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