Using behaviour change interventions to reduce sedentary time in people with chronic obstructive pulmonary disease

The Behaviour change techniques will be delivered by the PhD student who is the co-ordinating principal investigator who is a physiotherapist who has attended a HealthChange Methodology training module. The location where the intervention will be delivered will be in Physiotherapy departments (Joondalup Health Campus, Bentley Health Service and Rockingham General Hospital and an addition of Royal Perth Hospital site) for initial baseline measures and consent from participant twice (Phase 0) and once a week for eight weeks (Phase 1) and at participants' homes once a week for five weeks and then once a month for 5 months (Phase 2 and 3). The sessions will be for approximately 40 minutes. The content of the health education this will be conducted in all settings i.e. hospital and the participant's home, and will contain will be multi component with the aim of reducing sedentary time that has accumulated in prolonged unbroken bouts. Health education will contain simple content information about the general disease process of COPD and the impact of sedentary behaviour has on their cardio metabolic system and how these known risk factors can be reduced. The health education is delivered to the participant via personalised: face-to-face, one-on-one delivery mode, based on Theoretical Domain Framework and Michie's Taxonomies. The participant engages with behaviour change techniques by writing in a work book diary where the PhD student and participant will review action coping planning. Goals for reducing sedentary time and replacing it with light intensity physical activity, for the next or month depending on Phase are established during these sessions. The information is also conveyed by support of a loved-one who is invited to attend all sessions. There is also short " vignettes" short film of previous pilot study participant's lived experience of behaviour change. Other interactive modes of delivering behaviour change techniques will be also done with a support group format with other participants and their loved-one ( this will be done between Phase 1 and 2). The support group will be a one-off session which will be facilitated by the PhD candidate where participants and their loved one are invited. These sessions will be held at the local hospital where the participants did their pulmonary rehabilitation classes and it will run for about an hour. The content of this session will focus on the participant's experience of the study and the behaviour change intervention. The loved-one will also be able to contribute to the discussion of these experiences from their perspective. The session is designed to be supportive where information is shared and may help other participants. The session will be recorded. Additional strategies that may be used are prompting such as personalised phone or text messages depending on the participant's preference, which is provided to all participants once a week to encourage adherence to specific behaviour change goals for each participant. These messages are designed to reflect the participant's own requirement's with the behaviour change intervention, e.g. 'Betty, if you have been sitting continuously for 30 minutes, try and stand up and move for at least three minutes'. The Fitbit wearable device will be used as an intervention where the participant will wear the device on their non dominant wrist. The participant will wear this for 24 hours a day through out the study for nine months. The device will be able to give the participant instant self monitoring via a smart phone to give them feedback to their sedentary time and physical activity. Adherence with Fitbit use will be monitored remotely via Fitbit emails to the PhD student and reviewed once there is a scheduled visit throughout the Phases. At this stage the three recruitment sites are not offering Pulmonary Rehabilitation classes (PR) or assessments, as the hospital referrals of patients to the Pulmonary Rehabilitation class was the only source of recruitment for this study. The current patients in Phase 2 (PR) are being reviewed once a week by the treating physiotherapist via tele-health from the hospital to the patient's homes. The above intervention stays the same only the location and the delivery method may change while participants are in self-isolation. For Phase 1-3 the participants in the study are now being reviewed either via social distancing in an open air capacity e.g. nearby park or via visual audio technology e.g. face-time. Prior to seeing the participant checklist is done over the phone the day before the participant is reviewed to ensure safety for participant and PhD student. In regards to the semi-structured interview, focus group and exit interview this will be conducted using either audio recording with social distancing or via remote audio/ visual technology what ever is feasible for the participant and PhD student. The focus group will be was delayed to Phase 3 via audio/ visual technology due to not being able to safely conduct a face-to-face support group environment with participants.