Qualitative Evaluation of the e-coachER Randomised Controlled Trial: Participants’ views of the web-based support package for facilitating uptake of Exercise Referral Schemes and maintenance of longer-term physical activity

Conference:

SAPC ASM 2019 - Exeter

Talk Code:

3A.3

Presenter:

Jeffrey Lambert

Twitter:

@Jefflambert12

Co-authors:

Sarah Dean, Rohini Terry, Nigel Charles, Jeffrey Lambert, Colin Greaves, John Campbell, Adrian Taylor

Author institutions:

University of Exeter Medical School, University of Plymouth, University of Birmingham

Problem

Exercise referral schemes (ERS) aim to increase physical activity (PA) of patients with chronic conditions such has obesity, diabetes, hypertension, osteoarthritis and low mood. However, patient uptake and adherence to ERS limited. The e-coachER RCT aimed to determine whether augmenting usual ERS with a bespoke web-based behavioural support (informed by self-determination theory (SDT)), and pedometer, increased long-term PA for patients with chronic conditions. The present study aimed to qualitatively explore how participants experienced and engaged with the e-coachER intervention.

Approach

Semi-structured telephone interviews were conducted with participants who had logged on to e-coachER at least once (n=26). The topic guide focussed on all aspects of the intervention including the welcome pack, pedometer and web-based support. Interviews were recorded, transcribed and imported into NVivo Version 11. Two researchers analysed the transcripts thematically, focussing on ‘top level’ themes reflected in the e-coachER logic model.

Findings

Thirty-eight interviews were carried out in total with seven participant’s having more than one interview. Each interview lasted between 16 and 80 minutes. Participants expressed barriers such as time, ill-health, unexpected life events and IT related difficulties. Most participants found that e-coachER was easy to understand, flexible and supportive and served as a reminder to increase their PA. For many, e-coachER fostered a sense of competence by providing motivational feedback on self-monitoring and goal setting and inviting them to reflect on how they felt after engaging in PA. Many people also felt that e-coachER increased their sense of control, by suggesting other ways they could achieve their PA (e.g. by walking instead of taking the bus) and some felt that e-coachER facilitated connectedness by encouraging them to develop and expand their social networks. Finally, others experienced barriers to engagement which may have undermined these needs and subsequent PA.

Consequences

The e-coachER intervention was acceptable and positively experienced for many, but not all, of the participants interviewed. Many participants felt that their basic needs of competence, autonomy and relatedness were somewhat facilitated by e-coachER. In a wider context, this study provides valuable insights into how ERS augmented with web-based support is received by patients with a range of complex personal circumstances and co-morbidities.

Submitted by:

Jeffrey Lambert

Funding acknowledgement:

This research has been conducted independently by the University of Plymouth, University of Birmingham, Brunel University London, University of Edinburgh, University of Exeter, University of Southampton, Royal Cornwall Hospitals NHS Trust and University of St Mark and St John. It is funded by the Department of Health (DH) as part of the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project number 13/25/20).