Patient and public involvement and application of the Behaviour Change Wheel to promote physical activity following pulmonary rehabilitation in COPD: an intervention development study

Abstract

Background: Physical activity is not always maintained following pulmonary rehabilitation.

Aim: To report the development and design of an intervention to promote physical activity in COPD patients following a pulmonary rehabilitation programme.

Methods: Following the steps of the Behaviour Change Wheel framework, this study comprised of three stages 1) Selection of the physical activity behaviour and identification of the sources of behaviour that require change, including a systematic review of the literature on patient reported facilitators and barriers following pulmonary rehabilitation 2) identification of relevant behaviour change techniques (BCTs) to include in an intervention 3) context-based assessment of potential intervention strategies. We held meetings with health care professionals and COPD patients at each of these stages.

Results: From the modifiable physical activity behaviours, we selected daily step count. Psychological Capability, Social Opportunity, Reflective and Automatic Motivation were identified as sources of behaviour that require change. Social support, self-monitoring of behaviour and prompts and cues were BCTs identified as appropriate to include in the intervention. Assessment of potential intervention strategies resulted in the decision to deliver an intervention including a pedometer, step diary and adding COPD patients to a WhatsApp group chat with fellow pulmonary rehabilitation graduates.

Conclusion: The Behaviour Change Wheel with patient and public involvement enabled a systematic development of an intervention to be tested in a mixed methods feasibility trial.