Chapter 5: Study 3 - Development of the Exertime intervention

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Responsive learning environments

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Chapter 5: Study 3 - Development of the Exertime intervention

Protocol paper:

METHOD

Analysis

MAINTENANCE

IMPLEMENTATION

Treatment Fidelity Framework

ADOPTION

EFFICACY

2 x 2 x 2 Design so that know which mechanisms were effective

REACH

TABLE mapping BCTs and operationalisation

Designed using BCW and co-design desribed elsewhere

INTRO

Discussion prev lit all focused on decreased sitting

Using RE-AIM as process evaluation (not just efficacy important), and in line with other recommendations – see MacDonald et al., 2018. So can be compared and add to literature base.

Combined approach of theory-based co-design, and implementation based processes

AIM: To describe the protocol for the Exertime RCT

OBJ 3: To outline the use of the RE-AIM framework to evaluate the Exertime intervention

OBJ 2: To understand the value of behavioural regulation and social influence mechanisms in the Exertime intervention

OBJ 1: To use the TIDieR checklist to report the Exertime intervention and ensure high quality description

Exertime intervention description (Results)

Measures of Change / Analysis

Procedure

Describe, operationalise and justify BCTs: Environmental cues and promps / instruction on how to perform a behaviour / self-monitoring / social support

Descriptive norms (Kim et al., 2017 PA; Preibe & Spink, 2011 SB)

Raising awareness - sitting invisible (Gardner et al., 2019)

Conceptualisations of mechanisms

Intervention Design Process (Method)

The Behaviour Change Wheel

Double Diamond 2

DD Phase 3 DELIVER, DEVELOP, DELIVER [STAGE 4]

DEVELOP relationships with those assisting and DELIVER STAGE 4 = start with identifying SPOCs?

DELIVER sessions to supervisors

DD DEVELOP [STAGE 3]

Presented options for software to the steering group

Double Diamond 1

DD Phase 2 DISCOVER and DEFINE [STAGE 2]

Final intervention descrption

Feasibility of options through shift shadowing

I assessed feasbility through my own judgement? No progression criteria were applied, no one has checked the software actually fits with funcitonality of critical computer systems...

BCW = DD Phase 1 DISCOVER and DEFINE [STAGE 1]

STEP 3: Identify content (Behaviour change techniques) and implementation options

Identify mode of delivery

Discuss with supervisors

Present options to steering group, with consideration of criteria

STEP 2: Identify intervention options

Policy categories

Identify what you want intervention to do: Modelling and Environmental restructuring. APEASE criteria

STEP 1: COM-B: Understand the behaviour

Identify what needs to be changed

TDF optional step

Specify target behaviour by discussing / justifying focus with supervisory team

Select target behaviour

Defining the problem

Discussion

Chapter 6??

Changing personnel (6 month role rotation?)

Covid-19 section

Personal reflection

Context completely changed (social norms as influential now?)

Things the intervention couldnt do, but would have

Objective measures - blood pressure, activPAL...

No face to face suppot or training session

Lost some BCTs (1.9, 4.1, 8.1)

Reflections BCW / DD / My process

BCW could benefit from some iterations - whole 2nd DD

Introduction

4. Design Processes

Review of potential processes to design interventions See O'Cathain et al., 2019 (8) processes

Combined approach (8)

Needs to be formal?

Implementation based (4) RE-AIM

MacDoanld et al., 2018 systematic review. Reach and efficacy most reported. Implementation reporting mixed. Low adoption and maintenance reported

Theory driven (3)

Other frameworks or theroeis that could have been used

MRC

Intervention mapping (see concepts Golden Hours v0)

BCW + Widely used, BCTs comparable - Need to make MoA & causal pathways clear - Final decision with researcher

Koykka et al., 2019 (Action planning - habits)

+ Multiple theories - BCW, TPB, IM + Paid attention to context (teachers)

Descriptions of co-design principles office setting

Efficiency based (5) Stand Up Victoria

Hadgraft et al., 2016 Qual

Hadgraft et al., 2017 RCT -> Need to understand interpersonal infl

-> Bryne et al., 2020 need context to advance field Miller et al., 2019 review

Dunstan et al., 2013 Protocol - Measures

Neuhaus et al., 2014 + Iterative development + Multi-level, multi-component

-> Bryne et al., 2020 need causal pathways MoA (Carey et al., 2018), need to isolate BCT effects (Hagger et al., 2020)

Double Diamond (1 - Partnership)

Target population-centred (2) Participatory

SMArT Work

Edwardson et al., 2018 RCT + Effective long-term - Support measure broad

Munir et al., 2015 Protocol + Systematic BCW + Support through researcher

How as important as what! e.g., Hardcastle et al., 2017

5. Aim and Objectives of the chapter

O'Cathain et al., 2019: Development = whole process of int developmet Design = Point in process where developers decide content, format, delivery

AIM: To develop and design an intervention to address low physical activity in two British police forces

OBJ 3: To plan for change (HNA Step 3)

OBJ 2: To use the Behaviour Change Wheel to design a theory-based intervention that reduces sitting time amongst police control room workers

OBJ 1: To use a co-design approach to develop a solution to prolonged sitting in the police control room context

3. Theoretical underpinning

SDT (Kinnafick / Thorgersen-Ntoumani papers)

Howlett et al., 2020 COM-B and TPB predictive validity

Habit strength

Behavioural regulation, Social influences

- Theory is only one approach Research lending from PA?

1. Wellbeing in Police

Non-operational staff e.g., control room overlooked

Highlighting the issue: PA and Sedentary behaviour

Impacts on wellbeing

Impacts on health

2. Worksite interventions to increase PA and decrease sitting

Exertime = in police context

But dont which department in police!

Cooley et al., (2014)

+ Qualitative follow-up

Quite a few qual studies: Dewitt et al., 2019 (need org support)

Mainsbridge et al., (2020)

+ Exertime Tasmanian Police + Mood (POMS-SF Vigor and Fatigue) N.S., Stress (PSQ-Op&Org) Org decreased. + 13 week post-test, 26 week washout - PSQ-Op? - Small sample - Lack theoretical underpinning needed e.g. BCW

Pedersen et al., (2013) Mainsbridge et al., (2014)

+ Blood pressure, calories - No follow up

Stephenson et al., 2017 most freq: Prompts and cues Self-monitoring Social support (unspecified) Goal setting (beh) -> Need improved reporting

Shrestha et al., 2018 Cochrane review ->Sit-stand desks not effective