Chapter 5: Study 3 - Development of the Exertime intervention

Introduction

2. Worksite interventions to increase PA and decrease sitting

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

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

Exertime = in police context

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

+ Blood pressure, calories
- No follow up

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

Cooley et al., (2014)

+ Qualitative follow-up

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

But dont which department in police!

1. Wellbeing in Police

Highlighting the issue: PA and Sedentary behaviour

Impacts on health

Impacts on wellbeing

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

3. Theoretical underpinning

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

Behavioural regulation, Social influences

- Theory is only one approach
Research lending from PA?

Habit strength

SDT (Kinnafick / Thorgersen-Ntoumani papers)

5. Aim and Objectives of the chapter

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

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

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

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

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

4. Design Processes

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

Descriptions of co-design principles office setting

Target population-centred (2) Participatory

SMArT Work

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

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

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

Double Diamond (1 - Partnership)

Efficiency based (5) Stand Up Victoria

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)

Dunstan et al., 2013 Protocol
- Measures

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

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

Hadgraft et al., 2016 Qual

Theory driven (3)

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)

Other frameworks or theroeis that could have been used

Intervention mapping
(see concepts Golden Hours v0)

MRC

Implementation based (4) RE-AIM

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

Combined approach (8)

Needs to be formal?

Discussion

Reflections BCW / DD / My process

BCW could benefit from some iterations - whole 2nd DD

Covid-19 section

Things the intervention couldnt do, but would have

Lost some BCTs (1.9, 4.1, 8.1)

No face to face suppot or training session

Objective measures - blood pressure, activPAL...

Personal reflection

Context completely changed (social norms as influential now?)

Chapter 6??

Changing personnel (6 month role rotation?)

Intervention Design Process
(Method)

The Behaviour Change Wheel

STEP 1: COM-B: Understand the behaviour

Defining the problem

Select target behaviour

Specify target behaviour by discussing / justifying focus with supervisory team

Identify what needs to be changed

TDF optional step

STEP 2: Identify intervention options

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

Policy categories

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

Present options to steering group, with consideration of criteria

Discuss with supervisors

Identify mode of delivery

Double Diamond 1

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

DD Phase 2 DISCOVER and DEFINE [STAGE 2]

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...

Final intervention descrption

Double Diamond 2

DD DEVELOP [STAGE 3]

Presented options for software to the steering group

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

DELIVER sessions to supervisors

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

Conceptualisations of mechanisms

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

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

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

Procedure

Measures of Change / Analysis

AIM: To describe the protocol for the Exertime RCT

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

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

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

INTRO

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

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.

Discussion prev lit all focused on decreased sitting

METHOD

Designed using BCW and co-design desribed elsewhere

Procedure

TABLE mapping BCTs and operationalisation

Analysis

REACH

EFFICACY

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

ADOPTION

IMPLEMENTATION

Treatment Fidelity Framework

MAINTENANCE