Changing consultation behaviour in healthcare professionals and physical activity behaviour in adults with type 2 diabetes in primary care

Abstract

Behavioural interventions targeting physical activity alone produce clinically significant improvements in long-term glycaemic control in adults with type 2 diabetes. Effective translation of physical activity behavioural interventions into routine primary care is hindered by the lack of evidence-based training resources to equip healthcare professionals with the knowledge, skills and confidence to deliver behavioural interventions to their patients. This PhD thesis describes the development and open pilot testing of an evidence-informed multifaceted physical activity behaviour change intervention ‘Movement as Medicine for Type 2 Diabetes’ targeting: (i) consultation behaviour in primary healthcare professionals (online training programme); and (ii) physical activity behaviour in adults with Type 2 diabetes (patient toolkit delivered by primary healthcare professionals). Informed by multi-methodological development work (workshops to identify information/support needs of patients and healthcare professionals; systematic review to identify effective physical activity behaviour change components; and usability testing), Movement as Medicine for Type 2 diabetes was piloted in two primary care practices over a two month period. A qualitative process evaluation and treatment fidelity assessment were used to optimise the intervention by identifying barriers and enabling factors to implementation and informed revisions to content and study procedures. Six primary healthcare professionals completed the online training programme and delivered the toolkit to participating patients (N=30) during diabetes review appointments. Transferability of behaviour change techniques to other areas of practice was identified as a salient facilitator for healthcare professionals, although several implementation challenges were identified (e.g. previous negative experiences with supporting patients to increase physical activity behaviour). Intervention components were delivered by healthcare professionals to a satisfactory level of fidelity. Patients reported physical activity monitoring resources and review sessions as particularly beneficial components of the patient toolkit. Movement as Medicine for Type 2 diabetes was found to be acceptable and feasible in the primary care setting. Open pilot methodology facilitated optimisation of the intervention ahead of a planned pilot randomised controlled trial.