Table 8 Programme adoption and implementation of SOLAS intervention and participant recruitment linking change objectives to practical applications

Managers allocate resources to support service to deliver SOLAS intervention

PO.1

12.1 Restructuring the physical environment (in sites scoring <80 % on the resource checklist)

Managers approve the redeployment/purchase of equipment to allow delivery of the SOLAS intervention

Managers approve rental of leisure centre facilities to deliver the SOLAS intervention if clinic space unsuitable

INTENTIONS 

Managers provide written agreement to allow their service to participate in SOLAS feasibility trial

PO.1

1.8 Behavioural contract

Written agreement from each physiotherapy manager to:

i. allow their service area to participate in the feasibility trial and deliver treatment according to randomisation

ii. support participant recruitment to SOLAS feasibility trial

iii. nominate two physiotherapists to attend training if randomised to the SOLAS intervention arm

Physiotherapists agree to participate in the SOLAS feasibility trial

PO.2

1.8 Behavioural contract

Written agreement obtained from each physiotherapist to participate in the SOLAS feasibility trial which involves:

i. Screening the waiting list for potentially eligible participants

ii. Sending a standardised invitation letter to clients with support from the UCD research team

iii. Supporting the UCD research team in efforts to reach recruitment targets

iv. Attending and participating in training provided by research team

v. Providing treatment according to the random assignment of your site

vi. Documenting treatment provided

vii. Allowing audio recording and direct observation of treatment to assess fidelity

viii. Participating in an individual semi-structured interview if randomised to provide group treatment at the end of delivery.

KNOWLEDGE

Develops an understanding of the structure, content and materials within the SOLAS intervention

PO.3

5.1 Information about health consequences of the intervention

Physiotherapist training programme^a

Pre-reading information about intervention content and structure, selected research papers, brief power point lectures, physiotherapist training handbook, power point slides with script of intervention content, discussion about beliefs about consequences of the intervention components. On completion of training, physiotherapists receive copy of all intervention materials listed in Table 6.

Develops an understanding of the needs supportive interpersonal delivery style of the SOLAS intervention

5.3 Information about social and environmental consequences of the intervention

Pre-reading information about underpinning behaviour change theory, selected research papers, brief power point lectures, physiotherapist training handbook, discussion about beliefs about consequences of delivering the intervention the using a needs supportive interpersonal style strategies to

support participant autonomy for the behaviour:

• Offer a meaningful rationale for the particular behaviour

• Provide opportunities for input and choice to participants

• Use support and encouragement rather than pressurising behaviour

support participant competence to engage in the behaviour:

• Set clear expectations and provide appropriate direction

• Provide positive and information rich feedback

• Provide participants with opportunities to practice behaviours

• Use collaborative goal-setting, action planning and problem solving

support relatedness by encouraging interpersonal involvement

• Build relationships with participants (e.g. proximity, using names, etc.) and between participants

• Acknowledge and take into account participants’ feelings and perspectives

Develops skills in delivering the SOLAS intervention

PO.3

1.1 Goal setting (behaviour)

1.4 Action planning

Goal setting exercise—physiotherapists individually reflect and set a goal and action plan related to practising delivery of the needs supportive strategies discussed in training in their everyday clinical practice

1.2 Problem solving

Workshop and reflection during/after day 1 training on the challenges and possible solutions to delivering the intervention at their site for discussion with course facilitators and peers on day 2

2.2 Feedback on behaviour

Verbal feedback by research team during training; role play of delivering the intervention using a needs supportive interpersonal style.

Verbal and written feedback of training audio-recording of delivering the intervention using needs supportive interpersonal style strategies by research team following training

2.3 Self-monitoring of behaviour

Audio-recording of delivery of components of the intervention during training and self-rating of quality of delivery using a needs supportive interpersonal style following training

4.1 Instruction on how to perform the behaviour (i.e. deliver the intervention)

Brief power point lecture, physiotherapist training handbook

6.1 Demonstration of the behaviour

6.2 Social comparison

Video examples of delivering components of the intervention, e.g. good and poor practice goal setting, problem solving, giving feedback. Encouragement of physiotherapists to compare their use of a needs supportive interpersonal style with the video examples and their peers within the training programme

8.1 Behavioural practice of delivering elements of the intervention

Role play, peer observation and feedback, group discussion of delivering the intervention using a needs supportive interpersonal style

8.7 Graded tasks

Graded role play activities delivering the intervention using a needs supportive interpersonal style, i.e. simple one to one interactions progressing to microteaching activities delivering a component of the class to a group of peers

Improve confidence in ability to deliver the SOLAS intervention

PO.3

1.2 Problem solving

Workshop: physiotherapists estimate the number of exercise stations that could be provided in their clinic space and equipment, and identify the need for changes to the clinic space/equipment to support delivery of the intervention

2.2 Feedback on behaviour during training

Verbal feedback by research team during training; role play of delivering the intervention using a needs supportive interpersonal style.

