Background
Methods
Aim, design and setting
Materials and processes
Findings
Contributions of the study towards intervention development
Findings
Contributions of the study towards intervention development
Findings
Contributions of the study towards intervention development
Findings
Contributions of the study towards intervention development
Models and frameworks informing the study
Behaviour change wheel
Intervention functions | Definition |
---|---|
Education | Increasing knowledge or understanding |
Persuasion | Using communication to induce positive or negative feelings or stimulate action |
Incentivisation | Creating expectation of reward |
Coercion | Creating expectation of punishment or cost |
Training | Imparting skills |
Restriction | Using rules to increase the target behaviour by reducing opportunity to engage in competing behaviours |
Environmental restructuring | Changing the physical or social context |
Modelling | Providing an example for people to aspire to or imitate |
Enablement | Increasing means/reducing barriers to increase capability (beyond education and training) or opportunity (beyond environmental restructuring) |
Policies | |
Communication/marketing | Using print, electronic, telephonic or broadcast media |
Guidelines | Creating documents that recommend or mandate practice. Includes changes to service provision |
Fiscal | Using the tax system to reduce or increase the financial cost |
Regulation | Establishing rules or principles of behaviour or practice |
Legislation | Making or changing laws |
Environmental/social planning | Designing/controlling the physical or social environment |
Service provision | Delivering a service |
Use of the behaviour change wheel
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Step 1: Define the problem to be addressed in behavioural terms.
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Step 2: Select the target behaviour(s), i.e., the behaviours most likely to bring about change to address the problem.
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Step 3: Specify the target behaviour(s) in as much detail as possible.
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Step 4: Identify what component needs to change using the COM-B model.
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Step 5: Select the relevant intervention functions from the following list:education; persuasion; incentivisation; coercion; training; restriction; environmental restructuring; modelling and enablement (based on an assessment of the APEASE criteria: affordability, practicability, effectiveness, acceptability, side effects and safety, and equity) (Table 2).
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Step 6: Select the applicable policy categories to sustain the delivery of the identified intervention functions based on the APEASE criteria.
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Step 7: Select the relevant BCTs based on the APEASE criteria.
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Step 8: Select the mode(s) of intervention delivery based on the APEASE criteria, and confirm the intervention content.
Criterion | Description |
---|---|
Affordability | The ability of the intervention to meet the expense of the intervention. An intervention is affordable if the budget of the intervention allows it to be delivered to, or accessed by, all those for whom it is intended. |
Practicability | The viability of the intervention. A practicable intervention is one that can be delivered as designed through the means intended to the target population. |
Effectiveness and cost-effectiveness | The effect size of the intervention in relation to the desired objectives in a real world context. Cost-effectiveness refers to the ratio of effect to cost. |
Acceptability | The extent to which relevant stakeholders (public, professional and political) judge an intervention appropriate. |
Side-effects/Safety | An intervention may be effective and practicable but have unwanted or unintended consequences. This needs to be taken into consideration when planning the intervention. |
Equity | The extent to which an intervention may reduce or increase the disparities in standard of living, wellbeing or health between different sectors of society. |
NB: to fully understand the use of the BCW in designing interventions, the steps and the associated tables, the reader is referred to Michie et al. [29]
Results
The theoretical underpinning of the intervention
Stage 1: understand the behaviour
Question | Answer |
---|---|
What behaviour? | Increasing physical activity among PLWHA of low SES. |
Where does the behaviour occur? | At the community centre; at home. |
Who is involved in performing the behaviour? | HIV positive women of low SES at a community centre. |
Potential target behaviours relevant to improving PA engagement among PLWHA of low SES | Impact of behaviour change | Likelihood of changing behaviour | Spill over score | Measurement score |
---|---|---|---|---|
Walking, e.g., to and from church, the store, etc. |
Very promising
|
Very promising
|
Very promising
| Very promising |
Simple home-based exercises. |
Very promising
|
Very promising
|
Very promising
| Very promising |
Activities of daily living. |
Very promising
|
Very promising
|
Very promising
| Very promising |
