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Title: Using the behaviour change wheel to develop interventions to increase physical activity in adults with persistent musculoskeletal pain and improve the promotion of physical activity by healthcare professionals
Author: Marley, Joanne
ISNI:       0000 0004 6061 0214
Awarding Body: Ulster University
Current Institution: Ulster University
Date of Award: 2017
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Individuals with persistent musculoskeletal pain have an increased risk for developing a range of co-morbid health conditions and for all-cause early mortality. Improving levels of physical activity could attenuate such risks. Furthermore, physical activity and/or exercise can reduce pain and disability associated with persistent pain and are key treatment recommendations across many clinical guidelines. Improving levels of physical activity requires behaviour change. Whilst an individual plays a key role in changing his or her behaviour, healthcare professionals and non-NHS service providers can also play a pivotal role in supporting health behaviour change. This PhD thesis describes the development and optimisation of two evidenced-based multifaceted behaviour change interventions. The Active Living with Persistent Pain Programme designed to help individuals with persistent pain to become more physically active. And the Active Living with Persistent Pain - Training Programme, which targets the promotion of physical activity by healthcare professionals working in pain services. The behaviour change wheel was used to guide and inform intervention development which involved the use of several methodological approaches. A systematic review and meta-analysis was conducted to establish the effectiveness of interventions in changing physical activity levels in individuals with persistent pain. The content of the interventions was coded according to a 93-item behaviour change technique taxonomy. Focus groups based on the theoretical domains framework explored factors influencing target behaviours. Specifically, engagement in physical activity for individuals living with persistent pain (n=18), and the promotion of physical activity by healthcare professionals (n=6), charity staff/volunteers (n=8) and exercise professionals (n=6). The behaviour change wheel guided the systematic selection of intervention functions, policy categories, behaviour change techniques and the modes of delivery. An optimisation phase was conducted through participatory workshops using consensus methods. One workshop was held with individuals with persistent pain (n=20) and a second with healthcare professionals (n=52). Findings from the review indicated interventions are most effective in improving subjectively measured physical activity for up to six months post-randomisation. Twenty- eight unique behaviour change techniques were identified as present across the included studies. Using the theoretical domains framework several factors were found to impact on the target behaviours. Although the results varied across the different participant groups, the following domains were frequently coded: 'environmental context and resources' 'Knowledge', 'beliefs about consequences' and 'belief about capabilities'. Using these results, and guided by the behaviour change wheel, two multifaceted interventions were developed incorporating delivery of 38 behaviour change techniques in the Active Living with Persistent Pain Programme and 30 behaviour change techniques in the Active Living with Persistent Pain - Training Programme. Following optimisation, these were refined to the delivery of 32 and 24 behaviour change techniques, respectively. This thesis addresses gaps in knowledge regarding how behaviour change interventions should be developed and how health and social care staff can be supported to deliver behaviour change interventions. The results add to both the pain literature and the behaviour change literature by describing and specifying the design, content and a proposed mechanism of action for two theoretically informed behaviour change interventions. Recommendations for enhancing the role of non-NHS service providers in promoting physical activity for those with persistent musculoskeletal pain are also reported.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available