A co-production approach guided by the behaviour change wheel to develop an intervention for reducing sedentary behaviour after stroke

Jennifer Hall,David J Clarke,Sarah Morton,Claire F Fitzsimons,Rebecca Lawton,Gillian E Mead,Anne Forster,Coralie English,Jessica Hall

doi:10.1186/s40814-020-00667-1

Abstract

BackgroundStroke survivors are highly sedentary; thus, breaking up long uninterrupted bouts of sedentary behaviour could have substantial health benefit. However, there are no intervention strategies specifically aimed at reducing sedentary behaviour tailored for stroke survivors. The purpose of this study was to use co-production approaches to develop an intervention to reduce sedentary behaviour after stroke.MethodsA series of five co-production workshops with stroke survivors, their caregivers, stroke service staff, exercise professionals, and researchers were conducted in parallel in two-stroke services (England and Scotland). Workshop format was informed by the behaviour change wheel (BCW) framework for developing interventions and incorporated systematic review and empirical evidence. Taking an iterative approach, data from activities and audio recordings were analysed following each workshop and findings used to inform subsequent workshops, to inform both the activities of the next workshop and ongoing intervention development.FindingsCo-production workshop participants (n = 43) included 17 staff, 14 stroke survivors, six caregivers and six researchers. The target behaviour for stroke survivors is to increase standing and moving, and the target behaviour for caregivers and staff is to support and encourage stroke survivors to increase standing and moving. The developed intervention is primarily based on co-produced solutions to barriers to achieving the target behaviour. The developed intervention includes 34 behaviour change techniques. The intervention is to be delivered through stroke services, commencing in the inpatient setting and following through discharge into the community. Participants reported that taking part in intervention development was a positive experience.ConclusionsTo our knowledge, this is the first study that has combined the use of co-production and the BCW to develop an intervention for use in stroke care. In-depth reporting of how a co-production approach was combined with the BCW framework, including the design of bespoke materials for workshop activities, should prove useful to other researchers and practitioners involved in intervention development in stroke.

Highlights

Introduction to the topic of sedentaryDefining the problem, behaviour and the intervention target identifying the target behaviours for each user group behaviour
Hall et al Pilot and Feasibility Studies (2020) 6:115 (Continued from previous page). To our knowledge, this is the first study that has combined the use of co-production and the behaviour change wheel (BCW) to develop an intervention for use in stroke care
In-depth reporting of how a co-production approach was combined with the BCW framework, including the design of bespoke materials for workshop activities, should prove useful to other researchers and practitioners involved in intervention development in stroke

Summary

Introduction

Introduction to the topic of sedentaryDefining the problem (step 1), behaviour and the intervention target identifying the target behaviours for each user group behaviour (step 2). Stroke survivors are highly sedentary; breaking up long uninterrupted bouts of sedentary behaviour could have substantial health benefit. There are no intervention strategies aimed at reducing sedentary behaviour tailored for stroke survivors. The purpose of this study was to use co-production approaches to develop an intervention to reduce sedentary behaviour after stroke. Breaking sedentary behaviour with regular standing increases physical function in frail older adults [3]. UK Chief Medical Officer Physical Activity Guidelines recommend that older adults minimise the amount of time spent being sedentary and break up long periods of inactivity with light physical activity when physically possible or at least standing [4]. Reducing sedentary behaviour has been suggested as a new target for therapeutic intervention after stroke [6]

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