Combining patient perspectives and the Behaviour Change Wheel to develop knowledge translation interventions

Authors: Ma JK, Tsui K, Sequeira L, McQuitty S, Jiwa S, Hoens AM, Davidson E, Collins JA, Chan A, Shu H, and Li L

Presenter: Dr. Jasmin Ma

Institution: Arthritis Research Canada/University of British Columbia 


Although almost 50 barriers to participating in strength training among people with rheumatoid arthritis have been identified, there has been little done to address them. The Behaviour Change Wheel (BCW) is a theory-based process that can be used to systematically identify strategies to address barriers. The involvement of end-users in intervention development has been supported to increase the relevance and impact of research; however, no study has reported on engaging patient partners in using the BCW. The purpose of this study was to use both the BCW and patient perspectives to develop knowledge translation interventions to support strength training participation among people with rheumatoid arthritis. 


Seven patient partners of varying gender (male=2), age (range=22-76), strength training experience (no experience to exceeding the guidelines of strength training at least two days/week), and arthritis types (rheumatoid arthritis, osteoarthritis, Raynaud’s disease, psoriatic arthritis, juvenile idiopathic arthritis) and two researchers participated in the BCW process. Barriers to ST participation that were identified previously through semi-structured interviews with people with rheumatoid arthritis were coded by researchers using the capability, opportunity, motivation- behaviour model (COM-B) and the Theoretical Domains Framework (TDF). Patient partners reviewed and confirmed the findings. Both patient partners and researchers identified relevant knowledge translation intervention strategies by triangulating existing evidence on strength training behaviour change, suggested intervention strategies using the BCW, and patient perspectives.


Barriers were coded into capability (n=9), opportunity (n=27), and motivation (n=12) components. Researchers and patient partners considered all sources of evidence and identified capability and opportunity as the most salient components to affect ST behaviour in this population. Within capability and opportunity, specific TDF domains were identified to target including physical skills, goals, knowledge, environmental context and resources, and social influences. Pragmatically, patient partners and researchers highlighted the need for knowledge translation interventions directed towards healthcare providers. This included guidance on how to 1) tailor exercise advice based on whether the patient is experiencing a flare or has previous strength training experience, 2) identify and describe acceptable vs ‘bad’ pain during and following strength training, and 3) develop exercise prescriptions that fit with individuals’ daily activities and the variable nature of symptoms and disease activity (e.g., pain, stiffness, fatigue, flares). Furthermore, lessons learned from the patient engagement process were documented such as the need for flexibility in the BCW process, strategies for weighing the different perspectives, and acknowledging issues related to generalizability.


These findings will be used to develop a mixed-methods follow-up study to explore whether these gaps in knowledge align with health professional perspectives. Using the BCW and other theory-based methods are important approaches to identifying which intervention constructs should be targeted in a manner that is rigorous and generalizable; however, end-user perspectives provide insight into the specifics of how theoretical constructs should be targeted and put into practice in the real world.



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