A Short Message Service Intervention to Support Adherence to Home-Based Strengthening Exercise for People With Knee Osteoarthritis: Intervention Design Applying the Behavior Change Wheel.

Rachel K Nelligan,Rana S Hinman,Kim L Bennell,Lou Atkins

doi:10.2196/14619

Abstract

BackgroundKnee osteoarthritis is a chronic condition with no known cure. Treatment focuses on symptom management, with exercise recommended as a core component by all clinical practice guidelines. However, long-term adherence to exercise is poor among many people with knee osteoarthritis, which limits its capacity to provide sustained symptom relief. To improve exercise outcomes, scalable interventions that facilitate exercise adherence are needed. SMS (short message service) interventions show promise in health behavior change. The Behavior Change Wheel (BCW) is a widely used framework that provides a structured approach to designing behavior change interventions and has been used extensively in health behavior change intervention design.ObjectiveThe study aimed to describe the development of, and rationale for, an SMS program to support exercise adherence in people with knee osteoarthritis using the BCW framework.MethodsThe intervention was developed in two phases. Phase 1 involved using the BCW to select the target behavior and associated barriers, facilitators, and behavior change techniques (BCTs). Phase 2 involved design of the program functionality and message library. Messages arranged into a 24-week schedule were provided to an external company to be developed into an automated SMS program.ResultsThe target behavior was identified as participation in self-directed home-based strengthening exercise 3 times a week for 24 weeks. A total of 13 barriers and 9 facilitators of the behavior and 20 BCTs were selected to use in the intervention. In addition, 198 SMS text messages were developed and organized into a 24-week automated program that functions by prompting users to self-report the number of home exercise sessions completed each week. Users who reported ≥3 exercise sessions/week (adherent) received positive reinforcement messages. Users who reported <3 exercise sessions/week (nonadherent) were asked to select a barrier (from a list of standardized response options) that best explains why they found performing the exercises challenging in the previous week. This automatically triggers an SMS containing a BCT suggestion relevant to overcoming the selected barrier. Users also received BCT messages to facilitate exercise adherence, irrespective of self-reported adherence.ConclusionsThis study demonstrates application of the BCW to guide development of an automated SMS intervention to support exercise adherence in knee osteoarthritis. Future research is needed to assess whether the intervention improves adherence to the prescribed home-based strengthening exercise.

Highlights

Knee osteoarthritis is a chronic, highly prevalent condition with no known cure [1] and is a leading contributor to the burden of disease globally [2]
A total of 13 barriers and 9 facilitators of the behavior and 20 behavior change technique Behavior Change Wheel (BCW) (BCT) were selected to use in the intervention
Habit formation, which can take an average of 2 months and up to 8 months, is a key component to the successful adoption of a new behavior [53] and is important as exercise is encouraged on an ongoing basis for individuals with knee osteoarthritis to ensure long-term symptomatic relief [54]

Summary

Introduction

Knee osteoarthritis is a chronic, highly prevalent condition with no known cure [1] and is a leading contributor to the burden of disease globally [2]. Self-management and lifestyle modification to facilitate long-term symptom relief is advocated [5]. This includes exercise, which is recommended in all clinical guidelines irrespective of the person’s age, disease severity, pain, physical dysfunction, and/or comorbidities [5,6,7]. Adherence to exercise is often poor, in the mid to longer term [8,9,10,11,12,13], limiting its capacity to provide long-term symptom relief. Scalable interventions that facilitate exercise adherence are a research priority. Long-term adherence to exercise is poor among many people with knee osteoarthritis, which limits its capacity to provide sustained symptom relief. Scalable interventions that facilitate exercise adherence are needed. The Behavior Change Wheel (BCW) is a widely used framework that provides a structured approach to designing behavior change interventions and has been used extensively in health behavior change intervention design

Methods

Results

Discussion

Conclusion