Frontiers in Public Health (Oct 2015)
Can adding web-based support to UK primary care exercise referral schemes improve patients’ physical activity levels? Intervention development for the e-coachER study.
Abstract
Background: Promoting physical activity (PA) via primary care exercise referral schemes (ERS) is common but there is no rigorous evidence for long term changes in PA (Pavey et al, 2011) among those with chronic conditions. From July 2015, for 15 months, the e-coachER trial began to recruit 1400 patients (in SW England, Birmingham and Glasgow) with one or more chronic conditions including diabetes, obesity, hypertension, osteoarthritis, or depression, who are eligible and about to attend an ERS. The two-arm parallel RCT is powered to determine if the addition of a web-based, interactive, theory-driven and evidence-based support system (hosted on the ‘LifeGuide’ platform) will result in at least 10% more patients who do 150 mins or more per week of accelerometer assessed moderate or vigorous physical activity (MVPA) at 12 months. Aims: This presentation will provide details on the intervention development and data to be captured to inform a process evaluation. Methods: An initial version of e-coachER was produced, building on experiences from obesity and diabetes self-management interventions using the Lifeguide platform, and beta tested over 7 months. Co-applicants and researchers then provided feedback on a time-truncated version, and ERS patients on a real-time version, for 5 months before it was locked for the RCT. Within the trial, after participants are screened, provide consent and complete baseline assessments, they are randomised to receive usual ERS at each site or usual ERS plus a mailed Welcome Pack (including a user friendly guide to register for e-coachER access in-line, a free pedometer and a fridge magnet with daily recording strips for step counts or minutes of MVPA). Contact details for an e-coachER facilitator are provided for additional technical support. Results: At the core of the intervention are ‘7 Steps to Health’ aimed to last 5-10 mins each, to encourage patients to think about the benefits of PA, seek support from an ERS practitioner (and friends/family, and the web), to self-monitor PA with a pedometer and upload steps or minutes of MVPA, set progressive goals, build confidence, autonomy and relatedness (from Self-Determination Theory), find ways to increase sustainable PA more broadly, and deal with setbacks. An avatar (to avoid having to represent a range of individual characteristics such as age, gender, and ethnicity) and brief narratives are used throughout to normalise and support behaviour change and encourage e-coachER use. Automatic or patient chosen e-mails from the Lifeguide system promote on-going use of functions such as recording weekly PA and goal setting. For each site, participants are able to access links to reputable generic websites for further information about chronic conditions and lifestyle, links to other sites and apps for self-monitoring health behaviour and health, as well as modifiable options for local physical activity options. Conclusion: The Lifeguide platform for e-coachER is able to collect data on individual usage, and this will be used, along with semi-structured interviews, to conduct a process evaluation to fully understand if, for whom, and how the intervention facilitated long-term PA changes. Supported with funding from the NIHR (HTA) Project: 13/25/20
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