Abstract
BACKGROUND: The e-coachER trial aimed to determine whether adding web-based behavioural support to exercise referral schemes (ERS) increased long-term device-measured physical activity (PA) for patients with chronic conditions, compared to ERS alone, within a randomised controlled trial. This study explores the mechanisms of action of the e-coachER intervention using measures of the behaviour change processes integral to the intervention's logic model.
METHODS: Four hundred fifty adults with obesity, diabetes, hypertension, osteoarthritis or history of depression referred to an ERS were recruited in Plymouth, Birmingham and Glasgow. The e-coachER intervention comprising 7-Steps to Health was aligned with Self-Determination Theory and mapped against evidence-based behaviour change techniques (BCTs). Participants completed questionnaires at 0, 4, and 12 months to assess PA and self-reported offline engagement with core BCTs in day-to-day life (including action planning and self-monitoring) and beliefs relating to PA (including perceived importance, confidence, competence, autonomy and support). We compared groups at 4 and 12 months, controlling for baseline measures and other covariates. Mediation analysis using the product of coefficients method was used to determine if changes in process variables mediated intervention effects on moderate to vigorous physical activity (MVPA) recorded by accelerometer and self-report at 4- and 12-months.
RESULTS: The internal reliability (Cronbach's alpha) for all multi-item scales was > 0.77. At 4-months, those randomised to e-coachER reported higher levels of PA beliefs relating to importance (1.01, 95% confidence interval (CI): 0.42 to 1.61, p = 0.001), confidence (1.28, 95% CI: 0.57 to 1.98, p < 0.001), competence (1.61, 95% CI: .68 to 2.54, p = 0.001), availability of support (0.77, 95% CI: 0.07 to 1.48, p = 0.031), use of action planning (1.54, 95% CI: 0.23 to 2.85, p = 0.021) and use of self-monitoring (0.76, 95% CI: 0.19 to 1.32, p = 0.009) compared to ERS alone. There were no intervention effects on autonomous beliefs or perceived frequency of support, compared to ERS alone. At the 12-month follow-up, participants belief in the importance of PA was the only process measure to remain significantly higher in the e-coachER group when compared to ERS alone (0.75, 95% CI: 0.05 to 1.45). Intervention effects on perceived importance (2.52, 95% CI: 0.45 to 5.39), action planning (1.56, 95% CI: 0.10 to 3.54) and self-monitoring (1.92, 95% CI: 0.21 to 4.33) at 4-months significantly mediated change in accelerometer measured MVPA at 12-months (recorded in ≥ 10-min bouts).
CONCLUSIONS: e-coachER led to some short-term changes in most process outcomes. Some of these processes also appeared to mediate e-coachER effects on changes in accelerometer measured MVPA. Further work should be carried out to understand how best to design and implement theoretically underpinned web-based physical activity promotion interventions within ERS.
TRIAL REGISTRATION: ISRCTN, ISRCTN15644451 . Registered 12 February 2015.
| Original language | English |
|---|---|
| Article number | 128 |
| Journal | International Journal of Behavioral Nutrition and Physical Activity |
| Volume | 19 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 29 Sept 2022 |
Bibliographical note
Funding Information:We thank the Research Design Service South West, especially Andy Barton, for assisting with the funding application. We are grateful to the participants, the general practitioners and exercise professionals who supported the study, giving so generously of their time and sharing their experience with us. Likewise, the practice managers and administrative staff at all the collaborating practices. We would like to thank several people who contributed to the completion of the study, including Jennie King, Lucy Hughes, Hayley O’Connell, Nigel Charles and Rohini Terry who worked as researchers for the study. We thank Mary Steele and Ben Ainsworth for intervention development and data capture. Also, Melvyn Hillsdon and Brad Metcalf who provided valuable input into the analysis of accelerometer data, and Ben Jones for support in conducting the statistical analysis. We thank Ray Jones for his insights into digital interventions, and Jane Vickery who supported the Peninsula Clinical Trials Unit (PenCTU) trial management team. Also within the PenCTU, thanks go to Laura Cocking for overseeing the PenCTU data team, Brian Wainman and Mark Warner for data management, and Douglas Webb for trial management. We thank co-applicants Ben Jane, Jo Erwin, Paul Little and Anthony Woolf for their insights into commissioning and delivery of exercise referral scheme associated with the NHS. We thank the exercise referral scheme managers and employees at the NHS Greater Glasgow and Clyde Health Board (LiveActive ERS), Birmingham City Council (BeActive ERS) and Plymouth City Council (Everyone Active ERS) who provided valuable assistance to us throughout the study. We thank the Plymouth City Public Health team for ensuring that participants within the study were eligible for a subsidy while attending the exercise referral scheme. We thank the external members of the Trial Steering Committee (Sharon Simpson (Chair), Mark Kelson and Charlie Foster) and the Data Monitoring Committee (Paul Aveyard (Chair), Anne Haase and Richard Morris) for their advice and support throughout the study, and Chris Cavanagh as patient and public involvement representative.
Keywords
- Accelerometer
- Chronic conditions
- Exercise referral scheme
- Physical activity
- Self-determination theory
- Web-based support
ASJC Scopus subject areas
- Medicine (miscellaneous)
- Physical Therapy, Sports Therapy and Rehabilitation
- Nutrition and Dietetics
