Background
Methods
SMART MOVE trial
‘SMART MOVE’ Trial
| |
Registered with the International Standard Randomised Controlled Trials Register #ISRCTN99944116 and ethical approval obtained. | |
90 Participants recruited by primary care health professionals or self-referred. Screened by the research team for inclusion suitability. | |
Inclusion criteria: • Adult participants in the community • Over 16 years of age • Active android smartphone participants | Exclusion criteria: • Acute psychiatric illness • Pregnant women • Participants unable to undertake moderate exercise |
At baseline screening meeting, participants were given study information, signed consent, were randomised and completed quality of life and mental health score questionnaires. BMI, blood pressure and heart rate were measured. Smartphone application Accupedo-Pro Pedometer was downloaded onto the smartphones but step count display was not made visible. | |
Week 1: All participants continued their normal activity level while carrying the smartphone during all waking hours so the smartphone application could record their baseline step count while remaining invisible to the participant. | |
End of week 1: Randomisation code broken and participants assigned to control or intervention groups. | |
Control Group: • Smartphone application with step count continues to remain invisible • Given information on benefits of exercise • Instructed to increase physical activity with a goal of an additional 30 min walking exercise per day (equivalent to 10,000 steps per day) | Intervention Group: • Smartphone application and step count made visible (Fig. 1) • Given information on benefits of exercise • Instructed to increase physical activity with a goal of 10,000 steps per day and encouraged to use the smartphone application to achieve this goal |
After completion of eight-week trial: Quality of life and mental health score questionnaire administered and BMI, blood pressure, heart rate recorded. Quantitative results were analysed with the Statistical Package for the Social Sciences (SPSS) for primary outcome of mean difference in daily step count between baseline and follow-up at eight weeks and also secondary outcomes. After trial completion, all control groups participants were then also shown how to use the App | |
A qualitative evaluation was then carried out by interviewing a purposeful sample of post-trial participants to explore their experiences within four weeks of finishing the trial. |
Sampling and recruitment
Participant code | Intervention or Control | Age range | Gender |
---|---|---|---|
P1 | Intervention | 50–60 | F |
P2 | Intervention | 50–60 | M |
P3 | Intervention | 30–40 | F |
P4 | Control | 60–70 | F |
Data collection
In the topic guide, the term “App” is used to refer to the smartphone application under study. | |
Coherence is about sense making. 1. Did you have a clear understanding from the outset of how this intervention would benefit patients? 2. What strategies have you used previously to increase exercise amongst patients in the practice? 3. How does the App differ from previous strategies? 4. Do you think that one of your important professional roles is the discussion and promotion of increased activity levels with your clients/patients? 5. In your opinion, does the promotion of this strategy fit well with the overall goals and activity of your medical practice? Cognitive Participation is about engagement/‘buy in’: 1. How did you get involved and who told you about the idea? 2. Why was it right for you to get involved and promote this to your patient/clients? 3. Were you prepared to commit the time and effort to promote its use amongst patients/clients? 4. Who was driving this forward/encouraging involvement in this work? Collective action is about actions and interactions that are required to use the intervention: 1. Did the promotion of the App fit easily with your daily work practices or did you have to change your usual way of working/consulting with patients? 2. Can you talk about the training/education you received from the outset ….was this helpful/unhelpful and if so, in what ways? 3. What did you find easy and what did you find difficult about promoting the use of the App to your clients/patients? 4. Did you have to work with others to promote the use of the App – who? What was that experience like? Reflexive monitoring is about appraisal and evaluation: 1. Do you feel that using the App is an effective and worthwhile way to increase activity levels amongst patients and if so how do you know? 2. Can you tell about some of the feedback you’ve had from clients/patients who have used the App. 3. Do you have any suggestions for improving the promotion and use of the App amongst your clients/patients? 4. Is there anything you would do/do differently now in your consultations to promote the use of the application to patients? |
In the topic guide, the term “App” is used to refer to the smartphone application under study. | |
Coherence: 1. Can I take you back to the ‘life before the trial (!)’ can you tell me about other strategies you have used in the past to increase your exercise 2. In what way was the idea of using the App different from these other strategies? Cognitive participation is about engagement/‘buy in’: 1. How did you get involved - who told you about the idea? 2. Can you tell me why you thought it was right for you to get involved in the trial and to give this App a go? Collective action is about actions and interactions that are required to use the intervention: 1. Now let’s focus on when you were starting to use the App itself, can you talk to me about starting to use it and the strategies that made it easy to do so and difficult to do so? 2. What was your sense of trust in the App as a device to support/stimulate your exercise routines? 3. Can you tell me about the different skills you needed to use the App? (develop some prompts here based on your knowledge of the different tasks that people had to perform to use the App) 4. What are your thoughts about using the App once/now that the trial is over? Reflexive monitoring is about appraisal and evaluation: 1. Was using the application an effective and worthwhile way to improve your exercise? 2. How do you know? 3. Is it worthwhile to keep using the App now that the trial is over? |
Methodological considerations
Data analysis
Quality and rigour
Results
Theme 1: Strategies to promote exercise - personal and professional (sense-making work)