Exercising at the community centre |
Very promising
|
Very promising
|
Very promising
| Very promising |
Exercising during leisure (e.g., actively participating in organised sport) |
Unpromising but worth considering
|
Unpromising
|
Unpromising
| Unpromising |
Purpose: To describe the target behaviour according to who needs to do the behaviour, what needs to be done, when it needs to be done, where it needs to be done, how often and with whom | |
---|---|
Target behaviours | Walking to-and-from places; Doing simple home-based exercises and engaging in physical activity through activities of daily living; Doing simple exercises at the community centre. |
Who needs to perform the behaviour? | PLWHA of low SES |
What do they need to do differently to achieve the desired behaviour? | Walk at a moderate-to-vigorous intensity instead of using motorised transport; do home-based exercises; Do simple home-based exercises and activities of daily living at a moderate-to-vigorous intensity; Do simple exercises at the community centre at a moderate-to-vigorous intensity; seek out opportunities for being more active around the home, such as performing domestic chores, e.g., gardening, etc. |
When do they need to do it? | When going to-and-from places; during free time at home; during free time at the community centre. |
Where do they need to do it? | When going to-and-from places; at home; at the community centre. |
How often do they need to do it? | Whenever going to-and-from places; at least once every other weekday for at least 30 min or bouts of 10 min accumulatively. |
With whom do they need to do it? | Alone/in a group; alone/ with family and friends; with the exercise leader and other participants attending the community centre. |
Purpose: To identify what needed to change for PLWHA of low SES to engage in PA, Using the COM-B model | |||
---|---|---|---|
COM-B components | What needed to happen for the target behaviour to occur? | Is there a need for change? | Example of participant statement in focus group discussions to support inclusion |
Physical capability
| Developing the physical skills to perform the exercises, such as teaching participants how to correctly do sit-ups. | Yes, change was needed, as most PLWHA of low SES do not possess these skills. | “I do not know which exercises to do, …” |
Psychological capability
| Developing knowledge of exercises, the correct techniques used and the appropriate intensity. | Yes, change was needed in terms of knowledge of cost-effective home-based exercises, exercise technique and intensity. | “…, I do not have the information about exercising” |
Physical opportunity
| Accessing time, resources and locations to exercise and understanding when an opportunity to engage in PA presents itself. | Yes, participants needed to know the opportune time to exercise, the resources available and when and where to exercise. |
“I simply do not have the time, I come to the community centre every day in the morning, leave late, then at home I have to focus on the domestic chores”
|
Social opportunity
| Increasing social support from family and friends for engaging in PA | Yes, change was needed so that PLWHA of low SES can make use of social support to engage in PA |
“Let’s exercise as a group here at the community centre and, then, we can exercise alone at home”
|
Reflective motivation
| Instilling beliefs that engaging in PA will help manage HIV/AIDS by teaching the participants about the importance of PA in managing HIV and HAART-related complications. | Yes, change was needed as most PLWHA of low SES do not know the benefits of PA for managing HIV/AIDS. |
“I thought exercising was for fat individuals, I have already lost weight, due to the disease, so I thought exercising might worsen the situation”
|
Automatic motivation
| Establishing routines and habits for engaging in PA. Automatic motivation would also be derived from weight control, being more energetic, performing activites of daily living (ADLs) a lot easier, and enhanced quality of life (QoL) | Yes, change was needed to establish routines and habits. Change was also needed for compliance and sustainability of the programme. |
“I think we must record our exercise activities somewhere so that we keep track of the exercises we do”
|
Behavioural analysis of the relevant COM-B components | Physical capability, psychological capability, physical opportunity, social opportunity, and reflective and automatic motivation needed to change for the target behaviour to occur. |
Stage 2: identification of intervention options
Candidate intervention functions | Does the intervention function meet the APEASE criteria in the context of engaging PLWHA of low SES in PA? | Application of intervention function based on the studies identified in the systematic literature review [22] |
---|---|---|
Education | Yes, since it was practicable, as there was time available to teach PLWHA about the benefits of PA; about simple and cheap home-based exercises; about the barriers to PA and how to deal with them; as well as about the social support and self-efficacy for PA. | |
Persuasion | Yes, since it was likely to add value to the intervention. However, none of the researchers were trained to apply persuasive messages to motivate participants into adopting PA. | None of the studies |
