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Table 4 Intervention map linking change objectives to methods and practical applications

From: Using intervention mapping to develop a theory-driven, group-based complex intervention to support self-management of osteoarthritis and low back pain (SOLAS)

Change objectives and determinants of behaviour from TDF domains Physical activity performance objectives Class number Content Practical applications (mode of delivery) Behaviour change techniques as per behaviour change technique taxonomy v1 (Michie et al. [42, 44])
Desired outcome 1: Increases physical activity level of participants by end of programme and 6 month follow-up
KNOWLEDGE
Develops an understanding of
 ▪ the benefits of physical activity (PA)
 ▪ recommended types and levels of PA
▪ how to perform selected PA
PO.1, PO.3PO.2, PO.3 1–2 What are the benefits of exercise?; the Get Ireland Active physical activity recommendations; the current activity levels of Irish population according to age and chronic pain condition; what are appropriate exercises/walking/other physical activities Lecture; group discussion; programme handbook; picture handout of exercises for home practice 2.2, 2.7, 4.2, 5.1, 9.1
 ▪ SMART goals and its relevance for PA PO.4 1 What is SMART goal-setting?; how to complete a weekly goal setting sheet, review weekly goals and action plans Lecture; group discussion; programme handbook 2.2, 2.7, 4.2, 5.1, 9.1
 ▪ pacing and its relevance for PA PO.5 2 What is pacing and how to use it? Lecture; group discussion;
programme handbook
2.2, 2.7, 4.2, 5.1, 9.1
 ▪ tools for monitoring progress in PA PO.6 1–2 How to use an activity plan; How to use a pedometer Lecture; group discussion;
programme handbook
2.2, 2.7, 4.2, 5.1, 9.1
 ▪ typical challenges while engaging in PA PO.7 1,2,4,5 Factors influencing PA including fear of pain exacerbation Lecture; group discussion;
programme handbook
2.2, 2.7, 4.2, 5.1, 9.1
 ▪ available resources/facilities to support participation in PA PO.8 6 What are the resources or facilities available to support long term PA participation Local community resources handout 2.2, 2.7, 4.2, 5.1, 9.1
SKILLS
 ▪ Develops physical skills to engage in PA PO.3 1–6 Participation in supervised exercise class; participation in PA outside of the class Instruction and demonstration by physiotherapist; practice by participant; programme handbook to record progress; feedback from physiotherapist 2.2, 2.7, 4.1, 6.1, 8.1, 8.6, 8.7, 10.4, 12.6
Develops skills to
 ▪ apply relevant SMART goal setting to selected PA PO.4 1–6 Weekly review of PA progress utilising goal setting and action planning Group discussion;
practice by participant during and outside of class;
programme handbook to record progress; feedback from physiotherapist
1.1, 1.3, 2.2, 2.7, 2.3, 4.1, 6.1, 8.1, 10.4
 ▪ apply pacing to selected PA PO.5 2 Physiotherapist provides instructions on how to pace Instruction by physiotherapist;
practice by participant outside of class; feedback from physiotherapist
1.2, 2.2, 2.7, 4.1, 6.1, 8.1, 8.6, 8.7, 10.4
 ▪ to monitor progress in increasing PA PO.6 2–6 Weekly exercise diary in programme handbook; example of completed diary in programme handbook; pedometer provided to participants; demonstration of its use and written information in programme handbook Instruction and demonstration by physiotherapist; practice by participant; programme handbook to record progress 1.1, 1.3, 2.3, 4.1, 6.1, 8.1
 ▪ to cope with the challenges encountered while engaging in selected PAs PO.7 4–5 Practical relaxation session;
instruction on how to select and use alternative methods to cope with pain (e.g. ice, heat, TENS)
Instruction by physiotherapist;
practice by participant during and outside of class
4.1, 6.1, 8.1, 8.6
BELIEFS ABOUT CAPABILITIES
Improves self-efficacy in ability to:
 ▪ perform selected PAs
 ▪ engage in selected PAs
PO.2PO.3 1–6 Review of previous week’s physical activity; participation in supervised exercise class Group discussion; programme handbook to review progress; support from other participants; practice by participant; feedback from physiotherapist 1.2, 2.2, 2.3, 2.7, 3.1, 3.2, 3.3, 8.1, 8.7, 10.4, 12.5, 15.1
 ▪ use SMART goal setting PO.4 1–6 Review of previous week’s goal-setting; instruction on how to set SMART goals and complete goal setting worksheet Group discussion; programme handbook to review progress; support from other participants; practice by participant; feedback from physiotherapist 1.2, 2.2, 2.3, 2.7, 3.1, 3.2, 3.3, 6.1, 8.1, 8.7, 12.5, 15.1
 ▪ use pacing PO.5 2–6 Review participants’ attempts to pace; Instruction on how to pace Group discussion; support from other participants; practice by participant; feedback from physiotherapist 1.2, 2.2, 2.3, 2.7, 3.1, 3.2, 3.3, 6.1, 8.1, 8.7, 12.5, 15.1
