Older Adults' Experiences of Behavior Change Support in a Digital Fall Prevention Exercise Program: Qualitative Study Framed by the Self-determination Theory.

Beatrice Pettersson,Lillemor Lundin-Olsson,Marlene Sandlund,Maria Wiklund,Rebecka Janols

doi:10.2196/26235

Abstract

BackgroundExercise is an effective intervention to prevent falls in older adults; however, long-term adherence is often poor. To increase adherence, additional support for behavior change has been advocated. However, consistency in the reporting of interventions using behavior change techniques is lacking. Recently, a classification system has been developed to increase consistency in studies using behavior change techniques within the self-determination theory.ObjectiveThis study aimed to explore expressions of self-determination among community-dwelling older adults using a self-managed digital fall prevention exercise program comprising behavior change support (the Safe Step program), which was developed in co-creation with intended users.MethodsThe qualitative study design was based on open-ended responses to questionnaires, and individual and focus group interviews. A deductive qualitative content analysis was applied using the classification system of motivation and behavior change techniques as an analytical matrix, followed by an inductive analysis. Twenty-five participants took part in a feasibility study and exercised in their homes with the Safe Step program for 4 months. The exercise program was available on computers, smartphones, and tablets, and was fully self-managed.ResultsIn the deductive analysis, expressions of support were demonstrated for all three basic human psychological needs, namely, autonomy, competence, and relatedness. These expressions were related to 11 of the 21 motivation and behavior change techniques in the classification system. The inductive analysis indicated that autonomy (to be in control) was valued and enabled individual adaptations according to different rationales for realizing exercise goals. However, the experience of autonomy was also two-sided and depended on the participants’ competence in exercise and the use of technology. The clarity of the program and exercise videos was seen as key for support in performance and competent choices. Although augmented techniques for social support were requested, support through relatedness was found within the program.ConclusionsIn this study, the Safe Step program supported the establishment of new exercise routines, as well as the three basic human psychological needs, with autonomy and competence being expressed as central in this context. Based on the participants’ experiences, a proposed addition to the classification system used as an analytical matrix has been presented.Trial RegistrationClinicalTrials.gov NCT02916849; https://clinicaltrials.gov/ct2/show/NCT02916849

Highlights

BackgroundFall prevention interventions for older adults living in the community have the potential to reduce the physical and psychological distress resulting from a fall [1]
The inductive analysis indicated that autonomy was valued and enabled individual adaptations according to different rationales for realizing exercise goals
In this study, the Safe Step program supported the establishment of new exercise routines, as well as the three basic human psychological needs, with autonomy and competence being expressed as central in this context

Summary

Introduction

BackgroundFall prevention interventions for older adults living in the community have the potential to reduce the physical and psychological distress resulting from a fall [1]. Interventions aimed at supporting increased physical activity and improving adherence to interventions among older adults are rarely underpinned by behavior change theories [5]. There is growing interest in using digital technology to support behavior change, increase access to fall prevention interventions, and promote the self-management of physical activity [8,9,10]. The incorporation of individual and social behavioral change components in digital exercise programs has proven more successful in improving adherence and physical performance among older adults in comparison with those receiving a home exercise booklet [14]. It is of major importance that the interventions are reported in a structured way and evaluated in terms of which behavior change techniques older adults find supportive and in which context. Exercise is an effective intervention to prevent falls in older adults; long-term adherence is often poor. A classification system has been developed to increase consistency in studies using behavior change techniques within the self-determination theory

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Results

Discussion

Conclusion