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Table 2 Description of multi-faceted implementation strategy delivered to teams of physiotherapists mapped to Behaviour Change Wheel [37]

From: Brief physical activity counselling by physiotherapists (BEHAVIOUR): protocol for an effectiveness-implementation hybrid type II cluster randomised controlled trial

Implementation strategy [40]a

Mode of delivery/where/length/who delivered

Time-frame

Proposed mechanism of action

Intervention content

Barriers targeted

COM-B domains [41]

COM-B intervention functions

BCTs

Detailed explanation

Education

Series of short (2–8 min) education videos /online/~ 45 min in total/ LH, BB, research physiotherapists, consumers

Prior to attending workshop 1

Knowledge of PA guidelines, benefits of PA, consequences of inactivity, % meeting guidelines, what is PA counselling, what is the evidence for PA counselling and “what works” for supporting behaviour change, how many people to treat to have an effect, how many physiotherapists currently do it and if they don’t what stops them (include local data), what do patients think

Capability

Psychological-knowledge; Motivation-reflective & automatic

Education; persuasion

Information about health consequences; Feedback on behaviour; Feedback on the outcome(s) of the behaviour; Information about others’ approval; Credible source; Salience of consequences; Feedback on behaviour; Social comparison; Identification of self as a role model

Short videos on the study, what is PA, what are the PA guidelines, benefits of PA from a patient perspective, what is PA counselling, behaviour change theories, raising the topic of PA as PT, raising the topic of PA with CALD patients

Education and training (conduct educational meetings and ongoing training, make training dynamic, promote adaptability)

Workshops 1 & 2: face-to-face workshop/at team’s hospital/maximum 4 h/LH

Workshop 1: 2–3 weeks after hospital rotation

Workshop 2: 3 months later

How to do the different elements of PA counselling within usual care (Ask, Assess, Advise, Agree, Assist, Arrange, incorporating motivational interviewing techniques and behaviour change theories); skills at initiation & negotiating discussions about PA; prioritizing within usual care session; forgetting to ask or document about PA; lack of resources to do PA counselling; PA counselling not usual practice in clinical teams; building motivation in patients

Capability

Psychological-cognition, interpersonal & self-regulation; Motivation-reflective & automatic; Opportunities-physical & social

Education; training; enablement; persuasion; modelling; environmental restructuring

Instruction on how to perform a behaviour; demonstration of the behaviour; feedback on the behaviour; behavioural practice/rehearsal; social support (practical); goal setting (behaviour); action planning; information about others’ approval; social comparison; identification of self as a role model; prompts/cues; adding objects to the environment; Problem-solving

Made up of presentations (live & pre-recorded) from PTs, behavioural expert, CALD expert, patients (e.g. how to do the different elements of PA counselling and resources to support this); tasks (e.g. role-playing, using scripts, reviewing resources), discussions (e.g. group sharing reflections & experiences of the content presented and practised). Paper manual with slides and resources given to each participant); link to online resources including https://movingmedicine.ac.uk/

Create a learning collaborative

Communication platform/online-Microsoft Teams/length project/MJ, LH

Added at workshop 1

Lack of resources to set action plans, find local opportunities, measure PA, PA counselling not usual practice in clinical teams, promoting PA counselling not seen as a priority across the district, lack of time to find resources

Opportunity-social & physical; Motivation-reflective

Training; enablement; modelling; persuasion

Adding objects to the environment; social support (practical); problem-solving; action planning; social support (emotional); feedback on the behaviour

Access to online videos and workshop presentations, sharing resources developed across teams, place to communicate, ask questions, share feedback on audit

Tailored strategies to address community referral barriers (capture and share local knowledge)

Not yet determined, may vary between teams/LH, the research team

Start at workshop 1

How to find PA opportunities in the local community, how to refer to local community PA opportunities

Capability

Psychological-cognition & knowledge; Motivation-automatic; Opportunity-physical & social

Environmental restructuring; enablement; modelling; training

Adding objects to the environment; social support (practical); problem-solving; demonstration of the behaviour; instruction on how to perform a behaviour

Provide training in finding PA opportunities, help to develop links, referral resources, evaluation tools of community PA opportunities

Facilitationb (change record systems, promote adaptability, capture and share local knowledge) and Audit & Feedback within teams

Mix face-to-face & remote/in their clinical settings/monthly (1–2h)/LH

Between workshops 1 and 2

Fitting PA in usual sessions including measuring PA; lack of suitable PA resources (for physiotherapist & patient); how to find PA opportunities in the local community; how to refer to local community PA opportunities; PA counselling not usual practice in clinical teams

Opportunity-physical & social; Capability-knowledge & cognition; Motivation-reflective & automatic

Education; training; enablement; modelling; environmental restructuring

Demonstration of the behaviour; social support (practical); self-monitoring of behaviour; problem-solving; action planning; social support (emotional); feedback on the behaviour; behavioural practice/rehearsal; prompts/cues; adding objects to the environment

Working with the team to identify/modify/develop resources for their team (including local activity directory or similar resource), identify & connect with appropriate PA opportunities, modify physiotherapy assessment forms to include PA information to collect, audit and feedback with a colleague between workshops.

  1. Key: PA Physical activity, CALD Culturally And Linguistically Diverse, PT Physiotherapist, BCTs Behaviour Change Techniques
  2. aSecondary implementation strategies are in brackets; bFacilitation: “A process of interactive problem solving and support that occurs in a context of a recognized need for improvement and a supportive interpersonal relationship” p.9 [40]