Using Intervention Mapping to Develop and Facilitate Implementation of a Multifaceted Behavioural Intervention Targeting Physical Activity and Sedentary Behaviour in Stroke Survivors: Physical Activity Routines After Stroke (PARAS)

Abstract

BackgroundThe benefits of increased physical activity for stroke survivors include improved walking ability, balance and mood. However, less than 30% achieve recommended levels of physical activity, and high levels of sedentary behaviour are reported. We engaged stroke survivors, informal carers and healthcare professionals (HCPs) in a co-design process to develop an evidence-informed behavioural intervention targeting physical activity and sedentary behaviour for use by stroke rehabilitation teams. MethodsIntervention Mapping was used as a framework for intervention development. Step 1 involved a systematic review, focus group discussions and a review of existing care pathways. Step 2 involved identification of social cognitive determinants of behavioural change and behavioural outcomes of the intervention. Step 3 involved linking the determinants of behavioural outcomes with specific behaviour change techniques to target the behaviours of interest. Step 4 involved the development of the intervention informed by steps 1 to 3. Subsequently, an implementation plan was developed (Step 5) followed by an evaluation plan (Step 6). ResultsSystematic review findings informed selection of nine ‘promising’ behaviour change techniques (e.g. goal setting-behaviour; problem-solving). Focus groups with stroke survivors (n=18) and HCPs (n=24) identified the need for an intervention that could be delivered at different time points within the rehabilitation pathway, tailored to individual needs and circumstances with training for HCPs delivering the intervention. Intervention delivery was considered feasible within local community stroke services. The target behaviours for the intervention were physical activity and sedentary behaviour of stroke survivors. Assessment of acceptability and usability with 11 HCPs and 21 stroke survivors/relatives identified issues around self-monitoring tools; the need for a repository of local services for physical activity; and the need for face-to-face feedback provision to HCPs following delivery of the intervention for optimisation purposes. Face-to-face training for HCPs was delivered to support faithful delivery of the intervention within community settings. A feasibility study protocol was designed to evaluate the intervention.ConclusionsA systematic development process using intervention mapping resulted in a multi-faceted evidence- and theory-informed intervention (Physical Activity Routines After Stroke - PARAS) for delivery by community stroke rehabilitation teams. Trial registration: Trial identifier: ISRCTN35516780, date of registration: 24/10/2018, URL http://www.isrctn.com/ISRCTN35516780