We Walk: a person-centred, dyadic behaviour change intervention to promote physical activity through outdoor walking after stroke—an intervention development study

Abstract

ObjectivesTo develop We Walk, a theoretically informed, 12-week person-centred dyadic behaviour change intervention to increase physical activity (PA) in community-dwelling people with stroke (PWS) through outdoor walking.DesignThree-phase intervention development study. Phase 1: we reviewed literature on barriers and facilitators to PA after stroke and mapped them to the Behaviour Change Wheel and Theoretical Domains Framework to define intervention components. The Health Action Process Approach determined intervention structure underpinned by person-centred principles. Phase 2: stakeholder focus groups involving PWS, their companions and health professionals reviewed the draft intervention, and experts in behaviour change were consulted. Phase 3: informed by phases 1 and 2, the intervention and form of delivery were refined, with final review through patient and public involvement.SettingThree Scottish community rehabilitation stroke services.ParticipantsTwenty-three ambulatory community-dwelling PWS and their companions, thirty-seven health and exercise professionals, seven behaviour change experts.ResultsPhase 1 determined key intervention components: information about benefits of walking; developing motivation and confidence to walk; facilitating dyadic goal setting and making plans together; monitoring walking, overcoming challenges; and maintaining walking behaviour. Phase 2 review by stakeholder focus groups and behaviour change experts endorsed intervention components and structure, emphasising dyadic relational aspects as central to potential success. In phase 3, intervention content and handbooks for PWS and buddies were finalised. Healthcare professionals proposed third-sector delivery as most appropriate for intervention delivery. A detailed delivery manual was developed. Participants preferred facilitated face-to-face and telephone delivery.ConclusionsOur multilens intervention development approach ensured this novel intervention was evidence-informed, person-centred, theoretically coherent provided appropriate social support, and addressed issues of concern to PWS. This study established intervention components and structure and identified operational issues critical to future success. Future research will pilot and refine We Walk and evaluate acceptability, feasibility, effectiveness and cost-effectiveness.Trial registration numberISRCTN34488928.

WeWalk: walking with a buddy after stroke—a pilot study evaluating feasibility and acceptability of a person-centred dyadic behaviour change intervention

“…WeWalk was underpinned by research into barriers and facilitators to post-stroke PA [22,23] and structured using the Behaviour Change Wheel [24], the Health Action Process Approach (HAPA) [25], and person-centred principles developed by one of the research team [26]. The target behaviour of WeWalk was specified as outdoor walking [21]. Detailed intervention development processes, underpinning theories and the intervention logic model are published elsewhere [21].…”

“…The target behaviour of WeWalk was specified as outdoor walking [21]. Detailed intervention development processes, underpinning theories and the intervention logic model are published elsewhere [21]. Briefly, the work evolved from formative qualitative research by the team and from systematic reviews of the literature on physical activity promotion after stroke.…”

“…In this way, HAPA provided a framework for delivery of the components of WeWalk. We designed WeWalk as a person-centred intervention, using person-centred principles to guide delivery by the facilitator to ensure WeWalk aligned with participants' values, and facilitated their engagement in walking activities in ways that were meaningful to them and their context [21]. The initial intervention was developed and refined through consultation with PWS, their family members and health professionals, before review by experts in behaviour change.…”

“…The facilitator supports dyads to identify, enact and review meaningful walking goals for PWS, address challenges and plan for long-term maintenance of walking. Detailed intervention development processes are published elsewhere [21]. This study aimed to pilot WeWalk as the final stage of intervention development.…”

Effectiveness of a theory-based behavior change intervention on physical activity in patients with chronic obstructive pulmonary disease

“…It consists of three layers, in which the core is the COM-B ('capability', 'opportunity', 'motivation' and 'behavior') model. Currently, BCW has been widely used in the design of many interventions, including health-related behaviors such as smoking cessation [22] , healthy diet [23] , physical activity [24] , and reduction of alcohol intake [25] . However, no study in China has used the theoretical framework of BCW to improve PA behavior among COPD patients.…”