Developing Physical Activity Interventions: Stage 1 and 2

Lesson Objectives and Overview

• The course focuses on developing physical activity interventions as part of HHP:3045.
• The intervention design process is divided into four distinct stages:   - Stage 1: Understand the Behavior.   - Stage 2: Identify Intervention Options.   - Stage 3: Identify intervention content and implementation options.   - Stage 4: Evaluate the impact of the intervention.
• Specific research examples are utilized to illustrate these stages:   - Connell et al., 2015.   - Whitaker et al., 2022.

The ISLAGIATT Principle: What to Avoid

• ISLAGIATT stands for: "It Seemed Like A Good Idea At The Time."
• This principle describes interventions designed without a fundamental understanding of the influences on health behavior (such as physical activity) for a specific population in a specific context.
• Common pitfalls of ISLAGIATT-based interventions include:   - Not using established theory.   - Failing to consider the specific context of the target population.   - Resulting in small effect sizes.   - Ineffectiveness leading to a significant waste of time, money, and resources for all involved stakeholders.

The Alternative: The Four-Stage Process

• Stage 1: Understand the Behavior   - Step 1: Identify target population and behavior (The focus of this specific lecture).   - Step 2: Conduct a behavioral analysis and diagnosis.
• Stage 2: Identify Intervention Options   - Step 3: Select Intervention Functions.   - Step 4: Select Policy Categories.
• Stage 3: Identify Content and Implementation Options   - Step 5: Select behavior change techniques (BCTs).   - Step 6: Select modes of delivery.
• Stage 4: Evaluation   - Step: Evaluate and iterate the intervention using evaluation frameworks.

Stage 1: Understand the Behavior

Step 1: Identify Target Population and Behavior

• Defining the Group: Clearly specify the group whose behavior is the target for change.
• Defining Behaviors: Be specific about the behaviors to be changed, answering:   - What behavior?   - When does it occur?   - Where does it occur?   - How often does it happen?   - With whom is the behavior performed?
• Stakeholder Involvement: It is critical to involve stakeholders, defined as people who have an interest or concern in the intervention.   - Example: If employees are trying to become more active, stakeholders include the company employees, management, and health insurance/care providers.

Step 2: Conduct a Behavioral Analysis and Diagnosis

• The COM-B Model: Used to understand factors influencing the target behavior, including barriers and facilitators. The components are:   - Capability: Includes Physical capability (skill, stamina) and Psychological capability (knowledge, mental skills). Similar to the "Planning" aspect of behavior.   - Opportunity: Includes Physical opportunity (environmental supports/barriers) and Social opportunity (social norms, relatedness). Similar to the Self-Determination Theory (SDT) concept of "Relatedness" and the Theory of Planned Behavior (TPB) concept of "Subjective Norm."   - Motivation: Includes Reflective motivation (intentions, evaluations) and Automatic motivation (emotions, drives, habits). Reflective motivation is similar to TPB "Intention," while Automatic motivation relates to the "Motivational Continuum" in SDT.
• The goal is to outline what factors need addressing for behavior change to occur.

Real-World Example: Bike-to-Work Intervention (Exhibit 5.3)

• Behavioral Analysis Findings:   - Physical Capability: The population must have skill and stamina. Diagnosis: No change needed; employees indicated they have the skills.   - Psychological Capability: The population must know how to ride to work. Diagnosis: Change needed; employees need to know the safest and fastest routes.   - Physical Opportunity: Access to a bike, helmet, and time. Diagnosis: No change needed; employees have bikes and find it reduces commuting time.   - Reflective Motivation: Must see benefit and want to cycle. Diagnosis: No change needed; employees want to cycle and see benefits.   - Automatic Motivation: Positive emotional reaction, habit, or desire. Diagnosis: Change needed; employees indicated they are afraid to cycle and do not do it habitually.
• Intervention Target: The final diagnosis concluded the intervention must target psychological capability and automatic motivation.

Stage 2: Identify Intervention Options

Step 3: Selecting Intervention Functions

• Intervention Functions are activities within the intervention designed to change behavior by altering capability, opportunity, or motivation.
• Intervention Functions Definitions and Examples:   - Education: Increasing knowledge or understanding.   - Persuasion: Using communication to induce positive or negative feelings.   - Incentivization: Creating an expectation of reward.   - Coercion: Creating an expectation of punishment or cost.   - Training: Imparting skill (e.g., an athlete teaching a class).   - Restriction: Using rules to reduce opportunity to engage in competing behaviors (e.g., rules regarding screen time).   - Environmental Restructuring: Changing the physical or social context (e.g., building a new gym or adding equipment at parks).   - Modeling: Providing an example for people to aspire to or imitate.   - Enablement: Increasing means or reducing barriers to increase capability or opportunity beyond other functions (e.g., providing resources to reduce barriers).