Incentivisation | Yes, since the use of incentives can motivate participants to adhere to the intervention. Food and fruit packs could be used for incentivising. | [49] |
Coercion | No, since it does not stimulate the desired autonomous behaviour and can have legislative implications. | None of the studies |
Training | Yes, since it was practicable, as there was time to impart exercising skills to participants. Training could be used to teach participants simple home-based exercises or simple exercises to do at the community centre. | [48] |
Restriction | No, since it was not practicable, as there was not enough opportunities to apply this intervention function. Resources available did not permit the employment of this function in the intervention. | None of the studies |
Environmental restructuring | No, the theoretical frameworks informing the intervention (SCT and TTM) did not allow use of this intervention function (it applies to the Socioecological Model). | [52] |
Modelling | Yes, it was practicable to demonstrate how to do the simple home-based exercises and exercises at the community centre. | |
Enablement | Yes, it was practicable in order to increase the means for PA participation and reduce the barriers. | |
SELECTED INTERVENTION FUNCTIONS: Education; incentivisation; training; modelling; enablement |
Study | Specific physical activity behaviours targeted by intervention | Educational component and its focus | Intervention function/s | Policy category | Mode of delivery | Tailoring | Exercise tracking and monitoring |
---|---|---|---|---|---|---|---|
Albright et al. [43] | Teaching participants to accumulate 30 min of moderate-intensity PA e.g. walking 5 days a week. | Used eight 1-h weekly behavioural skill-building classes to inform and motivate women to become more physically active. | Education | Guidelines Service provision | Mailing Phone | Curriculum for the education component was designed to be culturally sensitive for the Latina population. | Pedometers PA self-monitoring logs |
Dutton et al. [44] | Taking the stairs; promoting walking; gardening; dancing | Not specified or N/A | Enablement | Service provision | Mailing Phone | Development of individualised goals; Intervention materials were tailored for each participant; recommendations were tailored to the individual’s current activity levels, activity preferences and capabilities. | N/A |
Emmons et al. [47] | Not specified or N/A | Taught participants on the social meanings of PA; social support | Enablement | Service provision | Mailing Phone | Intervention takes into account elements of the social context in which participants live. | N/A |
Hovell et al. [48] | Not specified or N/A | Included exercise education; proper foot wear; hydration; proper posture; proper attire; importance of warm-up/cool down; exercise safety; injury prevention; treatment of minor injuries; heart-healthy diet and exercise health benefits. | Education Training | Service provision | Face-to-face | Exercise education was culturally appropriate for low-literacy Latinas. Intervention took into consideration participants’ personal concerns. | Heart rate monitors |
Keyserling et al. [46] | Chair exercises | Taught problem solving skills; social support; lifestyle behaviour change strategies | Training Education Enablement | Service provision | Mailing Phone Face-to-face | Development of an individualised action plan. | Pedometer |
Lowther et al. [49] | Not specified or N/A | Not specified or N/A | Enablement | Service provision | Face-to-face | Not specified or N/A | Not specified or N/A |
Marcus et al. [50] | Not specified or N/A | Tip sheets on selected topics e.g. stretching; measuring heart rate | Education Enablement | Service provision | Mailing | Individually tailored feedback reports. The intervention addressed PA barriers identified by Latinas in focus group discussions. | Pedometers PA logs |
Pekmezi et al. [51] | Not specified or N/A | Not specified or N/A | Enablement | Service provision | Mailing | PA manuals were matched to participant’s current level of motivational readiness and participants were given individually tailored feedback. | Pedometers PA logs |
Pekmezi et al. [45] | Walking | Not specified or N/A | Enablement | Service provision | Mailing Phone | Personalised letters sent to participants; Messages tailored to the participant’s motivational readiness. | N/A |
Webel et al. [52] | Was dependent on the outcome of participant’s small self-designed experiments to improve health | Taught systems thinking; self-monitoring and goal setting; lifestyle routines; systems improvement strategies and social support; PA and self-experiments; patterns of exercise, types of fitness and testing small experiments; sleep; mental wellness behaviours; personal time; relapse prevention | Education Enablement | Service provision | Face-to-face | Included challenges specifically faced by PLWH. Individual participants determined and evaluated their own behaviour change. The intervention was culturally adapted. | Diaries of daily activities |
Whitehead et al. [53] | Not specified or N/A | Not specified or N/A | Enablement | Service provision | Mailing | Used individually tailored letters | N/A |
Intervention function | COM-B component | Potentially useful policy categories | Does the policy category meet the APEASE criteria? |
