesignSystematic review.Data sourcesWe carried out literature searches to August 2019 using six common databases.Eligibility criteriaStudies included published papers in peer-reviewed journals and grey literature (theses and dissertations) in the English language that included any PA behaviour change design (ie, randomised controlled trial, quasi-experimental) that focused on canine-related intervention. We grouped findings by population, setting, medium, research design and quality, theory and behaviour change techniques applied.ResultsThe initial search yielded 25 010 publications which were reduced to 13 independent studies of medium and high risks of bias after screening for eligibility criteria. The approaches to intervene on PA were varied and included loaner dogs, new dog owners and the promotion of walking among established dog owners. Findings were consistent in showing that canine-assisted interventions do increase PA (82% of the studies had changes favouring the canine-facilitated intervention). Exploratory subanalyses showed that specific study characteristics and methods may have moderated the effects. Compared with studies with longer follow-up periods, studies with shorter follow-up favoured behaviour changes of the canine intervention over the control condition.ConclusionCanine-based PA interventions appear effective, but future research should move beyond feasibility and proof of concept studies to increase rigour, quality and generalisability of findings.

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Physical activity on prescription in patients with hip or knee osteoarthritis: A randomized controlled trial

Clinical Rehabilitation ◽

10.1177/02692155211008807 ◽

2021 ◽

pp. 026921552110088

Author(s):

Regina Bendrik ◽

Lena V Kallings ◽

Kristina Bröms ◽

Wanlop Kunanusornchai ◽

Margareta Emtner

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Knee Osteoarthritis ◽

Controlled Trial ◽

Group Versus ◽

Activity Level ◽

Moderate Physical Activity ◽

Related Quality ◽

Advice Group

Objective: To evaluate whether physical activity on prescription, comprising five sessions, was more effective in increasing physical activity than a one-hour advice session after six months. Design: Randomized, assessor-blinded, controlled trial. Setting: Primary care. Subjects: Patients with clinically verified osteoarthritis of the hip or knee who undertook less than 150 minute/week of moderate physical activity, and were aged 40–74 years. Interventions: The advice group ( n = 69) received a one-hour session with individually tailored advice about physical activity. The physical activity on prescription group ( n = 72) received individually tailored physical activity recommendations with written prescription, and four follow-ups during six months. Main measures: Patients were assessed at baseline and six months: physical activity (accelerometer, questionnaires); fitness (six-minute walk test, 30-second chair-stand test, maximal step-up test, one-leg rise test); pain after walking (VAS); symptoms (HOOS/KOOS); and health-related quality of life (EQ-5D). Results: One hundred four patients had knee osteoarthritis, 102 were women, and mean age was 60.3 ± 8.3 years. Pain after walking decreased significantly more in the prescription group, from VAS 31 ± 22 to 18 ± 23. There was no other between groups difference. Both groups increased self-reported activity minutes significantly, from 105 (95% CI 75–120) to 165 (95% CI 135–218) minute/week in the prescription group versus 75 (95% CI 75–105) to 150 (95% CI 120–225) in the advice group. Also symptoms and quality of life improved significantly in both groups. Conclusion: Individually tailored physical activity with written prescription and four follow-ups does not materially improve physical activity level more than advice about osteoarthritis and physical activity. Trial registration: ClinicalTrials.gov (NCT02387034).

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Individualized behaviour change strategies for physical activity in multiple sclerosis (IPAC-MS): protocol for a randomized controlled trial

10.21203/rs.2.13365/v1 ◽

2019 ◽

Author(s):

Farren L. Goulding ◽

Charity Evans ◽

Katherine A. Knox ◽

Hyun J. Lim ◽

Michael C. Levin ◽

...

Keyword(s):

Physical Activity ◽

Multiple Sclerosis ◽

Controlled Trial ◽

Behavioural Change ◽

Activity Level ◽

Change Strategies ◽

Major Barrier ◽

Patient Reported ◽

The Impact

Abstract Background Multiple sclerosis (MS) is a chronic, degenerative disease of the central nervous system. Because of the long-term and unpredictable nature of the disease, the burden of MS is significant from both a patient and societal perspective. Despite a recent influx of disease-modifying therapies to treat MS, many individuals continue to experience disability that negatively affects productivity and quality of life. Previous research indicates that physical activity has a positive impact on walking function in individuals with MS, in addition to the usual beneficial effects on overall health. However, most people with MS are not active enough to gain these benefits, and a lack of support to initiate and maintain physical activity has been identified as a major barrier. This study will evaluate the impact of a novel intervention involving individualized behavioural change strategies delivered by neurophysiotherapists on increasing physical activity levels in individuals with MS who are currently inactive.Methods/Design This single-blinded, parallel-group, randomised controlled trial will be conducted in Saskatchewan, Canada. Eligible participants include individuals with MS who are ambulatory, but identified as currently inactive by the self-reported Godin Leisure-time Exercise Questionnaire (GLTEQ). The intervention will be delivered by neurophysiotherapists and includes individualised behavioural change strategies aimed at increasing physical activity over a 12-month period. The control group will receive usual care during the 12-month study period. The primary outcome is the change in physical activity level, as measured by the change in the GLTEQ score from baseline to 12 months. Secondary outcomes include the change in patient-reported outcome measures assessing MS-specific symptoms, confidence and quality of life.Discussion Physical activity has been identified as a top research priority by the MS community. Findings from this novel study may result in new knowledge that could significantly impact the management and overall health of individuals with MS.Trial Registration: This study is registered on ClinicalTrials.gov: NCT04027114 (July 10, 2019).

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