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Wondergem R1,2,3, Hendrickx W1,2, Wouters E3,4, de Bie R5, Visser-Meily J2,6, Veenhof C1,2,7, Pisters MF1,2,3
1Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands, 2Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands, 3Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands, 4Tilburg University, School of Social and Behavioral Sciences, Department of Tranzo, Tilburg, Netherlands, 5Maastricht University, Department of Epidemiology and Caphri Research School, Maastricht, Netherlands, 6Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, Netherlands, 7Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Utrecht, Netherlands
Background: People with stroke are highly sedentary. Research has shown that this increases the risk of stroke, cardiovascular disease and mortality. Therefore, reducing sedentary behaviour might reduce the risk of recurrent stroke, other cardiovascular events and death. Changing movement behaviour has been proven challenging and therefor well-defined intervention techniques need to be identified and should be personalized to improve uptake of the intervention.
Purpose: To systematically determine the behaviour change techniques (BCTs) for a behavioural change intervention, directed at reducing sedentary behaviour in community-dwelling people with first-ever stroke, using the stages of the Behaviour Change Wheel (BCW).
Methods: To complete the stages of the BCW, information was needed on understanding the behaviour, identifying intervention options and identifying content and implementation options. To acquire this information, a literature search and nominal group technique (NGT) sessions were conducted. The NGT sessions were conducted with professionals working with people with stroke in the Netherlands and with international experts on sedentary behaviour and/or stroke. To support personalized care BCTs were attributed within four profiles of people with stroke: without physical or cognitive impairments, with mainly physical impairments, with mainly cognitive impairments and with both cognitive and physical impairments. Professionals and experts identified eligible BCTs to reduce sedentary behaviour. Participants made their choice by rating the BCTs, starting from most important (eight points) down to zero points.
Results: The literature research and the NGT sessions have shown that an intervention aiming to reduce sedentary behaviour should focus specifically on sedentary behaviour and needs to be tailored to both stroke related and individual requirements. In total, 75 BCTs were identified as eligible to be included in an intervention to reduce sedentary behaviour. A mean of 30 BCTs per profile received points (range 29-33 BCTs). Including the eight BCTs with the highest score let to five BCTs to be included in all four profiles: 'goal setting', 'action planning', 'social support', 'problem solving' and 'restructuring of the social environment'. For people with a profile without cognitive impairments, 'self-monitoring', 'feedback on behaviour', 'information about health consequences' and 'goal setting on outcome' should also be included, while for people with cognitive impairments, 'prompts/cues', 'graded tasks', 'restructuring the physical environment' and 'social support practical' should be added as well.
Conclusion(s): The identified BCTs will serve as the basis for the further development of a personalized blended care intervention to reduce sedentary behaviour in people with stroke.
Implications: Tailoring the interventions to individual needs and BCTs as 'goal setting', 'monitoring of behaviour' and 'feedback on behaviour' were deemed crucial to reduce sedentary behaviour, which means that monitoring of the behaviour before and during the intervention is essential. The social context also was deemed an important target, specifically people with cognitive impairment need social support to reduce sedentary behaviour. Al these factors need to be included when targeting sedentary behaviour in clinical practice.
Keywords: Stroke, Sedentary behaviour, Behaviour change
Funding acknowledgements: Netherlands Organization for Scientific Research (NWO)
Purpose: To systematically determine the behaviour change techniques (BCTs) for a behavioural change intervention, directed at reducing sedentary behaviour in community-dwelling people with first-ever stroke, using the stages of the Behaviour Change Wheel (BCW).
Methods: To complete the stages of the BCW, information was needed on understanding the behaviour, identifying intervention options and identifying content and implementation options. To acquire this information, a literature search and nominal group technique (NGT) sessions were conducted. The NGT sessions were conducted with professionals working with people with stroke in the Netherlands and with international experts on sedentary behaviour and/or stroke. To support personalized care BCTs were attributed within four profiles of people with stroke: without physical or cognitive impairments, with mainly physical impairments, with mainly cognitive impairments and with both cognitive and physical impairments. Professionals and experts identified eligible BCTs to reduce sedentary behaviour. Participants made their choice by rating the BCTs, starting from most important (eight points) down to zero points.
Results: The literature research and the NGT sessions have shown that an intervention aiming to reduce sedentary behaviour should focus specifically on sedentary behaviour and needs to be tailored to both stroke related and individual requirements. In total, 75 BCTs were identified as eligible to be included in an intervention to reduce sedentary behaviour. A mean of 30 BCTs per profile received points (range 29-33 BCTs). Including the eight BCTs with the highest score let to five BCTs to be included in all four profiles: 'goal setting', 'action planning', 'social support', 'problem solving' and 'restructuring of the social environment'. For people with a profile without cognitive impairments, 'self-monitoring', 'feedback on behaviour', 'information about health consequences' and 'goal setting on outcome' should also be included, while for people with cognitive impairments, 'prompts/cues', 'graded tasks', 'restructuring the physical environment' and 'social support practical' should be added as well.
Conclusion(s): The identified BCTs will serve as the basis for the further development of a personalized blended care intervention to reduce sedentary behaviour in people with stroke.
Implications: Tailoring the interventions to individual needs and BCTs as 'goal setting', 'monitoring of behaviour' and 'feedback on behaviour' were deemed crucial to reduce sedentary behaviour, which means that monitoring of the behaviour before and during the intervention is essential. The social context also was deemed an important target, specifically people with cognitive impairment need social support to reduce sedentary behaviour. Al these factors need to be included when targeting sedentary behaviour in clinical practice.
Keywords: Stroke, Sedentary behaviour, Behaviour change
Funding acknowledgements: Netherlands Organization for Scientific Research (NWO)
Topic: Neurology: stroke
Ethics approval required: No
Institution: Utrecht University
Ethics committee: Not applicable
Reason not required: Ethical approval was not applicable because those involved were professionals providing their insights regarding a theoretical framework
All authors, affiliations and abstracts have been published as submitted.