Verbal and written feedback of training audio-recording of delivering the intervention using a needs supportive interpersonal style by research team following training

2.3 Self-monitoring of behaviour during training

Audio-recording of delivery of components of the intervention during training and self-rating of quality of delivery using a needs supportive interpersonal style following training

3.1 Social support (unspecified)

Encouragement from facilitator and peers for delivery of the intervention as intended during role play in training

3.2 Social support (practical)

Practical support from facilitator in supporting delivery of the intervention following training by provision of written feedback from audiorecordings

6.1 Demonstration of the behaviour

Video examples of delivering components of the intervention, e.g. good and poor practice goal setting, problem solving, giving feedback

8.1 Behavioural practice/rehearsal

Role play, peer observation and feedback, group discussion of delivering the intervention using a needs supportive interpersonal style

8.7 Graded tasks

Graded role play activities delivering the intervention using a needs supportive interpersonal style, i.e. simple one to one interactions progressing to microteaching activities delivering a component of the class to a group of peers

15.1 Verbal persuasion to boost self-efficacy to deliver the intervention using a needs supportive interpersonal style

Course facilitator with expertise in self-determination theory verbally persuades physiotherapists they can successfully deliver the SOLAS intervention using a needs supportive interpersonal style following training, and argues against self-doubts

15.3 Focus on past success

Group discussion on past experience in managing clients with chronic musculoskeletal pain, and/or delivering groups

Reduce concerns about potential for clients to experience flare-ups during the SOLAS intervention

PO.3

5.1 Information on the health consequences of engaging in physical activity

Brief power point lecture about managing flare-ups, physiotherapist training handbook, relaxation CD, discussion about beliefs about consequences clients experiencing flare-ups

9.1 Credible source

Course facilitator with expertise in chronic musculoskeletal pain management presents verbal and visual information from the literature concerning flare-ups and their management in the context of the SOLAS intervention

Improve physical environment to prepare for delivery of the SOLAS intervention

PO.4

12.1 Restructuring the physical environment (in sites scoring <80 % on the resource checklist)

12.5 Adding objects to the environment

Site visit by research team to provide advice on selection of appropriate room within clinic space or local leisure centre to deliver the education and exercise components of the intervention (including set-up of chairs/projector/laptop)

Research team make recommendations for redeployment/purchase of equipment within available resources (laptops, exercise machines) to allow delivery of the intervention

Research team provide colour laminates of each individual exercise of an age appropriate model to display during the intervention

Research team provide USB of intervention slides, handout with suggested script for each slide, programme handbook, programme materials.

Adapt social environment to prepare for delivery of the SOLAS intervention

PO.4

12.2 Restructuring the social environment

To ensure consistency across sites in delivery of the SOLAS intervention, one trained physiotherapist to deliver the intervention, but a second staff member (i.e. physiotherapist, student) can support delivery if concerns about safety.

Increases awareness of the SOLAS intervention, feasibility trial and participants recruitment pathway to referring GPs, primary care team and potential participants

PO.5

12.2 Restructuring the social environment (referral and screening procedures for potential participants to the trial)

Physiotherapists/managers will raise awareness of the SOLAS intervention within the feasibility trial with referring GPs at primary care meetings and relevant correspondence

Screening of GP referrals to identify potentially suitable participants for the SOLAS intervention by physiotherapists

Physiotherapists will send invitation letter to potential participants referred by GPs to raise awareness of the feasibility trial

Trial website to increase awareness of the trial to potential participants and referring GPs

Develop GPs understanding of the participant recruitment pathway to the SOLAS intervention and feasibility trial

PO.5

5.1 Provide GPs with information about health consequences of the SOLAS intervention and of clients who have agreed to participate in the feasibility trial

Letter to GPs giving information about the feasibility trial, content of SOLAS intervention and control arms and eligibility criteria

Letter to GPs when clients they refer become participants in the trial