Process evaluation of the British Lung Foundation Active Steps service

Abstract

Background: Active Steps, guided by the Behaviour Change Wheel, was developed to support inactive adults with lung conditions.

Aim: To conduct a mixed-methods process evaluation of Active Steps.

Methods: Active Steps comprised of 1:1 telephone health coaching, printed and digital resources for 12 months to increase physical activity. Implementation data (reach, dose and fidelity) were collected and summarised. Paired t tests were used to assess changes (mean, 95% CI) in mechanisms of impact (Capability, Opportunity, Motivation-Behaviour and Sport England self-efficacy scales) at 12 months. Interviews were completed with service users (n=10), service withdrawals (n=8) and British Lung Foundation (BLF) staff (n=10) and analysed thematically.

Results: Of those screened (n=553), 30% (n=166) were eligible for the service and consented for the evaluation. Service users were mostly Female (71%), White (95%), with COPD (67%). 88% (n=883) of intervention calls were completed. The number and duration of intervention calls (mean±SD) were 6 (±4) and 31 minutes (±7) respectively. There were statistically significant (p<0.05) increases in self-efficacy (0.6,0.2–1.0), physical capability (0.6,0.2–1.0), overcoming barriers (0.8,0.4-1.2), making plans (0.8,0.5–1.1) and daily routine (1.1,0.6–1.5). Interviews revealed facilitators (e.g. staff training) and barriers (e.g. health coach workload) to implementation as well as positive (e.g. encouragement, goals) and negative (e.g. ill health, facility access) factors influencing physical activity.

Conclusion: Active Steps was delivered as intended to support physical activity, but further consideration of staff workload and integration with local services may improve implementation.