Step 4: Selecting Policy Categories

• Policy categories are approaches used by stakeholders to support intervention implementation.
• Policy Categories Definitions and Examples:   - Communication/Marketing: Using print, electronic, or broadcast media.   - Guidelines: Documents recommending or mandating practice (e.g., putting specific guidelines in place).   - Fiscal Measures: Using the tax system to manage costs (e.g., taxing cigarettes or providing tax breaks for health initiatives).   - Regulation: Establishing rules or principles for behavior (e.g., requiring gym members to sign a paper agreeing to promote exercise).   - Legislation: Making or changing laws (e.g., a law requiring all universities to provide access to strength training devices).   - Environmental/Social Planning: Designing/controlling the physical or social environment.   - Service Provision: Delivering a service (e.g., providing free strength classes to all students).

Research Case Study: O’Connell et al. (2015)

• Identifying Target Population and Behavior:   - Focus: Sedentary behavior (SB) as a risk factor for poor health, independent of general physical activity.   - Identified Behavior: Breaking prolonged sitting with bouts of standing and light movement improves health.   - Context: Work sites are logical intervention points as many jobs are desk-bound.   - Evidence: Sit-stand desks reduce occupational and leisure sitting time.
• Intervention Strategy: Known as the SMArT Work intervention strategy.

Research Case Study: Whitaker et al. (2022) - INSPIRE

• Program Name: INSPIRE (INcreasing Steps in PREgnancy).
• Project Address: 225 S. Grand Avenue, 102 Field House, Iowa City, IA 52242.
• Contact Phone: $319\,335\,7907$.
• Target Population and Behavior:   - Physical activity (PA) is safe for mother and baby with many benefits, yet pregnant women are less likely to meet PA guidelines.   - High sedentary behavior increases the risk of hypertensive disorders of pregnancy, independent of PA.
• Behavioral Analysis and Diagnosis Survey Areas: Participants were asked to rank interests/agreement on:   - Benefits of PA for themselves and the baby.   - Safe and unsafe activity types.   - Managing PA when tired, nauseous, or busy (fitting into schedule).   - Sticking with PA despite disruptions or low motivation.   - Decreasing sitting time and home activity ideas.   - Using monitoring devices (Fitbit, pedometers) and health coaches.   - Walking games via smartphone apps and walking groups.   - Partner involvement and social media sharing.   - DVDs or online videos for use at home.   - Post-baby program continuation.
• Study Contacts and Schedule: 12 sessions conducted via Zoom or telephone:   - Session 1 (Weekly): PA benefits and safety.   - Session 2 (Weekly): PA tips and resources.   - Session 3 (Weekly): Targeting motivation.   - Session 4 (Weekly): Making time for PA.   - Session 5 (Bi-monthly): Social Support.   - Session 6 (Bi-monthly): Self-Efficacy.   - Session 7 (Bi-monthly): Making PA a habit.   - Session 8 (Bi-monthly): Long-term maintenance.   - Session 9 (Bi-monthly): Barriers to PA.   - Session 10 (Monthly): Pregnancy exercise maintenance.   - Session 11 (Monthly): Maintenance after baby.   - Session 12 (Monthly): Pregnancy exercise maintenance.

Health Benefits and Safety for Exercise in Pregnancy

• Major Health Benefits:   - Reduces risk of gestational diabetes, gestational hypertension, and preeclampsia by as much as $40\%$.   - Moderate exercise reduces the risk of catching a cold by as much as $50\%$.   - Improves mood, immune system, and control during transformative times.   - Wards off prenatal depression, which is linked to poor sleep and marital problems.   - Potential for easier labor, delivery, and quicker recovery.   - Improved sleep quality and energy levels.
• Safety Tips:   - Avoid excessive heat or high humidity.   - Stay well-hydrated (drink water before, during, after).   - Avoid long periods of lying flat on the back.   - Ensure caloric intake meets needs to prevent low blood sugar.   - Exercise on flat, level surfaces to prevent injury.
• Warning Signs (Stop Immediately and Contact Provider):   - Vaginal bleeding.   - Regular, painful contractions.   - Amniotic fluid leakage.   - Heavy breathing before exertion.   - Dizziness, headache, or chest pain.   - Muscle weakness affecting balance.   - Calf pain or swelling.