 ▪ use tools to monitor progress PO.6 2–6 Review participants’ attempts to use tools including pedometer; instruction on how to use monitoring tools Practical demonstration of pedometer; practice by participant; programme handbook to review progress; feedback from physiotherapist 1.2, 2.2, 2.3, 2.7, 3.1, 3.2, 3.3, 6.1, 8.1, 8.7, 12.5, 15.1
 ▪ cope with challenges encountered during PA participation PO.7 2–6 Factors influencing PA including fear of pain exacerbation; review participants’ attempts to select and use alternative methods to cope with pain (e.g. ice, heat, TENS); instruction on how to use alternative methods Group discussion; practice by participant; feedback from physiotherapist 1.2, 2.2, 2.3, 2.7, 3.1, 3.2, 3.3, 6.1, 8.1, 8.7, 15.1
 ▪ engage in long-term PA PO.8 6 Review participants progress over the course of the programme. Provide information regarding community resources to support activity maintenance Group discussion; support from other participants; feedback from physiotherapist; community resource leaflet 1.2, 2.2, 2.3, 3.1, 3.2, 3.3, 6.1, 8.1, 8.7, 15.1
BELIEFS ABOUT CONSEQUENCES
Reduce pain catastrophizing beliefs’ related to consequences of engaging in PA PO.2, PO.3, PO.7, PO.8 1–6 Information on pain related to physical activity participation [wks 2,5]; review of previous week’s physical activity; participation in supervised exercise class Lecture; group discussion; programme handbook to review progress; practice by participant; feedback from physiotherapist 2.2, 2.3, 2.7, 5.1, 5.6, 9.1, 10.4
EMOTION
Reduce fear related to engaging in selected PAs PO.3, PO.7, PO.8 1–6 Information on pain related to physical activity; review of previous week’s physical activity; participation in supervised exercise class Lecture; group discussion; social support from other participants, practice by participant; feedback from physiotherapist 2.2, 2.7, 2.3, 3.3, 5.1, 5.6, 8.1, 9.1, 11.2,
INTENTIONS AND GOALS
 ▪ Increase autonomous motivation to engage in selected PA
▪ Increase autonomous motivation to engage in long-term PA
PO.1, PO.2, PO.3PO.8 1–6 What are the benefits of exercise?; the Get Ireland Active physical activity recommendations; the current activity levels of Irish population according to age;
what are appropriate exercises/walking; review of weekly progress
Lecture; group discussion; social support from other participants; programme handbook to record physical activity goal; feedback from physiotherapist 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, 1.8, 3.1, 3.2, 3.3, 5.1, 6.2, 9.1, 10.4
Increase autonomous motivation
 ▪ to use SMART goal setting PO.4 1–6 What is SMART goal-setting?; how to review weekly goals and action plans; review of weekly progress Lecture; group discussion;
programme handbook; social support from other participants; feedback from physiotherapist
1.1, 1.2, 1.3, 1.4, 1.5, 1.7, 3.1, 3.2, 3.3, 5.1, 6.2, 9.1, 10.4
 ▪ to use pacing PO.5 2 What is pacing and how to use it Lecture; group discussion; feedback from physiotherapist 1.1, 1,2, 1.3, 1.4, 1.7, 3.1, 3.2, 3.3, 5.1, 6.2, 8.7, 9.1, 10.4,
 ▪ to use tools to monitor progress in PA PO.6 2–6 How to use an activity plan; how to use a pedometer; review participants’ attempts to use tools Lecture; group discussion;
programme handbook; feedback from physiotherapist
1.1, 1.2, 1.3, 1.4, 1.7, 1.8, 3.1, 3.2, 3.3, 5.1, 6.2, 9.1, 10.4
 ▪ to cope with challenges encountered during PA participation PO.7 1–6 Factors influencing PA including fear of pain exacerbation; review participants’ attempts to select and use alternative methods to cope with pain (e.g. ice, heat, TENS); instruction on how to use alternative methods Lecture; group discussion;
feedback from physiotherapist
1.1, 1.2, 1.3, 1.4, 1.7, 1.8, 3.1, 3.2, 5.1, 6.2, 8.7, 9.1, 10.4
BEHAVIOURAL REGULATION
 ▪ Develops ability to incorporate and monitor effects of PA into daily life PO.3, PO.5 1–6 Weekly activity diary record Programme handbook to record progress 2.3
 ▪ Develops ability to implement tools to monitor PA progress PO.6 2–6 Weekly activity diary record Programme handbook to record progress 2.3
Desired outcome 2: increase use of evidence-based self-management strategies by participants by end of programme and 6-month follow-up
Change objectives and determinants of behaviour from TDF domains Self-management performance objectives (PO) Class number Content Practical applications
[mode of delivery]
Behaviour change techniques as per behaviour change technique taxonomy v1 (Michie et al. [42, 44])
KNOWLEDGE
Develops an understanding of
 ▪ the rationale for self-management PO.9 1 Aims and structure of the programme;
prevalence, pathology and prognosis of OA and CLBP and their relevance to self-management.
