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Table 4 An overview of modifications made to the Movement as Medicine for Type 2 Diabetes multifaceted intervention

From: Systematic development of a theory-informed multifaceted behavioural intervention to increase physical activity of adults with type 2 diabetes in routine primary care: Movement as Medicine for Type 2 Diabetes

Revision

Source of data that informed revision

Justification for revision

Removal of the behaviour change technique ‘rewards contingent on progress towards behaviour’

Semi-structured interviews with healthcare professionals and patients and video recordings of consultations

Several attempts were made by healthcare professionals to deliver the technique; however, faithful delivery and quality of delivery emerged as ongoing issues. Healthcare professionals reported the technique as ‘uncomfortable’ to deliver and felt it was not well received by patients. Patients reported the technique as ‘unnecessary’ and considered positive feedback from healthcare professionals a sufficient reward. The intervention contains a number of other self-regulatory behaviour change techniques; therefore, the balance of motivational and volitional techniques was maintained

Inclusion of explicit feedback on outcomes of behaviour

Semi-structured interviews with patients

Patients requested a formal record of weight, waist circumference, blood pressure and glycaemic control (HbA1c) to allow them to monitor their behavioural progress against their own anthropometric and clinical outcomes. The ‘record of progress pad’ was subsequently redesigned to allow provision for this information. Removal of the technique ‘rewards’ and inclusion of ‘feedback on outcomes of behaviour’ ensured that the balance of motivational and volitional techniques was maintained

Redesign of the record of progress pad

Semi-structured interviews with healthcare professionals and patients

Healthcare professionals reported that there was insufficient space within version 1 of the record of progress pad to record PA goals and plans. Patients requested provision to record and monitor outcomes of behaviour. The record of progress pad was subsequently revised/optimised and reintroduced

Inclusion of an intervention component checklist

Semi-structured interviews with healthcare professionals

Healthcare professionals requested a paper-based checklist of intervention components/techniques available to them via the Movement as Medicine for Type 2 Diabetes intervention. They reported that this ‘visual aid’ would reduce cognitive burden, prompt use of specific techniques and thus increase the likelihood of implementation of intervention components

Insertion of an online contents page to direct users to descriptions of intervention components

Semi-structured interviews with healthcare professionals

An additional page was inserted into the online training programme to direct healthcare professionals to descriptions of each intervention component and examples of how each component could/should be used. The aim was to (1) increase fidelity of delivery of intervention components overall and to specifically target those that were frequently not delivered and (2) to increase quality of delivery

Insertion of additional online content to promote delivery of specific BCTs

Video recordings of consultations

Additional written information was inserted online to prompt delivery of barrier identification/problem-solving (i.e. to prompt use of problem-solving specifically) and time management