“No, again nothing formal, I suppose I might have you know outlined the benefits of weight bearing activities such as walking but I suppose nothing prescriptive or anything like that no.” [Dr 3]
“I was a bit shocked because I wasn’t doing as much running around as I thought I was doing.” [P3]
“I think it’s a difficult thing to engage with patients, I’ve always found it, I’ve never been particularly comfortable around raising issues around exercise and weight....” [Dr 1]
“What was attractive about this was the sort of more neutral conversation you could have, …didn’t have to necessarily be associated with a conversation about them being obese, overweight or anything like that…..” [Dr 1]
Theme 2: Roles and responsibilities to support active engagement with the app (participation work)
“I hoped to ….incorporate fitness into my lifestyle really ….unless it’s the walk with the kids or something like that, (exercise) was incidental….So basically I wanted it to incorporate (the App) so I would have some exercise throughout, a regular exercise during the week and that I’d be able to continue it after the study, that was the aim.” [P3]
“I think it is a good, you know to use because it’s quantifiable. You can see the amount of steps, it’s measurable. You know there's a definitive guide there.” [PN2]“I think if you're going into a doctor’s surgery and it is a wonderful aid and it is a great awareness for someone, you know so you can say yes this is the goal of 10,000, you’re back here at 2,000 so in the next few weeks we’re going to try and see can you go from 2,000 to maybe 4,000 and 6,000, 8,000 up, give a step by step approach.” [P3]
“I hated going out in the dark but I have gone out as far as the road and back to get my steps and I also had a, there’s a stepper upstairs and I went on that a few times…..My behaviour completely changed.” [P1]
“My apprehension is that people will come in for their smartphone you know to talk about but then they’ll start looking for medication and blood pressure and everything else along with it and then your consultation time is going to run over. So you know that’s one fear I have.” [PN2]
“I find a good barometer of the level of enthusiasm for this type of intervention is the haste with which the patient wants to get off that entire subject.” [Dr 3]
“We all, you know decided to engage with the process and I think it probably changed all our approach to the issues around weight and exercise….we’re all raising the topic a bit more and recording BMI… it has changed the way we operate as a team.” [Dr 1]
“Maybe if a suggestion that a doctor or the nurse could make it known that if the patient had any problems that the admin staff are there to help…but it’s not your place to approach them.” [NCS 2]
Theme 3: Utilisation challenges (enacting work)
“You know which is nice, it’s very clear, like it’s a very accessible app to most people because there isn’t much vocabulary involved, there isn’t much text involved in it, it’s all very clear, so for that reason I think it’s very accessible to most people.” [P3]“Anybody could use it…..if you could dial a number on a phone you could use it because it's on the screen and it just works.” [PN2]
“Yeah, well like I’ve said they liked that they could set goals for themselves, they liked that they could look back and see what the previous day had, how they had done on previous days.” [PN1]
“The daily graph because there was a kind of recognition of what you were doing a visual recognition of what you were doing.” [P1]
“But the negative feedback as I said was all to do with the battery drainage.” [PN2]“Well number one the battery (was) the biggest problem I had so I found myself then having to remember to keep charging it. I bought a charger for the car so that I could do it continuously….when it did get up and going and when you had access to it and were able to handle the technology yourself I found things did work better.” [P2]
“I think you have to realise that it is just an app and it is technology and technology isn’t going to be 100% the whole time and technology can be manipulated as well ….you just have to have a sense of honesty and trust in yourself, you know where you’re at and that’s it.” [P3]
“I think it’s simple…as you know a 30 second conversation…oh yeah we’re talking about exercise, there’s this really good app that I know about that counts your steps and gives you feedback on your exercise, would you be interested in it…ok go and have a conversation with the practice nurse about it…” [Dr 1]
Theme 4: Evaluation, adoption and adherence (reflexive monitoring)
“I just think that because you have full control of it yourself its useful because lots of people don’t like to join clubs or they don’t like to join weight watchers, or they don’t like to join exercise programs or groups. But you have control of this yourself. And you can just do it privately and nobody need know anything about it. And you can motivate yourself with yourself and nobody else. It doesn’t cost anything, it’s completely free. And even if you fall off and stop working at it today you can always start a month down the line or three weeks down the line or whenever. You can re-start just get yourself into gear and get going again.” [P4]
“I don’t carry it around with me all the time but I’m more aware now, ok I have a sense of right I know roughly how many steps I have now and I really need to go for a walk, or I really need to go for a long walk this evening, you know that type of way.” [P3]“I have to say that that app has… it’s kind of changed me…..I don’t know how I’d be if I turned it off. I won’t turn it off, not for the moment anyway. I am quite happy to have it on because I am much more conscious of going out for that walk.” [P1]
“Well I think the way has been simplified …… the best idea is to keep it simple…it’s not a magic pill, it’s just something extra to have, another conversation you can have, it’s another little prod that you can give in the right direction…non-judgmental way, provides a neutral space to talk about the issue…I think it’s just something extra.” [Dr1]“I suppose the confidence that working with it has brought, you know…you feel a bit more enthusiastic and you feel confident about being able to talk to patients about it.” [PN 1]
“We saw effects in the community in terms of a walking group and running group that was formed by somebody who was involved, who downloaded the application.” [Dr 1]
“I think the last thing is that the person who is spearheading the whole thing has to kind of lead by example themselves.” [Dr 4]