Fortune J1, Norris M1, Stennett A1, Kilbride C1, Lavelle G1, Hendrie W2, deSouza L1, Anokye N1, Victor C1, Ryan J1,3
1Brunel University London, London, United Kingdom, 2MS Therapy Centre, Norwich, United Kingdom, 3RCSI Royal College of Surgeons in Ireland, Dublin, Ireland
Background: The positive benefits of increasing physical activity and decreasing sedentary behaviour in people with multiple sclerosis (MS) have been clearly identified. Behaviour-change interventions in this population are often delivered remotely e.g. via telecommunication, or alongside significant additional therapy and demonstrate equivocal results. Studies in other populations suggest that face-to-face delivery is important for the effectiveness of the intervention. The iStep-MS trial is a randomised controlled trial of a behaviour-change intervention which aims to address these concerns. The programme was delivered by physiotherapists in four sessions over a three month period. Physiotherapists used behaviour-change techniques such as goal-setting, action planning, barrier identification/problem solving to promote change in physical activity behavior.
Purpose: The aim of this study was to explore participants' perspectives on how different aspects of the behaviour-change intervention contributed to the perceived success of the programme.
Methods: Participant experience was explored through semi-structured interviews at the completion of the intervention. A purposive sample of fifteen intervention participants with a range of ages, gender, type of MS and delivering physiotherapist were invited. Interviews were audio-recorded, transcribed and independently analysed through framework analysis which provides a clear audit trail enhancing transparency. Rigour was enhanced through processes including peer debriefing.
Results: Fifteen participants (5 male, age 39-71 years) undertook interviews. Participants favourably evaluated a number of intervention components however an overarching positive aspect of the programme was the way in which the intervention was delivered. Face-to-face interaction and support provided by the physiotherapist was perceived essential to the success of the programme. Two themes coming alongside and a guide along my path describe important elements of this interaction. Coming alongside describes the empathetic interaction with the physiotherapist. Persistent, non-judgemental support helped to establish a secure environment and person-centred rapport. A guide along my path describes the importance of the physiotherapist in mutual goal setting. Individually tailored, personally meaningful goals, produced collaboratively, resulted in realistic achievable targets which enhanced competence for physical activity and improved autonomy. These factors had a cumulative effect of making the participant feel that their individual perspectives, needs and concerns were being listened to and taken into consideration. Captured in the third theme “actually you can”, this sense of being valued enhanced people's confidence to self-regulate, break through barriers and engage in new physical activity behaviours facilitating a sense of control and empowerment over their condition.
Conclusion(s): Initiating and continuing behaviour-change is a complex process. Findings of the present study indicate that a successful complex physical activity intervention involves the effective delivery of individual intervention components and crucially the practical and interpersonal skills of the interventionist. These findings not only support the use of face-to-face intervention delivery but the adequate training of implementers to ensure adequate requisite skills.
Implications: Behaviour-change counselling taps into many intuitive communications skills of physiotherapists and indicates a key future role in structured behavioural change interventions. Optimizing physiotherapy services within this area requires tailored training to ensure service providers have an adequate understanding of the theoretical and practical techniques required to achieve successful implementation.
Keywords: Qualitative research, behaviour change, multiple sclerosis
Funding acknowledgements: MS Society UK
Purpose: The aim of this study was to explore participants' perspectives on how different aspects of the behaviour-change intervention contributed to the perceived success of the programme.
Methods: Participant experience was explored through semi-structured interviews at the completion of the intervention. A purposive sample of fifteen intervention participants with a range of ages, gender, type of MS and delivering physiotherapist were invited. Interviews were audio-recorded, transcribed and independently analysed through framework analysis which provides a clear audit trail enhancing transparency. Rigour was enhanced through processes including peer debriefing.
Results: Fifteen participants (5 male, age 39-71 years) undertook interviews. Participants favourably evaluated a number of intervention components however an overarching positive aspect of the programme was the way in which the intervention was delivered. Face-to-face interaction and support provided by the physiotherapist was perceived essential to the success of the programme. Two themes coming alongside and a guide along my path describe important elements of this interaction. Coming alongside describes the empathetic interaction with the physiotherapist. Persistent, non-judgemental support helped to establish a secure environment and person-centred rapport. A guide along my path describes the importance of the physiotherapist in mutual goal setting. Individually tailored, personally meaningful goals, produced collaboratively, resulted in realistic achievable targets which enhanced competence for physical activity and improved autonomy. These factors had a cumulative effect of making the participant feel that their individual perspectives, needs and concerns were being listened to and taken into consideration. Captured in the third theme “actually you can”, this sense of being valued enhanced people's confidence to self-regulate, break through barriers and engage in new physical activity behaviours facilitating a sense of control and empowerment over their condition.
Conclusion(s): Initiating and continuing behaviour-change is a complex process. Findings of the present study indicate that a successful complex physical activity intervention involves the effective delivery of individual intervention components and crucially the practical and interpersonal skills of the interventionist. These findings not only support the use of face-to-face intervention delivery but the adequate training of implementers to ensure adequate requisite skills.
Implications: Behaviour-change counselling taps into many intuitive communications skills of physiotherapists and indicates a key future role in structured behavioural change interventions. Optimizing physiotherapy services within this area requires tailored training to ensure service providers have an adequate understanding of the theoretical and practical techniques required to achieve successful implementation.
Keywords: Qualitative research, behaviour change, multiple sclerosis
Funding acknowledgements: MS Society UK
Topic: Neurology
Ethics approval required: Yes
Institution: Brunel University London
Ethics committee: CHLS REC
Ethics number: 6181-NHS-Apr/2017-7016-2
All authors, affiliations and abstracts have been published as submitted.
