Department of Sport and Exercise Medicine, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Oxford, OX3 7LD, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England.
BMC Pregnancy Childbirth. 2022 Mar 26;22(1):253. doi: 10.1186/s12884-022-04539-9.
BACKGROUND: Physical activity (PA) interventions are an important but underutilised component in the management of gestational diabetes mellitus (GDM). The challenge remains how to deliver cost effective PA interventions that have impact on individual behaviour. Digital technologies can support and promote PA remotely at scale. We describe the development of a behaviourally informed smartphone application (Stay-Active) for women attending an NHS GDM clinic. Stay-Active will support an existing motivational interviewing intervention to increase and maintain PA in this population. METHODS: The behaviour change wheel (BCW) eight step theoretical approach was used to design the application. It provided a systematic approach to understanding the target behaviour, identifying relevant intervention functions, and specifying intervention content. The target behaviour was to increase and maintain PA. To obtain a behavioural diagnosis, qualitative evidence was combined with focus groups on the barriers and facilitators to PA in women with GDM. The findings were mapped onto the Capability Opportunity Motivation-Behaviour (COM-B) model and Theoretical Domains Framework to identify what needs to change for the target behaviour and linked to appropriate intervention functions. Finally, behaviour changes techniques (BCT) and modes of delivery that are most likely to serve the intervention functions were selected. Current evidence, patient focus groups and input from key stakeholders informed Stay-Active's development. RESULTS: We found that psychological capability, reflective and automatic motivation, social and physical opportunity needed to change to increase PA in women with GDM. The four key intervention functions identified were Enablement, Education, Persuasion and Training. Stay-Active incorporates these four intervention functions delivering ten BCTs including: goal setting, credible source, self-monitoring, action planning, prompts and cues. The final design of Stay-Active delivers these BCTs via an educational resource centre, with goal setting and action planning features, personalised performance feedback and individualised promotional messages. CONCLUSION: The BCW has enabled the systematic and comprehensive development of Stay-Active to promote PA in women with GDM within an NHS Maternity service. The next phase is to conduct a trial to assess the feasibility and acceptability of a multi-component intervention that combines Stay-Active with PA Motivational Interviewing.
背景:身体活动(PA)干预是管理妊娠糖尿病(GDM)的重要但未充分利用的组成部分。挑战仍然是如何提供具有成本效益的 PA 干预措施,从而对个人行为产生影响。数字技术可以大规模地支持和促进远程 PA。我们描述了为在 NHS GDM 诊所就诊的女性开发的一种基于行为的智能手机应用程序(Stay-Active)。Stay-Active 将支持现有的动机访谈干预措施,以增加和维持该人群的 PA。
方法:应用行为变化轮(BCW)的八步理论方法来设计应用程序。它为理解目标行为、确定相关干预功能以及指定干预内容提供了系统的方法。目标行为是增加和维持 PA。为了进行行为诊断,结合了关于 GDM 女性 PA 障碍和促进因素的焦点小组的定性证据。研究结果被映射到能力机会动机-行为(COM-B)模型和理论领域框架上,以确定目标行为需要改变的内容,并与适当的干预功能相关联。最后,选择了最有可能为干预功能服务的行为改变技术(BCT)和交付模式。当前的证据、患者焦点小组和关键利益相关者的投入为 Stay-Active 的开发提供了信息。
结果:我们发现,在 GDM 女性中增加 PA 需要改变心理能力、反思和自动动机、社会和物理机会。确定的四个关键干预功能是赋权、教育、说服和培训。Stay-Active 包含这四个干预功能,提供十种 BCT,包括:目标设定、可信来源、自我监测、行动计划、提示和线索。Stay-Active 的最终设计通过教育资源中心提供这些 BCT,具有目标设定和行动计划功能、个性化绩效反馈和个性化促销信息。
结论:BCW 使 Stay-Active 的系统和全面开发成为可能,以促进 NHS 产科服务中 GDM 女性的 PA。下一阶段是进行一项试验,评估将 Stay-Active 与 PA 动机访谈相结合的多组件干预措施的可行性和可接受性。
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