---|---|---|---|
Education
| Psychological capability; reflective motivation | Communication/marketing | Too expensive, since persons of low income are more likely to be of low literacy levels, as well as being unemployed, so they may not be able to read or access relevant information, including communication technologies. |
Guidelines | No, PA guidelines for PLWHA already exist. | ||
Regulation | Possibly in the long term, but not at the present time, because rules or principles of practice can only be established over time. | ||
Legislation | Not practicable in this context, as the intervention does not aim to make or change laws. | ||
Service provision | Yes, and very practicable, because the intervention designers aim to deliver a service to PLWHA of low SES. | ||
Incentivisation
| Reflective motivation; automatic motivation | Communication/marketing | Too expensive, since the participants are of low income or unemployed and of low literacy levels and not able to read or afford information communication technologies. |
Guidelines | No, PA guidelines for PLWHA already exist. | ||
Fiscal measures | Not relevant in this context, this policy uses the tax system to reduce or increase the financial cost in order to change behaviour. | ||
Regulation | Possible in the long term, but not present moment, because this policy seeks to establish rules or principles of behaviour. | ||
Legislation | Not practicable in this context, since the intervention does not seek to make or change laws. | ||
Service provision | Yes, very practicable, because the intervention designers aims to deliver a service to PLWHA of low SES. | ||
Training
| Physical capability; psychological capability; automatic motivation; physical opportunity | Guidelines | No, PA guidelines for PLWHA already exist. |
Fiscal measures | Not relevant in this context, since this policy uses the tax system to reduce or increase the financial cost in order to change behaviour. | ||
Regulation | Possible in the long term, but not at the present time, because rules or principles of practice can only be established over time. | ||
Legislation | Not practicable in this context, since the intervention does not seek to make or change laws | ||
Service provision | Yes, very practicable, because the intervention designers aim to deliver a service to PLWHA of low SES. | ||
Modelling
| Psychological capability; reflective motivation; automatic motivation; social opportunity | Communication/marketing | Too expensive, since the participants are of low income or unemployed and of low literacy levels so they may not be able to read or afford information communication technologies |
Service provision | Yes, very practicable, because the intervention designers aim to deliver a service to PLWHA of low SES. | ||
Enablement
| Psychological capability; reflective motivation; automatic motivation; physical opportunity; social opportunity | Guidelines | No, PA guidelines for PLWHA already exist |
Fiscal measures | Not relevant in this context, since this policy uses the tax system to reduce or increase the financial cost in order to change behaviour. | ||
Regulation | Possible in the long term, but not at the present time, because rules or principles of practice can only be established over time | ||
Legislation | Not practicable in this context, since the intervention does not seek to make or change laws. | ||
Service provision | Yes, very practicable, because the intervention designers aim to deliver a service to PLWHA of low SES. | ||
Policy category selected: Service provision |
Stage 3: identifying intervention content and implementation options
BCTs identified in the systematic review | BCTs identified through the BCW |
---|---|
Provide information on the consequences of the behaviour to the individual | Information about health consequences |
Provide information on the consequences of the behaviour in general | |
Provide feedback on the performance | Feedback on the behaviour |
Prompt review of the outcome goals | Feedback on outcomes of the behaviour Goal-setting outcome |
Prompt self-monitoring of the behavioural outcomes | Self-monitoring of the behaviour |
Prompt self-monitoring of the behaviour | Self-monitoring of the behaviour |
Model/Demonstrate the behaviour | Demonstration of the behaviour |
Provide instruction on how to perform the behaviour | Instruction on how to perform the behaviour |
Plan social support/social change | Social support (unspecified) Social support (practical) |
Goal-setting behaviour | Goal-setting behaviour |
Prompt review of the behavioural goals | Review the behavioural goals |
Action planning | Action planning |
Mode of delivery | Does the mode of delivery meet the APEASE criteria in the context of increasing PA for PLWHA of low SES? | |||
---|---|---|---|---|
Face-to-face | Individual | Yes | ||
Group | Yes | |||
Distance | Population level | Broadcast media | TV | These modes of delivery are not relevant, as PLWHA of low SES are unlikely to have access to phones, computers or be exposed to other forms of media. |
Radio | ||||
Outdoor media | Billboard | |||
Poster | ||||
Print media | Newspaper | |||
Leaflet | ||||
Digital media | Internet | |||
Mobile phone application | ||||
Individual level | Phone | Phone helpline | ||
Mobile phone text | ||||
Individually accessed computer programme |