Application of self-management strategies
Written patient information leaflet; programme handbook; lecture; group discussion
Group discussion
2.2, 2.7, 4.2, 5.1, 9.1
 ▪ evidence-based pharmacological and non-pharmacological pain management strategies relevant to their pain condition PO.10 2, 4 Factors influencing pain;
pain gate theory;
safe application of ice, heat. Evidence for TENS, acupuncture. Drug pyramid of analgesic, anti-inflammatory, opioid and steroid medication; rationale for selection of approaches
Lecture; programme handbook
Group discussion
2.2, 2.7, 4.2, 5.1, 9.1, 11.1
 ▪ pain coping strategies PO.11 2, 5 Factors influencing pain;
anxiety, mood and pain;
relaxation techniques;
progressive muscular relaxation
Lecture, group discussion, programme handbook, practical relaxation session 2.2, 2.7, 4.2, 5.1, 5.6, 9.1
 ▪ healthy eating guidelines and healthy weight PO.12 3 Prevalence of obesity in Ireland; relationship to joint and back pain, life expectancy; balanced weight, waist size for low, moderate, high risk, relationship to physical activity and its measurement; healthy eating guidelines; food pyramid, eatwell plate, portion size, food and exercise Lecture; group discussion; programme handbook; practical demonstration of waist measurement 2.2, 2.7, 4.2, 5.1, 9.1
 ▪ how to perform selected specific exercises PO.13 1–6 Types of specific exercises and their effects Lecture, programme handbook, practical demonstration of exercises 2.2, 2.7, 4.2, 5.1, 9.1
SKILLS
Develop skills to appropriately:
 ▪ select and use evidence-based pharmacological and non-pharmacological pain management strategies relevant to their pain condition PO.10 4–6 Reflection on ability and outcome of previous weeks selection and use of pharmacological and non-pharmacological pain management approaches relevant to their pain condition Group discussion; feedback from the physiotherapist 1.2, 2.2, 2.7, 4.1, 6.1, 10.4, 11.1
 ▪ select and use pain coping strategies PO.11 5–6 Reflection on ability and outcome of selection and use of pain coping strategies Group discussion, programme handbook
Feedback from the physiotherapist
Practical class in relaxation skills
1.2, 2.2, 2.7, 4.1, 6.1, 8.1, 10.4, 13.2
 ▪ follow healthy eating guidelines and monitor weight PO.12 3–4 Reflection on ability and outcome of monitoring healthy eating and weight Group discussion; programme handbook 1.2, 2.3, 4.1, 6.1, 8.1
 ▪ engage in specific exercises PO.13 1–6 Supervised group exercise class Participation in exercise class and peer observation;
discussion with physiotherapist during exercise session, group discussion
1.1, 1.2, 2.2, 2.3, 2.7, 4.1, 6.1, 8.1, 8.7, 12.6
BELIEFS ABOUT CAPABILITIES
Increase self-efficacy in ability to:
 ▪ use evidence-based pharmacological and non-pharmacological pain management strategies relevant to their pain condition PO.10 4–6 Reflection on ability and outcome of previous weeks selection and use of pharmacological and non-pharmacological pain management approaches relevant to their pain condition Group discussion and feedback from physiotherapist 1.2, 2.2, 2.7, 3.1, 3.2, 3.3, 10.4, 15.1
 ▪ apply pain coping strategies PO.11 5–6 Reflection on ability and outcome of selection and use of pain coping strategies Group discussion and feedback from physiotherapist 1.2, 2.2, 2.7, 3.1, 3.2, 3.3, 8.1, 10.4, 15.1
 ▪ follow healthy eating guidelines and monitor healthy weight PO.12 3–4 Reflection on ability and outcome of monitoring healthy eating and weight and use of tools to support this Group discussion and feedback from physiotherapist 1.2, 2.2, 2.3, 3.1, 3.2, 3.3, 10.4, 12.5, 15.1
 ▪ engage in specific exercises PO.13 1–6 Supervised group exercise class
