Applying the behaviour change wheel to develop a smartphone application ‘stay-active’ to increase physical activity in women with gestational diabetes

Abstract

Background Physical activity (PA) interventions are an important but underutilised component in the management of gestational diabetes mellitus (GDM). The challenge remains how to deliver cost effective PA interventions that have impact on individual behaviour. Digital technologies can support and promote PA remotely at scale. We describe the development of a behaviourally informed smartphone application (Stay-Active) for women attending an NHS GDM clinic. Stay-Active will support an existing motivational interviewing intervention to increase and maintain PA in this population. Methods The behaviour change wheel (BCW) eight step theoretical approach was used to design the application. It provided a systematic approach to understanding the target behaviour, identifying relevant intervention functions, and specifying intervention content. The target behaviour was to increase and maintain PA. To obtain a behavioural diagnosis, qualitative evidence was combined with focus groups on the barriers and facilitators to PA in women with GDM. The findings were mapped onto the Capability Opportunity Motivation-Behaviour (COM-B) model and Theoretical Domains Framework to identify what needs to change for the target behaviour and linked to appropriate intervention functions. Finally, behaviour changes techniques (BCT) and modes of delivery that are most likely to serve the intervention functions were selected. Current evidence, patient focus groups and input from key stakeholders informed Stay-Active’s development. Results We found that psychological capability, reflective and automatic motivation, social and physical opportunity needed to change to increase PA in women with GDM. The four key intervention functions identified were Enablement, Education, Persuasion and Training. Stay-Active incorporates these four intervention functions delivering ten BCTs including: goal setting, credible source, self-monitoring, action planning, prompts and cues. The final design of Stay-Active delivers these BCTs via an educational resource centre, with goal setting and action planning features, personalised performance feedback and individualised promotional messages. Conclusion The BCW has enabled the systematic and comprehensive development of Stay-Active to promote PA in women with GDM within an NHS Maternity service. The next phase is to conduct a trial to assess the feasibility and acceptability of a multi-component intervention that combines Stay-Active with PA Motivational Interviewing.

Development of a behavior change intervention to improve physical activity adherence in individuals with metabolic syndrome using the behavior change wheel

“…Additionally, the advantages of apps also include convenience and being inexpensive and automation, and they allow users to receive health services in any environment and at any time. Given these attractive features that met the APEASE criteria, researchers started to deliver physical activity interventions via apps [ 59 , 60 ]. According to previous experience of physical activity interventions, the context of epidemic era, features of app, our research team chose app as model of delivery.…”

Study protocol: use of a smartphone application to support the implementation of a complex physical activity intervention (+Stay Active) in women with gestational diabetes mellitus—protocol for a non-randomised feasibility study

“…The development of Stay-Active involved focus groups as part of Patient and Public Involvement (PPI) in line with Oxford University Hospital Trust’s PPI Strategy and Policy. 16 Amy Wire (patient representative) provided input and oversight in the study protocol.…”

“… 15 The development process was informed by current evidence, focus groups and input from key stakeholders. 16 The final design of Stay-Active delivers 10 BCTs via an educational resource centre, with goal setting and action planning features, personalised performance feedback and individualised promotional messages ( table 1 and online supplemental material 1 show the integration of BCTs within Stay-Active). A unique feature of this app is the clinicians ability to interact with the user.…”

“…This multicomponent application was designed following a systematic approach using the Behaviour Change Wheel (BCW) 15. The development process was informed by current evidence, focus groups and input from key stakeholders 16. The final design of Stay-Active delivers 10 BCTs via an educational resource centre, with goal setting and action planning features, personalised performance feedback and individualised promotional messages (table 1 and online supplemental material 1 show the integration of BCTs within Stay-Active).…”

Use of the behaviour change wheel to improve everyday person-centred conversations on physical activity across healthcare

“…The BCW helps contextualise change on an individual level and the determinants of what needs to happen to achieve organisational or system-level change. It has been used successfully to develop similar interventions improving the Capability Opportunity Motivation-Behaviour (COM-B) of healthcare professionals to deliver physical activity interventions in cancer care [ 46 ], therapeutic radiography [ 47 ], gestational diabetes [ 48 ], depression [ 49 ] and prevention of psychosis in ultra-high risk young people [ 50 ]. We believe this is the first study to utilise the COM-B framework to inform interventions focused on improving the frequency and quality of conversations on physical activity in managing long-term conditions.…”