Practice of selected exercises at home; provision of theraband to support exercises at home
Participation in self-selected exercises and progressions with support and feedback from physiotherapist. Peer observation and discussion. Completion of weekly exercise diary in class 1.2, 2.2, 2.3, 2.7, 3.1, 3.2, 3.3, 8.1, 8.7, 10.4, 12.5, 15.1
BELIEFS ABOUT CONSEQUENCES
 ▪ Reduce pain catastrophizing beliefs’ associated with pain condition by using pain coping strategies PO.10, PO.11 2–6 Review of previous week Group discussion; discussion with physiotherapist 2.2, 2.3, 2.7, 5.1, 5.6, 9.1, 10.4
 ▪ Reduce pain catastrophizing beliefs’ related to consequences of engaging in specific exercises PO.13 1–6 Supervised group exercise class Participation in exercises, peer observation and group discussion
Review of outcome of previous weeks home exercises programme; discussion with physiotherapist
2.2, 2.3, 2.7, 5.1, 5.6, 6.1, 8.1, 9.1
EMOTION
 ▪ Reduce fear associated with pain condition by using pain coping strategies PO.10, PO.11 2–6 Pain and factors influencing it;
review of previous week
Lecture;
group discussion and feedback
2.2, 2.3, 2.7, 3.3, 5.6, 9.1, 11.2
 ▪ Reduces fear related to engaging in selected specific exercises PO.13 1–6 Supervised group exercise class Participation in exercises; peer observation and group discussion 2.2, 2.3, 2.7, 3.3, 5.6, 8.1, 9.1, 11.2
INTENTIONS AND GOALS
Increase autonomous motivation to:
 ▪ self-manage their pain condition
▪ use evidence-based pharmacological and non-pharmacological pain management strategies relevant to their pain condition
PO.9, PO.10 2–6 Factors influencing and easing pain;
review of previous week; planning for subsequent week to select and use relevant approaches
Lecture; group discussion led by physiotherapist 1.2, 3.1, 3.2, 3.3, 5.1, 6.2, 9.1, 10.4
 ▪ to use pain coping strategies PO.9, PO.11 2–6 Factors influencing and easing pain;
review of previous week; planning for subsequent week to select and use relevant approaches
Lecture; group discussion led by physiotherapist 1.2, 3.1, 3.2, 3.3, 5.1, 6.2, 8.7, 9.1, 10.4
 ▪ to follow healthy eating guidelines and to monitor healthy eating and weight PO.9, PO.12 3 Effect of diet and weight on pain
Review of previous week, planning for subsequent week to select and use relevant strategies
Lecture; programme handbook;
group discussion led by physiotherapist
1.1, 1.2, 1.3, 1.4, 1.5, 1.7, 3.1, 3.2, 3.3, 5.1, 6.2, 9.1, 10.4
 ▪ to perform selected specific exercises PO.9, PO.13 1–6 Effect of specific exercise on joint and back pain;
supervised group exercise class; home exercise programme
Lecture; programme handbook; group discussion;
participation in group exercise class and home exercise programme; peer observation and discussion
1.1, 1.2, 1.3, 1.4, 3.1, 3.2, 3.3, 5.1, 6.2, 8.7, 9.1, 10.4
BEHAVIOURAL REGULATION
 ▪ Develop ability to monitor pain condition to select and apply evidence-based pharmacological and non-pharmacological pain management strategies relevant to their pain condition PO.10 2–6 Weekly activity diary; record of pain-related symptoms Programme handbook 2.3
 ▪ Develop ability to monitor pain condition to select and apply appropriate pain coping strategies PO.11 2–6 Weekly activity diary; record of pain-related symptoms Programme handbook; use of relaxation CD at home 2.3
 ▪ Develop ability to monitor healthy eating and weight PO.12 3–6 Food and exercise diary
Measurement of waist size demonstrated by physiotherapist
Programme handbook
Tape measure provided
2.3
 ▪ Develop ability to incorporate and monitor effects of specific exercise in daily life PO.13 1–6 Weekly specific exercise diary Programme handbook
Completion of weekly exercise diary in class
2.3